SUTURING

 It refers to sewing together two structures using suture thread on a needle. It is done to
provide

anatomical continuity and for having healing purpose.

Broadly classification of suturing:-

 

   Absorbable suture                                 Non-absorbable suture

EX :- plain- catgut, chronic –catgut,                              Ex :- nylon silk, poly-sterin, steel,

cotton  

poly-glycdic acid, poly-glycdin 910,                                  poly-propylene

monocryl, poly-dioxanone

  

On the basis of origin, suture are of two types :-

1)   Natural  :- Cotton, silk

2) Synthetic :- Monocryl and prolene

On the basis of structures sutures are of two types

1) Mono- filament :- Ex: Plain catgut, cotton, chronic catgut, monocryl

2) Multi-filament :- Silk, ploy glactin 910

 On the basis of finishing or colors :-

1)  Dyed :- Monocryl,silk

2) Undyed :- Plain catgut, cotton

TOPIC:- DRAPING

After part preparation,The procedure of covering(Draping) the patient and surrounding

areas with a sterile barrier to create and maintain a sterile fill during a surgical procedure
is called Draping.
  The procedure of Draping is to eliminate the passage of micro-organism between
non- sterile and sterile area.
 Draps(draping material) can be disposable or non-disposable.

Steps of Draping :-

                                                     Absorbable Suture

Absorbable Suture are broken down by body via enzymatic reactions or hydrolysis and get

absorbed within the body. They are usually in deep tissue and tissues that heal rapidly.

1) Plain catgut

         It is commonly used in sutures

         Absorbable, monofilament

         Undyed, natural

         Made up of intestine of sheep & goat.

         Clean water colour

         It passes through tissues smoothly & easily.

         Degradable within 1 week because its strength loose.

2) Chronic Catgut

         Absorbable suture, monofilament

         Dyed, Natural

         Brown in colour

         Loses its strength by the end of 2nd week &* then gets degradable.

         Used for ligating blood vessels

         Also used for suturing the mucous of gi tract

         Also used in musceles

3) Poly-glycolic acid
         It is manmade(synthetic)

         Absorbable, dyed

         Dark, violet, multifilament.

         Loses its strength 60-90 days &gets degrable

 4)  Poly-Glactin 910

         Synthetic

         Absorbable, multifilament

         Dyed

         Loses its strength

5) Monocryl
         Monofilament, Synthetic

         Absorble , Dyed

         Golden colour

         Creates low tissue reactions

         After 3-4 weeks it starbs degradation

                                 

6)  Polydioxan one

         Monofilament , synthetic

         Absorable , Dyed

         Dark blue colour

         After 3 weeks, degration

                                  

Non- absorable
  They are used in those tissues that heal slowly such as used on used on Tendon, facia.
They are more strong than absorbable. After 3-5 years, it start absorbable also used to on
abdomen.

1) Silk  

         Made from silkworms

         Dyed, multifilament

         Natural

         Blade colour

         Non absorbable
 2)  Poly propylene

         Synthetic, monofilament

         Dyed, blue colour

3) Polyster

         Synthetic, dyed

         Multifilament, green colour.

4) Nylon

         Synthetic, Monofilament

         Dyed, grey colour

5) Steel

         Non absorbable, monofilament

         Natural undyed

         Silver colour

6) Cotton

         Non absorbable, multifilament

         Natural, undyed

         White, blue, black

        Method of Suturing

1) Continuous Suturing :- 

It can be applied rapidly and very effectively .It commonly used to close the
peritonium.    

 Disadvantage : If any break occur in tread so whole suture will be open.

2) Intruppt Suturing :-   

  It is commonly used inserted from the one side of the wound and tied on the other side.It
is strong and can be used in the area of stress. Ex. Outside area of slain like

caesarean                                                          

Advantage : If any break occurs in one suture, so it will not create effect on other sutures.
 3)  Button hole / balance suturing:  It is writinuous type of suturing where the
needle is passed through the loop at each side. Avoid multiple

nodes.

4) Vertical matress suturing : It is signed problem for skin purpose.

It is passed at 2 level, one deep to provide support of wound and second superficully to
draw edges. Used in deep levels.

5) Horizontal matuecs suturing :-

Niddle is passed from one end to other end and again to the first one, then node is tied

                                         Topic – Drains

A Drain is a tube that facilitutes   the removal of blood, pus or other fuids from the wound

Indications:- Why do we use drain :-

 A prevent an excessive amount of blood & pluids that collects in the cavity of body
like lungs
 It provides mean of irrigation in specific
 Circumstances.
 To encourage the drainage of pus form an abscess. ( inflammation)

  Types of Drains:-

1) Open or Corrgated drains :-

  It is corrugated sheet made of red rubber plastic
 Drain fuid gels collected in gauze pad
 They are usually  used in muscles
2) Closed or tube Drains :-

 It consists soft tubes with a bag or gaze bottle to collect the pus or fluid, blood
 They are usually used in hollow cavities, chest, abdomen outhopadcic
 They have less chance of infection.

 They are of two tubes

One hole tube           

Multiple hole tubes

   Advantage: If one hole blocks so puss can come from multiple hole.

Under water seal Drains :-

It is a special tube of Drain which is usually used in lungs,

chest to suck the air. It only sucks the air and other drains suck the fluid .

TOPIC:- Urinary Catheterization

Cather  :- It is a soft hallow tube made of rubber, plastic or silicon .

Urinary Catheterization :-

It is the insertion of the hollow tube through the urethra into the urinary bladder for
removing urine

Indications :- Why urinary catheterization

         To empty the Bladder before, during and after surgery

         For long surgery, after which the patient cannot empty his/her bladder.

         For measuring the urine output in which critical ill patient.

         To obtain uncontaminated urine sample

Equipments used in urinary catheterization :-

         Cather

         Syringe 10 cc (cubic centre)

         Sterile water

         Betadine

         Lubricants ( lignocaine gel)

         Urine collection bag

         Sterile gloves

         Tape for fixing

         Bowel

         Sponge Pieces

         Sponge holders

         Cotton balls

Procedure
 Explain the procedure to the patient
 Wash your hands properly & wear sterile gloves
 Clean the perineum area properly. Sterling from the centre of outwards towards
the skin.
 A sterile and proper size cather should be selected
 A sterile and proper size cather should be selected
 A good source of list should be available for visualization.
 Lubricute the cather with jelly ( lignocaine) and pass it without touching its inner
side
 In male patient , hold the penis with sterile gauge retract the pounon if
necessary. male
urethra is usually S shaped & in order to straight it, Draw the penis upwards &
forwards at
the 90° to the patient’s legs .
 Position in female , in female keep the knees flexed and feet, about & feet
apart.
 Draping
 Inseution cather after this cover the area 

Complication of Urinary catheterization :-

1)      UTI

2)      Chances of injury of urethra

3)      If proper  a septic conditions are not followed, chances of infection are high.

4)      If cather is not inseld properly , it may cause trauma

Types of catheter
1) Plain catheter:-

- Usually made of red rubber

- It is used for 10-15 nun .it’s for one time just use it to remove urine & remove it ,that’s
mean

- it’s Disposable
2)  Indewelling Catheter :-

-  It’s a catheter which stays within the body for a longer period of time (2-3
days)                             
Ex:-                                                                                                                                   
                                                  - Faleys catheter, Gibbons, Malicot

 1. Foleys Cather :- (made up of silicon)

-    It is of two types: 2way and 3 way

i) 2way catheter

- It consists of main channl for drainage of urine and a side channel for its fixing through

which normal saline (chemical water)

ii) 3 Way Catheter

-It has three opening. One  for drainage, second for irrigation and third for influtting

Ballon

2) Gibbons Catheter :-
-   It’s  commonly made up of plastic

- This catheter has two ribbons attached to its upper and which can be fixed to the

reproductive part by using the adhesive tape.

-  It’s less relaxed irritation than foleys catheter.

TOPIC: DRESSING

They are the materials placed directly over wound or traumatic tissues to promote
comfort ,

provide support , encourage healing and for aseptic (infection less) purpose.

 
 Components of Dressings :-
 

1) Contact layer:- it‘s placed directly over the wound. It’s usually made up of mesh
guaze

piece. It is non absorbable and allows secretions passed to the absorbent layer.

2) Intermediate layer :-consisting of an absorbent material usually made up of

cotton. The

thickness this layer depends upon the amount of drainage expected.

3) Outer layer :- it helps to keep the contact an intermediate layer in close

proximity in order

to promote drain of secretions.

  Procedure of Dressing:-
1)      Wash your hands and wearing gloves

2)      Clean the wound with butadine

3)      After opening the dressing place it over the wound

4)      Use dressingthat is larger enough to extend atleast 1-1.5 inch beyond the edges of

wound.

5)      Secure the dressing by using adhesive tape.