Suturing

Question 1

What is required for the local anaesthetic?

Answer 1

Syringe - 5ml
Green needle - drawing up
Orange needle - injection
Local anaesthetic - Lidocaine - check expiry date! and concentration, w/ or w/o adrenaline ; be aware of BNF max dose and allergy status

Question 2

How do you complete the anaesthetic part of the procedure?

Answer 2

Wash hands, wear gloves
Draw up lidocaine (after checking expiry) and dispose of green needle, attach orange
Clean wound/injection site
Insert needle near inner edge of wound, use forceps to pull back if necessary, draw back to check not in vessel then inject a small volume slowly whilst withdrawing needle to distribute through layers of skin
Repeat on both sides along whole edge of wound

Can also be done external to the wound but do not cross contaminate ie alternating inside and outside wound margins

Wait for it to take effect and check by poking with forceps

Question 3

What equipment is required for suturing?

Answer 3

Scissors
Needle holder
Forceps - toothed and non toothed
Appropriate suture - needle and size

Question 4

How do you complete the suturing part of the process?

Answer 4

Take the needle holder in your right hand, stabilise body with index finger
Remove suture from packing with needle holder
Take wound edge between teeth of forceps (in left hand) and raise, pass needle through towards you through outer layer of skin in the centre of the wound
Hold the tail end of the needle with forceps and readjust needle holder then pull whole needle through skin til 1 inch of thread remains
Readjust needle in needle holder then repeat steps above, piercing the other side of the wound from the underside of the skin and pull towards you
Pull thread through until taught

Question 5

How do you tie off the suture?

Answer 5

Wrap around the long end of the thread around your needle holder, going under the holder then over towards the wound - wrap twice
Hold the wrapped long end in your left hand and the other end with the tips of the needle holder and pull your hands in opposite directions to form the knot close to the skin
Repeat this process but in reverse, working towards you and a thrid time working away again
Cut off the tail threads with about 0.5-1cm away from the skin