surgical prep + suture Flashcards
Describes the initial prep vs final prep
Initial
1. in prep room
2. wearing clean, exam gloves
3. using clean, non-sterile supplies for initial scrub of Pt
Final
1. In OR, cap & mask
2. exam gloves for final scrub
3. open gown / sterile gloves
4. scrub
5. put on gown & sterile gloves
How many reps of scrub during both initial and final preps?
3 total (of alcohol –> scrub)
Finish with scrub (contact time while moved into OR)
Pre-scrub mental checklist:
Cap and Mask on?
Gown and Gloves dropped?
remove Jewelry, Tuck in scrub top
List the 7 steps in scrub method
- open scrub brush
- wet hands and forearms
- clean under nails with fingernail pick
- wet scrub brush and create lather over areas to be scrubbed
- use sponge side (brush for fingernails and cuticles)
- choose timed or anatomic methods
- rinse fingertips –> elbows and allow water to drip off
When do you glove up in the OR?
Once gown is on and rear waist ties / neck closure are fastened; do NOT take hands out of gown cuffs until gloves are on! (closed glove method)
Where is the sterile field?
hands above your waist and below your shoulders
What is the only direction you can adjust the drape?
AWAY from incision!
What is the order of the quarter drape placement? What goes over this drape?
- surgeon side
- cranial end
- caudal end
- opposite end
The patient drape covers the quarter drape
Order of suture sizes (smallest to largest)
3-0 (3 zeros)
2-0 (2 zeros)
0 (1 zero)
1
2
3
Pros and cons of monofilament suture
Pros: moves thru tissue well, no wick (decreased capillarity)
Cons: less pliable (flexibility), susceptible to damage, increased memory
Pros and cons of multifilament (braided) suture
Pros: increased strength, increased pliability
Cons: increased wick (increased capillarity -> BACTERIA!)
What is natural suture made of? pros, cons?
Gut or silk
Pros: increased handling / decreased memory
Cons: Not uniform; unpredictable b/c loss of tensile strength
Synthetic suture pros / cons
Pros: more predictable loss of tensile strength
Cons: decreased handling / increased memory
What is the definition of absorbable suture?
Loss of tensile strength within 60-90 days in living mammalian tissue; become absorbed via phagocytosis by mø
Most common absorbable, synthetic suture? (2)
Monocryl (poligleaprone 25)
PDS II (polydioxanone)
What are 3 types of non-absorbable suture?
Natural: silk
Synthetic: prolene & nylon
Catgut and Chromic gut - pros and cons? When to never use?
BRAIDED, ABSORB
Pros: good handling, ligation of small vessels, rapidly healing tissue (mucosa, gingiva)
Cons: high tissue reactivity, not for prolonged strength, poor knot security when wet. Never use for infected wounds!! (low tensile strength!)
Monocryl (poligecaprone 25) (capone wore a monocle)
Pros & cons?
MONOFILAMENT, ABSORB
Pros: good handling, pliable, strength, absorbs predictably, minimally reactive, use in contaminated wounds
Cons: $$$. 50% of tensile strength lost @ 1 week, 70-80% at 2 weeks
Vicryl (polyglactin 910)
Pros and cons?
BRAIDED MULTI-FILAMENT, ABSORB
Pros: soft, good handling and knot security, minimally reactive
Cons: increased tissue drag and capillary action. 50% tensile strength lost at 2-3 weeks
PDS II (polydioxanone)
Pros & cons?
MONOFILAMENT, ABSORB
Pros: prolonged tensile strength (6-8 weeks). minimally reactive, can be used in contaminated wounds, no tissue drag, good handling/knot security
Cons: $$$
Silk (non-absorbable suture) - when is it completely absorbed by? other cons?
NATURAL, BRAIDED, NON-ABSORB
by 2 years, 56% tensile strength @ 12 weeks
cons: high tissue reactivity
Prolene (non-absorbable suture) pros and cons?
SYNTHETIC, MONOFIL, NONABSORB
Pros: resistant to degradation, lack of tissue reactivity, can be used in contaminated wounds
Cons: poor handling (increased memory, slip), poor knot security
Nylon (non-absorbable suture) pros and cons:
SYNTHETIC, MONOFIL, NONABSORB
Pros: monofilament, inexpensive
Cons: increased memory, poor knot security
Identify
Swaged: where needle is attached to suture. Single-use (swaged)
Use of this suture needle?
Taper Points - SOFT TISSUE, LUMINAL ORGANS (VISCERA). Incisions we don’t want to leak!
Use of this suture needle?
Reverse Cutting - skin, tough, thick fibrous tissue. Stays sharp (cutting edges + sharp tip)
Suture for MCT near the eye? Why?
Monocryl (monofilament, absorbable) or Vicryl (braided, absorbable) —- absorbable, soft, good handling / knot security, minimally reactive
Suture type to use in gingiva?
Absorbable, monofilament - monocryl (not chromic gut b/c this pt was a heavy chewer - want suture with good tensile strength
