Page 1 of 2: OSCE-Buster: Suturing - Correct Procedure

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

u r expected to put two sutures either on dummy,s arm or an suture slab
1--check the identity
it is usually assumed that u r scrubed ,area is painted and Anaesthesia is given
2--check ur trolly
3--procedure
--assess nerve ,tendon or vascular injury
--clean and sterlize around wound
--local Anaesthesia infiltration
--remove dead or doubtful tissue
-exclude serious injury
--suture wound ensure hemostasis
-apply dry dressing
CLEAN AND STERLIZE AROUND WOUND
a wide area around wound is cleaned
-hairy skin should be saved
-once clean a wide area is sterlized
-drap area e sterile towel
LOCAL Anaesthesia
local infiltration using 1 or 2 % lignocain(tadrenaline)
-NB max dose of lignocain is 200 mg
-never use adrenaline in areas supplied by end arteries ie finger toe ,penis
repeated infiltration around the lios of the wound can be done relatively painlessly after raising an initial weal e a fine needle
REMOVE DEAD /DOUBTFUL TISSUE
once anaesthetized (allow proper time for this to occur),the wound should be explored for bleeders ,dead or doubtfully viable tissue, foreign material
-skin edges r trimmed e a scalpel back to bleeding edges
-deeper tissues r cut back to viable bleeding tissue
EXCLUDE SERIOUS INJURY
preoperative assesment should include assesment of nerve,tendon or vascular tissue
-communited # should be excluded
-penetrating wound injury should be excluded
-intraoperative assesment should include these considerations
SUTURING THE WOUND
use monofilament synthetic sutures of smallest appropriate gouge
-simple skin closure of clean superficial wound
-entry and exit point should be equal and 3 mm either side of the wound
-only hold needle e instrument
-hold the needle at 1/2--2/3 along its length
-sutures should be evenly spaced use halving technique
-knot should be tied on the same side leave tails of approximate 5 mm
-lay knots on the same side of the wound
-knots should be positioned away from edge of the skin
-tension should be just sufficient to oppose wound edges
DRESSING
HAIRY AREA
opsite spray
SMALL WOUND
-simple semi permeable water proof
LARGE AREAS
-non adherent absorbant dressing
-semi permeable film dressig(eg opsite tegaderm)
JOINT AREA
-non adhesive dressing keep in place by cotton conforming bandages eg killing or slinky or elastic net surgical tubular stockingette
POST OP CARE
analgesia
--2 hour effect of local Anaesthesia
-rest the injured part
-elevation of the limb
-immoblization if involve digts
-simple oct (OVER THE COUNTER) medicines
-keep clean and dry, interfere e as little as possible
REMOVAL OF SUTURES
for each suture
the tail is grasped in foresep
knot is elevated
cutter is passed beneath knot and used to cut suture close to skin
knot is gently pulled to remove suture
TIMING OF REMOVAL OF SUTURES
SITE DAYS

head and neck 3-4 days
laparoscopy 3-5

pages and upper arms 7-8
laparotomy. thoracotomy.and perinium----------7-14
hands and feet--------------------------------10---12
back----------------------------------------14
if it is a Z cut please secure the angles first

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

this is a very rare station
initial deep bite about 7--8 mm from the edge
subsequent bite is 1--2 mm from the edge
unfortunately leaves a double row of puncture marks

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

HAEMOSTASIS
hemostasis is achieved intra operatively by
--identification and crushing of bleeders
-closure of dead space
-application of direct pressure for minimum of 2 minutes
-tie off bleeders
-diathermy
-positional change of pt
-post operatively
-direct pressure
-indirect pressure bandage

Guest · Credits: 77790 My Scrapbook My Reading List 262569 Books

guest????? · Credits: 77790 My Scrapbook My Reading List 262569 Books

the above post is by me but my name is not there
what is this rxpg-----------------------it is me sajida

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

what is happening to the site---strange

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

haemorrhage
heamatoma
pain
infection
dehiscence
keloid scarring
contracture
loss of function

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

sajida · Credits: 105317 My Scrapbook My Reading List 6 Books

A 62 years old woman has cut her leg 2 hours ago while gardening,she requires suture to the open wound, her tetanus immunization is up to date
using the plastic model of the leg .demonstrate the technique of suturing

1--Explain the examiner that u would introduce urself to the patient,donot address the mannikin

2---Explain the examiner that u would explain the pt that the leg wound require suturesexplain that it will not hurt as I will give her local anaesthetic injection
She will not require a tetanus booster as her tetanus status is upto date ie last booster e in 5 years

-3---I will establish that she has full range of movements of the leg,and no neurovascular compromise or tendon injury

--Have the pt lie in the supine position assuming the wound is on her anterior leg

--Don a pair of sterile gloves

--Drape the area of the wound e sterile drapes and clean the wound e diluted hydrogen peroxide or betadin using aseptic technique

4--Prepare a 10 ml syringe e 1-2% lignocain hydrochloride e adrenaline 1;80 000
the latter is useful to maintain a relatively bloodless field
-
-Warn the pt that she may feel a bee sting sensation of the local Anaesthesia going in,using a 21 gouge needle infiltrate the skin around the wound and the underlying subcutaneous tissue--Always withdraw suction before advancing the needle to ensure that u donot hit a blood vessel

5--explain the examiner that u would wait for several min to be fully anaesthetized and inform the pt that she will feel pressure but should not feel sharp pain

6-close the deeper layer of subcutaneous tissue e inverted absorbable suture(vicryl or dexon) on a cutting needle,Approximate the skin edges e intrupted non absorbable9nylon or prolin),in the leg 2-0 suture should be of sufficient strength

7--Apply steristrips and sterile guaze dressing over the wound

8--Explain to the examiner that u would inform the pt that the suture will need to be removed in a week time ans that she should make arrangements at her local GP surgery to see the nurse for suture removal

9- Explain to the examiner that u would inform the pt that if she develops signs of infection ie temp, wound breakdown ,wound discharge etc then she should return to casualty or see her GP for assesment and antibiotic

10-Explain to the examiner that u would give her painkillers to take home ie pcm or ibrufen, coproxamol or cohydramol depending upon the size and depth of the wound

11--tell examiner that i would thank the pt for her cooperation

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