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Infection Risk Management: SSI > Basics Of Sutures > Flashcards

Basics Of Sutures Flashcards

1
Q

What three outcomes do doctors look for when using sutures?

A

Appropriate and predictable strength for tissue layer.

Minimum tissue trauma and reactivity. (Passes smoothly through tissue)

Antibacterial protection. (Minimize bacterial colonization)

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2
Q

What suture is recommended for closure of the surface of the skin?

A

None.

Topical skin adhesives are recommended.

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3
Q

Surgeons may sometimes suture the peritoneum. Why?

A

To avoid adhesions with the intestines.

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4
Q

Ethicon suture sizing ranges from ___ to ___ with ___ being the largest and ___ being the smallest.

A

Range from 7 to 11-0

7 is the largest.

11-0 is the smallest.

7-0 approximately corresponds to the thickness of human hair.

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5
Q

What Ethicon suture is recommended for the Subticular layer?

A

MONOCRYL PLUS Antibacterial.

Poliglecaprone 25

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6
Q

What Ethicon suture is recommended for the Subcutaneous/Fat layer?

A

MONOCRYL PLUS Antibacterial (poliglecaprone 25)

Coated VICRYL PLUS Antibacterial (polyglactin 910)

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7
Q

What Ethicon suture is recommended for the Fascia layer?

A

PDS PLUS Antibacterial (polydioxanone)

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8
Q

What Ethicon suture is recommended for the Organ/Space layer?

A

Prolene (polypropylene)

Ethibond Excel (polyester suture)

Coated VICRYL PLUS Antibacterial (polyglactin 910)

PDS PLUS Antibacterial (polydioxanone)

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9
Q

Triclosan used in PLUS sutures is proven in vitro to inhibit bacterial colonization of the suture for how long?

A

7 days or more

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10
Q

Suture materials are classified as __________ and _________.

A

Synthetic (polyester, nylon, other polymers)

Natural (gut, silk, stainless steel)

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11
Q

What are some of the other polymers in the synthetic category?

A

Prolene (polypropylene)

Pronova poly (Hexafluoropropylene-VDF)

Monocryl (poliglecaprone 25)

PDS (polydioxanone)

Coated Vicryl (polyglactin 910)

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12
Q

Gut and silk sutures are derived from:

A

Gut: submucosa of sheep intestine or serosa of cow intestine

Silk: filament of silkworm cocoon

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13
Q

Stainless steel sutures are used for what type of closure?

A

Sternal closures.

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14
Q

What are the advantages of synthetic sutures?

A

Low inflammatory response.

Not significantly affected by body responses (temperature, infection, etc.)

Can be antibacterial.

Greater predictability that Natural sutures.

Optimizes strength, strength retention, absorption, and pliability.

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15
Q

What are the advantages of natural sutures?

A

Silk has good handling.

Stainless steel can create a high tension closure.

Surgeons are often trained with natural.

It is perceived as less expensive.

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16
Q

All PLUS sutures are which:

 Synthetic and Absorbable

 Synthetic and Non-Absorbable

 Natural and Absorbable

 Natural and Non-Absorbable
A

Synthetic and Absorbable

17
Q

Absorbable sutures lose _________ and ________ over time.

A

Strength and mass.

*note: Non-absorbable sutures generally retain strength and mass.

18
Q

Absorbable sutures last for ________ to ________, where Non-absorbable sutures last for _________ to _________.

A

Absorbable: days to weeks

Non-absorbable: months to years

19
Q

TSR profile stands for?

A

Tensile Strength Retention.

 The sutures ability to retain strength over time within the body.

 Suture strength needs to last long enough for the wound to support itself.

Note: Tensile strength and mass aren’t always linear. Mass may remain even when strength is diminished.

20
Q

Absorption refers to the loss of _______?

A

Mass

21
Q

How do synthetic sutures absorb?

A

Process of hydrolysis.

 Water breaks up the chemical bonds of the polymer. 

 This process results in predictable degeneration of the material.
22
Q

How do natural sutures absorb?

A

Immune response.

 White blood cells attack and remove the material.

 Degeneration can be unpredictable based on patient factors (age, nutrition status, disease process, etc.)
23
Q

When should non-absorbable sutures be used?

A

When permanent support is needed.
(Cardiac valve replacement, sternotony closure, vessel anastomoses, prosthetic vascular graft implantation)

Bone and tendons (they have a longer healing period than absorbable sutures can support)

Also when suture removal is intended
(Skin sutures that will be removed in 7 days, sutures securing drain that will be removed when drain is no longer needed)

24
Q

Monofilament suture has ______ surface area than a braided suture and causes less tissue ______ because of smoother passage. It is also has ______ reactivity and a ______ infection risk.

A

Monofilament: Less surface area. Less tissue trauma. Less reactivity. Less infection risk.

25
Q

Why does a braided suture have a higher risk for infection?
Cause more tissue trauma?
Cause more reactivity?

A

The rough texture creates increased surface area and is more likely to harbor bacteria. It is also more likely to spread bacteria and fluid via wicking. (Capillarity- the spread of bacteria and fluid along the suture strand)

Rough texture can also cause tissue sawing. (Damage)

Larger surface area also increases risk for tissue reaction.

26
Q

Tissue trauma depends on ________ and ________.

A

Tissue factors and suture size.

27
Q

Braided sutures naturally have crevices called interstices. When does a monofilament suture have interstices?

A

When it is tied into a knot. The knot then has interstices.

28
Q

Which type of suture tends to retain package shape? Monofilament or braided?

A

Monofilament.

29
Q

_____________ sutures have a larger knot tower and MORE knot slippage.

A

Monofilament.

30
Q

Braided sutures have a flatter knot and their _______ _________ helps reduce knot slippage.

A

Rough surface.

31
Q

What are two techniques for wound closure suturing?

A

Continuous: multiple passes with one suture. Knots on both ends.

Interrupted: series of individual loops and knots.

32
Q

Advantages of the interrupted suturing technique are?

A

Stronger if another pass breaks.

Less risk of capillarity.

Note: Braided is best suited because of the increased number of knots (more secure)

33
Q

What are the advantages of the continuous suturing technique?

A

More even tension throughout.

Faster with fewer knots.

Note: Monofilament is best suited because of smoother passage, less capillarity/harboring of bacteria.

Infection Risk Management: SSI (4 decks)

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