Chp 55 Drapes Sutures Needles
|Disposable surgical drapes|| - are available in several diff. materials and sizes and typically have an opening (fenestration) for the operative site.|
- the drape is placed over the operative area using sterile technique after the pts skin preparation has been completed. This procedure is in chp 56.
|Sutures||- the word suture is used as both a noun and a verb.|
- a noun it refers to a surgical stitch or the material used to close a wound.
- as a verb - it is the act of stitching.
- 1865 LISTER - made antisepsis and the disinfection of suture materials.
PURPOSE: to hold the edges of a wound together until natural healing can occur.
** sutures are sized according to the USA Pharmacopoeia (USP) scale.
- a suture may also be used as a LIGATURE.
|Suture Materials (in past)|| - precious metals|
- horse hair
- animal tendons
- cotton and linen cord.
|Ligature|| - is a strand of suture material used to tie off a blood vessel or to strangulate tissue.|
- if a ligature is used to tie off an internal tubular structure, it must last permanently or long enough for the structure itself to disintegrate.
|Ideal Suture Material - 4 ideas|| - easy to handle and makes a secure knot|
- does not induce a localized tissue reaction and is nonallergenic
- has adequate strength w/out cutting through tissue
- can be sterilized.
|physicians preferrence|| - based on specific properties|
- desirable rate of absorption or nonabsorbable
- natural or synthetic
- suture size and packing.
|Absorbable Sutures||- is dissolved by the bodys enzymes during the healing process|
- is used when deep incisions or lacerations require inner layers of sutures to close the wound
- used in areas where suture removal is difficult such as oral surgery
- ex) catgut, made from pig, sheep, cattle intestine.
- plain catgut - used in tissues that heal most rapidly such as mucosa and subcutaneous tissues.
|plain catgut - absorbable|| - used in tissues that heal most rapidly such as mucosa and subcutaneous tissues. |
- breaks down in 1 week.
|Chromic catgut -absorbable||- is coated with chromic salts which delays the absorption of the suture material up to 80 days.|
|catgut - absorbable||- was once the suture material of choice but has been replaced by Vicryl.|
|Vicryl - absorbable||- is a synthetic absorable suture made of polyglactin.|
|other materials absorbable|| - Dexon, PDS, Maxon.|
- remain stable longer than natural catgut.
- up to 11 weeks
- allowing the wound to heal completely before absorption.
|Nonabsorbable Suture|| - is left in the wound site until healing is complete|
- frequently used in minor surgical procedures.
- most suturing is superficial.
- in areas where sutures can be removed after healing has taken place.
|silk - non-absorb||- is stron and is easy to tie. it is treated with a coating to prevent tissue drag and flaking.|
|polyester non-ab||such as Dacron and Prolene, are among the strongest non-ab sutures in league with surgical steel. fine filaments are braided and have great tensile strength.|
|nylon - non-ab|| is strong and has a high degree of elasticity|
- it is primarily used for skin closure.
- owing to elasticity and stiffness, many knots must be used b/c the knots tend to untie if placed incorrectly.
|Surgical staples non ab|| - skin closure.|
- they are made of stainless steel
- made of titanium
- made in multi sizes.
- inserted and removed with tools.
|Steri-Strips non ab|| - which are self adhesive tapes that are placed over the wound, pulling the wound ends together. |
- can be used to support a wound if there is a potential tension at the site.
- or for superficial wounds such as a laceration of the forehead.
|Tissue adhesives||similar to glue can be used for superficial wounds.|
|Suture Size and Packaging||- suture material comes in a variety of diameters and lengths. |
diameter - of the suture strand determines its size, with the smaller gauges numbered below 0 (pronounced AUGHT) and the larger gauges identified with numbers above 0.
ex) 2-0 is thinner than size 0, which is thinner than size 2.
- the sizes from 2-0 to 6-0 are used most frequently in the medical office.
- the length - of suture varys but strands precut in 18, 24, 54, and 60 inch lengths.
|ZERO / 0||Aught|
|Needles||- are chosen according to area in which they are used and the depth and width of the desired suture. |
they are classified according to:
- shape - straight/curved
- most sutures are applied with curved needles because they allow the phy to penetrate the surface then come back up again on the other side.
- the sharper the curve of the needle, the deeper the surgeon can pass into the tissue.
- needle point can:
- or cutting edge
- a taper is used on delicate tissues.
- a cutting edge - is used on the skin, it lacerates the skin as the needle is passed through, advantageous on tougher tissues like connective tissue.
* most needles are made with the thread attached or SWAGED.
* atraumatic needles do not have an eyelet and cause the least amount of tissue trauma as they are used.
* packaged as a single, individual pack, or multipack.
****The most common needle type used for minor skin repair is the curved, cutting - edged, swaged, needle.
|Suture Sizes|| 6-0 = .07mm|
5-0 = .10 mm
4-0 = .15 mm
3-0 = .20 mm
2-0 = .30 mm
0 = .35 mm
1 = .40 mm
2 = .5 mm