1. Suture Materials ABSORBABLE: lose their tensile strength within 60 days. NON- ABSORBABLE:

2. Surgical Needles

3. Surgical Instruments

4. Needle Holders

5. Forceps Tissue forceps Dressing forceps

6. Suture Removal Scissors

7. Wound Evaluation Time of incident Size of wound Depth of wound Tendon / nerve involvement Bleeding at site

8. Wound Irrigation Check physician's order for dressing change. Prepare necessary equipment and supplies: Sterile dressing set. Sterile irrigation solution. Clean disposable gloves. Sterile gloves Sterile gauze. Sterile syringe. Sterile basin. Sterile forceps. Rubber sheet. Disposable bag. Tape. Blanket.

9. Identify the client. Explain the procedure to the client. Determine if the client has allergy to any of the materials or solutions needed for the procedure. Wash hands. Close the room door or curtains & windows. Place the bed at a comfortable position. Assist the client to a comfortable position. Expose the area and drape the client with blanket if needed. Place rubber sheet under the wound area. Using aseptic technique, open sterile set on work area.

10. Principles And Techniques Place disposable bag within easy reach for use during the irrigation. Wear clean disposable gloves and remove the soiled dressings. Assess the wound for size, appearance, amount of drainage and the appearance of the surrounding tissues. Discard the dressings in disposable bag. Remove gloves and put them in disposable bag. Using sterile technique,prepare a sterile field and add all the sterile supplies needed for the procedure to the field.

11. – Pour warmed sterile irrigating solution into the sterile container or basin. – Wear sterile gloves. – Position the sterile basin below the wound when collect the irrigating fluid. – The irrigation solution will flow from the upper end of the wound toward the lower end. – Make sure all areas of the wound are irrigated. – Use a syringe with an irrigating tip to flush the wound. – Insert irrigating tip into the wound until resistance is met. – Watch for the solution to flow smoothly and evenly. – When the solution from the wound flows out clear, discontinue irrigation.

12. Dry the surrounding skin with a sterile gauze sponge. Apply a new sterile dressing to the wound. Apply dry sterile gauze over wound. Remove gloves and dispose of them properly. Secure dressing with tape. Return the bed to the lowest position and raising the side rails as needed. Remove the equipment and dispose it properly. Wash hands. Documentation.

13. Suturing Apply the needle to the needle driver – Clasp needle 1/2 to 2/3 back from tip Rule of halves: – Matches wound edges better; avoids dog ears – Vary from rule when too much tension across wound

14. Suture Removal Time frame for removing sutures: Average time frame is 7-10 days FACE: 4-5 days BODY & SCALP: 7 days PALMS, BACK OR OVER JOINTS: 10 days Any suture with pus or signs of infections should be removed immediately.

15. Suture Removal 1. Clean with hydrogen peroxide to remove any crusting or dried blood 2. Using the tweezers, grasp the tie and cut the suture below the tie, close to the skin 3. Pull the suture line through the tissue- in the direction that keeps the wound closed - and place on a 4x4

16. Suture Removal Once all sutures have been removed, count the sutures The number of sutures needs to match the number indicated in the patient's health record