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Suture and Needles Nursing Lecture 1

Sutures
needles
Nursing Lecture
&

Belardo
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SUTURE MATERIALS
1. Sutures
Suture is a generic term for materials used to sew together tissues
or to hold it together in place. No true ideal suture exists. Its
appropriateness is dependent on the type of surgery and the surgeon’s
preference. Certain characteristics of suture come into play in establishing
which suture is appropriate. A nurse should be familiar with sutures as he
or she is familiar with the other instruments.
This way appropriateness and evaluation on its effect on healing can be
assessed.

To suture means to stitch together edges of tissues, although other


materials other than sutures can be used to stitch together edges.
To ligate means to tie off or isolate a mass of tissue or blood vessel
It promotes hemostasis and allows visibility in the surgical field.

Suture Characteristics
Physical: Inherent Handling: How the Tissue reaction: The
property of the suture suture performs when reaction the suture
its in used induces on the body
Configuration Pliability Absorption
Capillarity Friction Allergic reaction
Diameter Risk for infection
Tensile Strength
Knot Strength
Memory

Physical Characteristics
• Configuration: one thread or multiple threads
o Monofilament: Easily pliable, but more prone to break:
Usually for vascular surgery
o Multifilament: Stronger but more prone to cause infection.
• Capillarity. It’s the ability of the suture to absorb and carry fluid
along the thread. ↑ Capillarity means increased risk of infection.
• Diameter. The cross sectional size of the suture, measured in
millimeters. The smaller the size the weaker the tensile strength
• Tensile strength the amount of weight that can break a suture. ↑
Tensile strength means it can withstand more force. Long tensile
strength means it can last longer with that specific strength. Most
sutures lose tensile strength as it is absorbed or encapsulated
o Steel is the strongest among the non absorbable, while silk
is the weakest.
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o Polyglycolic is the strongest among the absorbable, while


cutgut is the weakest.
• Knot strength. The force necessary to cause a given type of knot to
slip, either partially or completely. The Knot is the weakest part of
the suture since there is no actual link between the two ends of the
suture.
• Elasticity. Inherent ability to regain original from and length after
having been stretched.
• Memory. Capacity of a suture to return to its former shape after
being re-formed, as when tied; high memory yields less security.

TYPES OF SUTURE MATERIAL

Absorbable Sutures
• Absorbable sutures can be digested (by enzyme activity) or
hydrolyzed (by reaction with in tissue fluids to breakdown) and
assimilated by the tissues during the healing process.
• Usually used on fast healing tissues since its absorb quickly.
o Stomach
o Colon
o Bladder
• Surgical gut
o Surgical gut is obtained from the collagen of the submucosal
layer of the small intestine of sheep or the intestinal serosa
of cattle or hogs.
o Chromatization delays absorption of the suture in living
mammalian tissue. The put chromium on the suture so that it
is not absorb quickly.
• Collagen Sutures
o From cattle tendons
• Synthetic absorbable sutures
o Vicryl, Dexron and Polsorb.
o Vicryl can be used in the presence of infection.
.
Nonabsorbable Sutures.
• Nonabsorbable sutures are sutures the resist digestion by the
body. They don’t degrade.
• Used for tissues that are slow healing
o Skin
o Fascia
o Tendons
• Silk
o From silk worm cocoon
o Considered the best suture in terms of handling.
o Capillary action pulls liquid along suture can lead to
infection.
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o Not truly a nonabsorbable suture since it disappears after


several years.
o Losses tensile strength in 1 year.
o Can cause spitting in which the suture migrates up to the
wounds exterior surface.
• Cotton
o Made from twisted cotton fibers
o Gains tensile strength when wet
o Rarely used today.
• Nylon
o Synthetic material with high tensile strength
o But has poor knotting ability, because of this surgeons
usually ties three knots.
• Polypropylene
o Monofilament, has high tensile strength and cause minimal
tissue reaction.
• Stainless Steel
o Very high tensile strength
o Hard to handle can cause injury to the surgeon and the
patient.
o Steel can rip and tear tissue if too tight.

TYPE OF TISSUE PREFERRED SUTURE


Bone surgery Nonabsorbable: Stainless steel
Cardiovascular surgery Nonabsorbable
Colon Absorbable
Drain sutures Absorbable
Fascia Nonabsorbable: Long tensile
strength
Gallbladder Absorbable
Gynecologic surgery Absorbable
Infected wounds Nonabsorbable
Kidney Absorbable
Liver Absorbable
Mesentery Absorbable
Neurosurgery Nonabsorbable: Silk
Ophthalmic surgery Nonadsorbable:Silk
Oral cavity Absorbable
Peritoneum Absorbable. May not be sutured.
Respiratory tract Nonabsorbable / Staples
Skin Nonabsorbable
Small intestine Absorbale
Spleen Absorbable: Vicryl
Stomach Absorbable suture: Vicryl
Subcutaneous fat Absorbable
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Tendon surgery Nonabsorbable: Stainless steel


Urinary tract surgery Absorbable
Vascular prostheses Nonabsorbable

Sutures are removed when the wound no longer needs the support
provided by the wound suture. When the suture is removed too early it
may lead to failure to heal and infection. If its removed too late it could
cause scarring. Sutures are removed depending on where the wound is
located and the overall nature of the wound. The area is cleansed first with
an antiseptic. Hydrogen Peroxide is used to dissolve crusting around the
sutures.

AREA TIME
Face 3 -4 days
Scalp 5 days
Trunk 7 days
Arm or Leg 7 - 10 days
Foot 10 – 14 days

2.Skin Staples
• Alternative to suturing
• Frequently used for large skin closure and anastomosis hollow
organs.
• Since it does not involve stitching, its time saving.
• Staples are removed using as special extractor

3.Skin Tapes
• This are used on wounds that have minimal tension and low risk for
infection.
• Can also be used to reinforce staples and sutures.
• Main advantage is that it is not as scary looking as a stitch and does
not require suture removal.
• A disadvantage is that it does not keep deep tissue held together
and cannot minimize bleeding tendencies.

4.Surgical Adhesives
• Act as glue to keep wounds close
• Requires mixing first before use
• Indicated to areas not subjected to movement and tensions.
• Fast closure and less pain.
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SURGICAL NEEDLES
Allows the suture to pass thru the tissue.
A surgical needle can be categorized according to its three characteristics
or parts

ANATOMY OF A SURGICAL NEEDLE


Eye Body Point
The eye determines how The body or the shaft The point is the
the needle is attached to refers to the part in piercing end of the
the suture. which the needle is needle. The point
held. It may be determines whether
rounded or flat in the needle can
diameter and it can penetrate a tissue
be curved or straight efficiently.
in form
Eyed Round Regular cutting
French or Spring Flat Taper Point
Eyeless Triagular Penetrating Point
(Swagged/Atraumatic) Curved Blunt Point
Straight Protect-point
Reverse cutting
Spatula side cutting
Lancet

Eye of the needle


• Eyed needles requires the scrub nurse to thread the suture thru the
eye or needle hole.
• French or Spring needles also requires threading but does not
involve inserting the suture thru the needle hole. Instead it is pulled
against the eye to force the suture inside.
• Eyeless or swagged needles do not require threading since the
needle and suture are as one piece. This results to a smaller
diameter on the point in which the needle and suture are attached.
This means that there is less trauma to the tissue as the needle
passes thru. This is the reason why eyeless needles are called
atraumatic or “absence of trauma”.
Body of the needle
• The body is the largest part of the needle.
• It is where the tip of the needle holder is placed.
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• Its shape in diameter whether round, flat or triangular corresponds


to the point of the needle to allow continuity is structure so that it
will smoothly pass thru tissues.
• The shape in form is classified by using the circle as a reference. ¼
needle body looks like ¼ of a circle. The shape in form depends on
the thickness of tissue to make it easier for the surgeon to pierce
the tissue.
Point
• The point is the penetrating end of the needle.
• Needle points are determined by the density of the tissue.

Kinds of Needle point

• Regular Cutting
o Point is triangular. Cutting edge is in the INNER curvature

o Skin closure, Plastic surgery, Subcutaneous tissue

• Reverse Cutting
o Point is triangular. Cutting edge is in the OUTER curvature
o Retention sutures, Skin closure, Fibrous tissue and ligaments
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• Taper Point
o Pointed needle with no cutting edge
o Soft tissue closure, GI suture, and Fascia

• Blunt Point
o Round point with no cutting edge.
o Soft, friable tissue, liver, intestine, kidney, muscle, uterine
cervix.
o Gynecologic surgery since accidental puncture is common.
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• Spatula Side Cutting


o Has two cutting edges on the side. cuts layers from the side
of the needle.
o Ophthalmic surgery,retinal repair.

• Cutting Taper Point


o Reverse cutting needle with a taper body
o Used for microsugery of tough tissues like blood vessels.

• Hand Honed Reverse Cutting


o Same as Reverse Cutting but sharper
o Used for cosmetic plastic surgery

• Lancet
o Spatula needle with a cutting point
o Used for Ophthalmic microsurgery.
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HANDLING SUTURES AND NEEDLES


1. The Scrub nurse opens the packet by following the marked edge of
the wrapper
2. Grasp the loose end of the suture and hold the packet with the
other hand.
3. If the needle is already attached to the suture, Use a needle holder
to pull the needle out of the packet.
4. The needle holder is placed on the body about 1/8 inch down from
the tip of the needle holder.
5. The needle holder should grasp the needle on the flattened surface
to prevent it from breaking or bending.
6. Usually the suture will have package memory, in which it retains
the shape of the packet. To remove the kinks gently pull the free
end and abduct the hand holding the other end to straighten it.
7. Never run the suture along your hand to remove the kinks. This
could damage the suture.
8. Long sutures are hard to handle and can cause an infection if it
touches a contaminated area. Short sutures make tying difficult.
9. A curved needle is threaded from within its curvature. This
prevents it from pulling out during suturing.
10. Allow about 4 inches allowance from the needle eye to prevent
accidental pull outs.