Presented by Angel Sheridan FNP

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Presentation transcript:

Presented by Angel Sheridan FNP Basic Suturing Presented by Angel Sheridan FNP

Objectives Identify important components in evaluating lacerations and wound healing. Identify and demonstrate proper selection and use of instruments used in suturing. Discuss types of anesthetics and methods of administration. Discuss various types and sizes of suture material and their indications. Discuss and practice basic wound closure techniques. Discuss safe handling techniques for sharps. Identify common complications associated with wound closure. Discuss and practice alternative skin closure methods. Discuss appropriate wound care and followup.

Wound Evaluation Location Size Depth Shape MOA Time elapsed Foreign body/contamination Circulatory/Motor/Sensory Patient dependent factors Tetanus

Risk Factors Delayed presentation Foreign bodies Contaminated wounds Bites Puncture wounds Crush wounds Open fracture Tendons

Selecting/Handling Equipment Face shield Syringe/needle Anesthetic Suture Forceps Scissors Needle Holder

Anesthesia Lidocaine 1% Lidocaine 2% Lidocaine with epi Topical Buffering

AnesthesiaTips Avoid letting them watch injection Always aspirate before injection Start with topical dripping of anesthetic Inject within wound

Suture Material Absorbable Non-absorbable Braided/Non-braided Types of needles Curved/Straight Cutting/Tapered Size

Suture Size Face: 6-0 Scalp: 4-0 (blue) Back/torso: 3-0, 4-0 Extremities: 4-0, 5-0

Wound Preparation Cleaning Irrigating Debridement Foreign Body Hair

Basic Wound Closure Simple interrupted Continuous (running stitch) Vertical Mattress Horizontal Mattress

Tips Comfort Lighting Wound eversion Rule of halves Equal distance Corners Landmarks

SHARPS!!!

Complications Swelling Pain Fever Infection Wound dehiscence Scarring

Alternative Skin Closure Methods Steri-strips Adhesive Glue Staples

Followup Care Cleaning Dressing Splinting Antibiotics Clean and dry Recheck Suture removal

Suture Removal Face 3-5 days Neck 4-6 days Scalp 7-10 days Trunk 7-10 days Arms/Legs 7-14 days Joints 14 days

Bibliography Wound care manual- Johnson& Johnson Wounds and lacerations-emergency care and closure. Mosby 2005 Basic laceration repair. New England Journal of medicine. Oct 355:17 Essentials of skin laceration repair. Http://www.aafp.org/afp Basic suturing workshop for Family Practitioner students. www.slideshare.net/umiami/basic