Sponges and Sutures Flashcards
What is the purpose of sponges / swabs
- Absorb blood and fluids
- Protect the tissues e.g from diathermy burn
- Dressing
- Cleanse the wound and skin
- Blunt dissection (with fingers)
- Keep the tissue moist e.g. intestines
What the the two types of swabs/ sponges
Radio-opaque (x-ray detectable) and non radio-opaque (non x-ray detectable)
What are the radio - opaque swabs/ sponges
- Peanut swabs
- Raytec gauze
- Penny towel / laparotomy / abdominal pack
- Tonsil swabs
What are the non radio - opaque swabs/ sponges
- Anaesthetist gauze
2. Plain gauze
List the characteristics of Raytec gauze
- Packed in bundles of 10s (3’x3’ or 4’x’4’)
- Radio - opaque thread is blue/black
- Never used for dressing
- When peritoneum is opened used as ‘swab on stick’ in abdomen surgery
List the characteristics of penny towel/ laparotomy/ abdominal pack
- Packed in bundle of 2 or 5
- 20 x 33cm
- Muslin material with tail
- Radio-opaque thread
What are the uses for penny towel/ laparotomy/ abdominal pack?
Major surgeries – abdomen, pelvis, thorax, extensive incision, reconstruction
- Absorb extensive blood clot and fluid
- Provide warmth to exposed tissues i.e. colon
- Protect tissue/ skin while retractor lining on top
List the characteristics and purpose of peanut swabs?
- Pack in bundle of 5
- Each mounted on tissue clamp
- 0.65 x 1.25cm
Purpose is to absorb blood in paediatric and blunt dissection
List the characteristics and uses for non radio - opaque anaesthetic gauze
They are green in color and used by anaesthesia department only.
The purpose is to wipe secretions like saliva, eye protection (e.g. from laser) and skin prep for regional anaesthesia procedure
List the characteristics and uses for non radio - opaque plain gauze & ribbon or roller gauze
Plain gauze – packed in bundle of 10s, it is used for cleansing, dressing of wounds / drain site
ribbon or roller gauze – there are various width and length. Used for packing of cavity eg oral cavity or open wound after incision & drainage
What are the guidelines for counting swabs (preoperatively)
- Loosen the bundle of swabs lightly
- Hold entire bundle in one hand on the folded edge
- Pick up one swab at a time
- Show the radio-opaque thread / intact loop of penny towel to the circulating nurse
- Count concurrently and audibly in the presence of circulating nurse
What are the guidelines for counting swabs (preoperatively) #2
- Recount if interrupted or when in doubt
- Remove/Discard the bundle if there are discrepancies
- Additional package should be counted away from counted items already on the trolley
- Ensure circulating nurse record immediately and initialed all additional count in the sheet
How to care for swabs / sponges intraoperatively
- Keep count of swabs/sponges at surgical site
- Maintain two sponges/swabs at operating field at one time
- Use abdominal packs/penny towel and swab sticks if the wound is big and deep
- Do not cut swabs or sponges
- Do not remove any swabs/ sponges from the OR until the operation is over
How to care for swabs / sponges intraoperatively #2
- Pass soiled or wet sponges/swab to the circulating nurse
- Count, bag up and place soiled/wet swabs aside if maximum consumer package of 2/5/10 is reached
- Documentation - initial name and strike off bundle
- Count all swabs within cavity, before closure of cavity and skin (Counts are taken in three areas: floor, trolley and operative field)
- Inform surgical team the outcome of counts
What is the purpose of sutures?
Sewing tissue together
Tie (ligate) of blood vessels, or stitch to hold edges of a wound or surgical incision
Material used to assist tissue approximation and healing
What are the two types of suture
Absorbable and non absorbable
What are the two parts of the suture?
Needle with eye or eyeless (mostly are eyeless)
suture strand
What are the common terms associated with sutures?
Absorbable Non absorbable Atraumatic - eyeless Non - atraumatic - eye Free ties Tie on stick/ stick tie Round body/ cutting needle
What is absorbable suture and what are the different examples?
They are temporary and are absorbed or digested by the body cells and tissue fluid in which they are embedded during and after the healing process.
Some examples include, vicryl, monocryl, Plain catgut, chromic catgut, PDS II
What is non- absorbable suture and what are the different examples?
They are permanent and cannot be absorbed or digested by the body cell or tissue fluid.
Examples include, sofsilk, prolene, surgical stainless steel, ethilon, ethibond
What are free ties suture
Graps two ends with the thumb and index finger and pulling taut when handling to surgeon
stick ties/ tie on stick – ties clip on artery forceps
no needle attached and the purpose is to tie off bleeding blood vessels
What are the three types of suture
Point and body shape
- Taper – Taper point and round or quadrangle body (cross section) for muscle, nerve, peritoneum and blood vessels.
- Blunt – Blunt tip and flat body (cross section) for kidney, liver, spleen and bowel
- Taper cut – Small triangular cutting point and flat body (cs) for fascia and ligaments
How to mount the needles?
1/3 or 1/2 of the shaft away from the eye
at the tip of the needle holder
What are the nursing responsibilities?
- Importance of understanding the type of suture and needle characteristics (look out for any defect)
- provide alternative when the requested is not available
- Prevent patient injury - E.g. use of absorbable suture where permanent wound support is desired can result in wound separation
What are the guidelines on needle counting
- Perform initial closure and final counts
- Concurrently and audibly count with circulating nurse
- Suture packet to be tallied with needles
- Prepare in order or usage
- Give one needle at a time
- Additional supplied to be obtained from circulating nurse
- Receive and check that needle is intact
- Needle passed out are to be countered and initialed in swab/sponge count chart
- Proper disposable of needles into sharp resistance box
What to do if there is procedural discrepancy?
Account for missing needle or part of needle
Inform the surgical team
conduct a thorough search
Xray may be required
incident report in event of missing needle
