Suture and Needles Nursing Lecture

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Sutures needles Nursing Lecture

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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 Handling: How the Tissue reaction: The suture performs when reaction the suture its in used induces on the body Pliability Absorption Friction Allergic reaction Risk for infection

Physical: Inherent property of the suture Configuration Capillarity Diameter 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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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. o

• 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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Not truly a nonabsorbable suture since it disappears after several years. Losses tensile strength in 1 year. 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. PREFERRED SUTURE Nonabsorbable: Stainless steel Nonabsorbable Absorbable Absorbable Nonabsorbable: Long tensile strength Absorbable Absorbable Nonabsorbable Absorbable Absorbable Absorbable Nonabsorbable: Silk Nonadsorbable:Silk Absorbable Absorbable. May not be sutured. Nonabsorbable / Staples Nonabsorbable Absorbale Absorbable: Vicryl Absorbable suture: Vicryl Absorbable

TYPE OF TISSUE Bone surgery Cardiovascular surgery Colon Drain sutures Fascia Gallbladder Gynecologic surgery Infected wounds Kidney Liver Mesentery Neurosurgery Ophthalmic surgery Oral cavity Peritoneum Respiratory tract Skin Small intestine Spleen Stomach Subcutaneous fat

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Tendon surgery Urinary tract surgery Vascular prostheses

Nonabsorbable: Stainless steel Absorbable 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 Face Scalp Trunk Arm or Leg Foot TIME 3 -4 days 5 days 7 days 7 - 10 days 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 o Point is triangular. Cutting edge is in the INNER curvature Skin closure, Plastic surgery, Subcutaneous tissue

• Reverse Cutting
o o Point is triangular. Cutting edge is in the OUTER curvature Retention sutures, Skin closure, Fibrous tissue and ligaments

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• Taper Point
o o Pointed needle with no cutting edge Soft tissue closure, GI suture, and Fascia

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

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

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

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

• Lancet
o o Spatula needle with a cutting point 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.

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