Page 2 of 2: OSCE-Buster: Suturing - Correct Procedure

sajida · Credits: 105517 My Scrapbook My Reading List 6 Books

in suturing__
never use the same toothed forcepsused for cleaning the wound wjen it comes to stiching it...always ask for a new one....and also always pleae clean awound from inside out NOT outside in.after all perfectly suturing an infected wound is useless

sajida · Credits: 105517 My Scrapbook My Reading List 6 Books

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sangy · Credits: 2202 My Scrapbook

many thanks again

Guest · Credits: 79189 My Scrapbook My Reading List 262569 Books

. Sutures. Patient sustained a cut with a sharp edge. Tetanus jab has already been given, wound has been anaesthetised; you are gowned and gloved; clean and give two sutures.
As usual, the examiner is watching you come in to offer a hand-shake. I was locking my fingers in a ready-for-surgery pose and used my elbow to open the door handle and my bum to open the door. The examiner was watching me through the glass and when he saw me he did not offer his hand. Instead, he asked me to proceed. I checked if the consent has been taken and he said everything has been done and not to waste time. I could not see any syringe nor NS so I asked for it. He said that’s all. So I checked for anaesthetic action, cleaned the skin with anti-septic solution that was given and did the two sutures in time. He was impressed and asked me what did I do. Told him that I did research and had done surgery in the past. If someone has shake hands when you’re supposed to be on glove, apologise him and ask for a new pair of sterile gloves; no need to panic!

snehith4368 · Credits: 602 My Scrapbook

can someon update on perfect wound suturing procedure as per present protocol??

LondonStudDoc · Credits: 206 My Scrapbook

Suturing

 Introduction, check the name & age, gain consent

The doctor has asked me to put some stitches in to help your wound heal – it shouldn’t be painful as I’ll numb the area with an injection of local anaesthetic – is that ok?

 Wash hands

 Take a quick history of the injury
o Ask about any potential glass and if so, refer to XR

 Ask about pain and if they’ve had some analgesia

 Ask if any allergies

 Take a focussed history of things that affect wound healing:
o Diabetes
o Warfarin
o Steroids
o Keloid if Afro-Caribbean

 Ask about tetanus status: booster needed if:
o Not had one in last 10 years
o Wound very contaminated

 Expose the patient: wound, joint above and joint below

 Assess neurovascular status

 Comment on the wound:
o Clean edges?
o Heavily contaminated?
o Heavily bleeding?

 Cleansing:
o Mechanical: Patient washes it with soap and water
o Irrigate with normal saline
o Freshen wound edges with a scalpel if needed

 Prepare equipment:
o Locate sterile trolley
o Open the outer pack and tip the inner pack onto the trolley
o Open up the inner pack
o Tip sterile gloves onto the trolley
o Pour antiseptic into the sterile receiver
o Open suture (e.g. 4/0 monofilament with curved needle) into sterile area
o Locate a 5ml syringe, 21G needle to draw up anaesthetic and 25G to infiltrate
o Wash hands and dry on the sterile towel, put on gloves
o Ask assistant to open the lidocaine, draw up using the 21G needle, detach and place in sharps bin, attach the 25G needle
o Clean the skin with antiseptic soaked cotton on a pair of forceps
o Explore the wound with a pair of toothed forceps, discard!
o Drape area with sterile towel
o Infiltrate with local anaesthetic using an aspiration technique (Sharp scratch! Tell them they will still feel pressure!)
o Allow time for anaesthetic to work! (5-10 min – check with a sharp needle edge before proceeding!)

 Method:
o Pick up suture with the needle holding forceps
o Grasp the wound edge with toothed forceps
o Insert needle 1-2mm from the wound edge, just below the dermis
o Pull suture through
o Pass needle through the opposite wound edge
o Tighten and oppose would edges, without tension and with slight eversion
o Knot: 2x clockwise, 1x anticlockwise, 2x clockwise
o Trim ends to ~5mm
o Repeat 5mm apart, pull knots to the same side of the wound
o Apply sterile gauze to cover the wound

Put all sharps in the sharps bin and tidy the area

Sutures:

Advise the patient to make an appointment with their GP to have the practice nurse remove their sutures

 Face – 5/0 out in 3-5 days
 Scalp – 3/0 out in 10 days
 Ear – 1/0 out in 5 days
 Neck / chest / back / abdomen – 4/0 out in 10 days
 Hands and feet – 5/0 out in 10-14 days
 Arms- 4/0 out in 10 days
 Legs- 2/0 out in 10 days

Wound care:
Advise to keep clean and dry

Tell the examiner you would provide an information sheet

Complications:

Advise the patient to return to casualty / GP if they experience: temperature, wound breakdown, wound discharge

haemorrhage
heamatoma
pain
infection
dehiscence
keloid scarring
contracture
loss of function

Tell the examiner you would advise the patient on some analgesia to take home / get e.g. paracetamol / ibuprofen

Ask the patient if they have any questions
Thank them for their cooperation

Alternatives:

Glue
Staples
Steristrips

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