Technique for removing sutures from the surgical wound. How to properly process the seam after surgery. Nurse Circumstances and Behavior Model

INSTRUCTIONS

SUITATION TECHNIQUE.

I N S T R U K T I A

The instruction was considered at the meeting of the Central Committee No. 4

Minutes No. ___ dated _____________ 2014

Chairman of the Central Committee No. 4 _____________ V.N. Rozhko

Compiled by A.A. Lisov

Indications: treatment of wounds.

Contraindications: purulent processes in the wound, PST was not performed.

Real patient problems: psycho-emotional discomfort (pain, fear), physio-iatrogeny, other problems identified during the manipulation.

Potential patient concerns: infection of the wound, additional traumatization of the wound, damage to the neurovascular bundle, inversion of the wound edge inward.

Equipment:

Sterile:

1. anatomical tweezers -1, surgical - 2, pincers - 4,
2. Gegar needle holder - 1,
3. Cooper scissors - 1,
4. silk,
5. triangular needles - 2,
6. sterile wipes, gauze balls, 4 towels,
7. sterile wooden sticks with cotton wool wrapped around the end,
8. 1% solution of iodonate,
9. cleol,
10. trays,
11. mask, oilcloth apron, rubber gloves,
12. containers with solutions for disinfection,
13. band-aid,
14. bandages of various widths,
15. needle syringe,
16. 0.5% solution of novocaine in ampoules or sterile containers.

1. Examine the medical appointment (for paramedics, self-record the appointment).
2. The patient is invited to the dressing room. Have a conversation with him, answer questions, reassure. Lay the patient on the operating table or seat him next to the table on a chair.
3. Wear a mask, oilcloth apron.
4. Wash hands and put on sterile gloves.
5. Cover the microtable.
6. Fix the needle in the needle holder and load the needle with a silk thread 10-12 cm long.
7. Treat the edges of the wound with iodonate (from the center to the periphery). Delimit the operating field with towels and napkins, securing them with toes. Perform infiltration anesthesia or conduction anesthesia of the wound.
8. Grab the edge of the wound with tweezers, pierce the skin and subcutaneous tissue with a needle, stepping back from the edge of the wound 5 mm. Stitch the bottom of the wound. Sew the second edge from the inside to the outside, piercing the needle at the same distance.
9. Bring the edges of the wound together (with two tweezers if they work together).
10. Tie the ends of the thread to the side of the wound edge and cut at a distance of 0.5 cm from the knot.
11. Apply the next seam with an interval of 1-2 cm.
12. Treat the seam with iodonate with blotting movements.
13. Apply a sterile bandage. Remove socks, towels and napkins.
14. Disinfect used equipment.

Indications: formed wound scar (6-16 days).

CONTRAINDICATIONS: unformed scar.

Real patient problems: psycho-emotional discomfort (fear, pain), physiatrogenicity, other problems identified during the manipulation.

Potential Patient Problems: infection, additional traumatization of the scar, divergence of the edges of the wound.

Equipment:

• dressing room standard equipment,
• suture removal kit: Cooper scissors - 1, anatomical tweezers - 1, surgical tweezers -1 (sterile in kraft packaging),
• sterile wipes, balls in bix in kraft packaging,
• solutions: 1% iodonate, cleol,
• scalpel,
• tray,
• protective equipment for the health worker: apron, mask, gloves,
• containers for disinfection.

Execution sequence:

Sources used:

1. Obukhovets T.P. , Sklyarova T.A., Chernova O.V. Fundamentals of nursing. – Rostov-on-Don, 2002

2. Gritsuk I.R., Vankovich I.K. – Minsk, 2000.

"Medicine"

"Sisterhood"

Technique for removing interrupted sutures

from an operating wound

Skin interrupted sutures are designed to hold the edges of the wound. After the wound has healed, they are removed. The number of days during which interrupted sutures remain on the skin depends on the nature and location of the wound. Interrupted sutures should be removed 5-7 days after their application. If the postoperative wound is large, then interrupted sutures should be removed first after one, and the rest should be removed the next day.

The decision to remove the interrupted sutures is made by the doctor. When removing interrupted sutures, asepsis rules should be observed.

1) healing of the postoperative wound.

1) sterile tray;

2) sterile wipes;

4) sterile anatomical forceps;

5) sterile scissors or sterile suture cutters;

6) antiseptics for the treatment of skin and hands of medical staff;

7) rubber gloves;

12) tray for waste materials;

14) auxiliary tray;

15) containers with disinfectant.

Preparatory stage of the manipulation.

1. The day before, inform the patient about the need to perform the manipulation. Explain the nature of the intervention to reduce anxiety as much as possible.

2. Before starting the manipulation, check the sterility of the materials and instruments used.

3. Wear an apron, mask, gloves.

4. Treat surfaces with a disinfectant.

5. Wash your hands, change gloves.

6. Put sterile wipes, tupfers, tweezers, scissors or suture cutters into a sterile tray.

7. Put an antiseptic, glue, bandage, scissors, adhesive plaster on the auxiliary tray.

8. Install the waste tray.

The main stage of the manipulation.

1. Remove the bandage with tweezers and discard.

2. Check the wound and assess the possibility of removing interrupted sutures.

3. Count the number of stitches to be removed.

4. Treat the postoperative wound with blotting movements with an antiseptic solution twice (wide, narrow) changing napkins or tupfers.

5. Grab the suture knot with anatomical tweezers and lift it slightly.

6. Cut the thread under the knot with scissors or suture cutters, as close to the skin as possible, at the border of the white section of the thread.

7. Gently, without excessive force, pull the seam with tweezers and remove the thread from the fabrics. The part of the thread lying on the surface should not get under the skin when pulled, so as not to cause infection of the wound.

8. Put the removed thread on a gauze napkin.

9. Check the integrity of the wound, if it gapes, ask the doctor for advice: it may not be necessary to remove all the stitches.

11. Treat the wound with an antiseptic.

12. Apply a sterile napkin to the wound.

13. Fix the napkin in one of the following ways: (cleol, adhesive plaster, soft bandage).

The final stage of the manipulation.

1. Disinfect used tools and dressings in accordance with the instructions.

2. Remove rubber gloves and immerse in a container of disinfectant.

3. Wash your hands, dry them.

4. Make an entry in the log about the assignment.

1) infection of the wound in case of non-compliance with the rules of asepsis and the technique of removing interrupted sutures.

1. Order of the Ministry of Health of the Republic of Belarus dated June 21, 2006 No. 509 “On the standardization of training in the technique of performing medical manipulations in institutions providing secondary specialized education in a medical profile”.

2. I.R. Gritsuk, I.K. Vankovich, "Nursing in Surgery" - Minsk: Higher School, 2000.

3. Jaromich, I.V. Nursing and manipulation technique - Minsk: Higher School, 2006.

When using site materials, an active link to it is required

/ Algorithm 38 Removal of an interrupted skin suture

Removal of an interrupted skin suture.

7th day after surgery (scar formation)

2 Venue. dressing room. All medical items (gown, sheets, diapers, trays, containers for solutions, etc.) are initially sterile, that is, they are used after sterilization, which is carried out (in a dry-heat cabinet) or provides delivery to and from the autoclave dressing nurse. Nurse clothing: gown, cap, mask, glasses (if necessary), shoe covers over shoes, gloves over gown sleeves.

Two trays, one sterile and one non-sterile. In a sterile tray, the nurse collects:

3 anatomical tweezers

Cooper scissors 1 pc

Sterile balls 5-7 pcs

Sterile wipes 3 pcs (see note)

Next to the tray is

Jar with 1% iodonate solution

A non-sterile tray is used to store used instruments and dressings before disposal or further processing (PSO)

1 Two napkins are prepared in advance with their sizes corresponding to the size of the wound.

2 One napkin is used to drop the removed stitches on it.

4 Nurse Circumstances and Behavior Model

Working day of the surgical department. The dressing nurse needs to remove single interrupted sutures from a clean postoperative wound on the abdomen. The patient came to the dressing room on his own at the appointed time.

5 Action algorithm

Introduction (a conscious patient does not need an assistant). We introduce ourselves, explain the essence of the manipulation (I will remove the stitches), we get consent. We lay the patient on the couch, ask him to bend his knees. We appeal to the patient with a request to report changes (deteriorations) in the condition.

Example: Hello, my name is Irina, today we are finishing the treatment of the wound, for this it is necessary to remove the stitches, do you agree? How can I call you? - Ivan Ivanovich. Ivan Ivanovich, please lie down on the couch (help if necessary), bend your knees. If my actions cause you great pain (tolerable pain will almost always be), you do not tolerate but let me know, okay? We get an affirmative answer.

Remove the old dressing with tweezers. Since the manipulation is carried out at the stage of scarring, the dressing will not dry out, there is no soaking stage.

We put a napkin in the wound area (10-15 cm) to collect the removed stitches

We carry out diagnostic manipulations: we determine the phase of the wound process (in our case, the formation of a scar), we make sure that there are no inflammatory changes.

We examine the wound and sutures, if necessary, we palpate the tissues around the wound

We carry out infection prevention

With a ball on tweezers moistened in a solution of iodonate with blotting movements, we process the area of ​​\u200b\u200bthe seams (borders - the places where the ligatures exit) 1 time. Napkin - in a dirty tray.

With the second ball on the same tweezers, we treat the skin around the wound with sliding movements from the center to the periphery 1 time. An antiseptic should be applied to an area of ​​at least 5 cm in all directions from the wound line.

With the same tweezers, we pull the ligature over the knot area up and towards the wound until the part of the thread that is not stained with iodonate is exposed. We bring the tip of the scissors under the ligature in the area of ​​​​its unpainted part and cross. We remove the ligature with tweezers, examine it (it is important to make sure that part of the ligature does not remain in the wound). We drop the ligature on a pre-prepared napkin. Tweezers - in a non-sterile tray.

We remove all (or not all, for example, through one as prescribed by a doctor) sutures and lay them out on a napkin. After you have made sure that the seams are approximately the same length (completely removed), the napkin is folded and dumped into a non-sterile tray.

We carry out the prevention of infection of "ligature punctures"

With a ball on tweezers moistened in a solution of iodonate with blotting movements, we process the area of ​​\u200b\u200bthe seams (borders - the places where the ligatures exit) 1 time. The ball is in a dirty tray.

With tweezers, apply a sterile napkin pre-cut to size on the wound, over the first second. Tweezers - in a dirty tray.

We fix the dressing material in the wound area with the help of an adhesive plaster. In addition to the adhesive plaster, you can use a glue bandage for fixing.

Dirty dressings and gloves are placed in a container for further disposal, and the instruments are subjected to pre-sterilization treatment.

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On what day after the operation the sutures are removed, postoperative suture care

Sometimes a person cannot avoid surgery. In this case, an incision is made on the body, which is then sutured. Next comes the process of restoration and regeneration. On what day after the operation are the sutures removed and is scar care necessary?

Features of removing postoperative sutures

Most surgeries require an incision in the patient's tissues. In order for the wound to grow together, a suture is needed. Although this process is very unpleasant, it is very important.

Of course, no one removes the stitches on their own. All manipulations should be carried out only by a doctor. He will also evaluate the condition of the incision site, and may adjust the time of extraction of the threads. As for the materials with which wounds are sutured, the following are used.

Fixed

Resorbable materials that do not need to be removed include catgut. Produced from the intestines of animals. They are used in heart surgery and transplantation of internal organs. Convenient for superficial shallow wounds and incisions (rupture of the perineum after childbirth).

Removable

These are silk threads, nylon, nylon and even staples or wire. Such materials securely fix the wound, and the likelihood of suture divergence is minimal. Requires mechanical removal.

So on what day are the stitches removed after the operation? This usually happens 7-10 days later. This period also depends on the type of operation and the characteristics of the patient. With surgery on the abdomen, face, chest, the healing period will be approximately 7 days. After delivery by caesarean section, the process will take up to 8-10 days.

The sutures are removed only when the edges of the wound have already grown together. It's also not worth overdoing. This threatens that the threads begin to grow into the skin and a rather noticeable mark may remain.

Before removing the threads, the doctor treats the operation site with an antiseptic. For manipulations, tools such as tweezers and scissors (or a scalpel) are needed. When applying several stitches, they can be removed not all at once, but gradually.

This procedure can hardly be called pleasant, but at the same time it is almost painless. This is an important and necessary step on the road to recovery.

What determines the period of removal of the threads

What is the timing of suture removal? It depends on various factors, the most common are:

1. Part of the body. Different parts of the body are supplied with blood in different ways. Somewhere the regeneration process is faster, somewhere slower. First of all, connecting materials are removed from the face and neck area (sometimes for 4-5 days). Later - from the feet and legs (day).
2. The presence of an infection. If the incision is infected, the threads can be removed the next day. Sometimes it is necessary that the wound be open.
3. Body mass. The larger the fat layer, the worse the tissues grow together, and the blood circulation slows down.
4. Dehydration. The lack of fluid in the body negatively affects electrolyte metabolism and inhibits important processes.
5. Age. With age, the ability to regenerate decreases. For older people, it will take much longer for the incision to heal (about 2 weeks).
6. Presence of chronic diseases and immune status. Adverse processes in the body (HIV infection, chemotherapy) slow down the healing rate and increase the risk of complications after surgery.

The decision on when to remove the postoperative suture should be made by the attending physician. For this, indicators of age, health, and the characteristics of a particular operation are taken into account. Despite accepted norms, terms may vary.

Processing and required materials

Sutures require processing for two weeks after surgery. This is necessary in order to exclude infection and suppuration of the incision site.

For manipulations, the following materials may be needed:

An example processing algorithm looks like this:

1. Moisten a sterile bandage with hydrogen peroxide and blot the affected area. Use tweezers. If you have a seam, the processing should be delicate. No need to rub or press hard.
2. You can lightly cauterize the wound with alcohol (especially if the seam is inflamed in some places).
3. You need to apply a sterile bandage. Before this, the material is wetted in a solution of sodium chloride (10%) and squeezed out. Another napkin is superimposed on top and fixed with a bandage and adhesive plaster.
4. With a good condition of the seam and the absence of suppuration, it is enough to repeat the procedure every two days.

You do not need to remove the crusts, whitish coating of the epithelium on your own. If they are damaged, the skin is re-injured and the cosmetic seam may become more noticeable. It is impossible to completely get rid of it and the scar will accompany you for the rest of your life.

Aftercare of the scar

If during the examination the doctor confirmed that everything is fine with the incision site, special care is not required. It is enough to treat the scar with brilliant green once a day. It is better not to take cotton wool, its fibers can catch on fabrics, and it will be quite problematic to remove them.

If the scar does not ooze, then there is no need to apply a plaster. On the contrary, for the speedy healing, air access is needed.

The very next day after removing the stitches, it is allowed to wash in the shower. The water temperature should be comfortable and close to body temperature. It is best to use a piece of gauze and baby soap for the area around the scar. After a shower, this area is smeared with baby cream (not the scar itself).

Do not forget to monitor the condition of the skin even after the stitches are removed. If you notice the appearance of discharge or blood, you need to inform the doctor. Sometimes the processing has to be entrusted to medical personnel.

The time of suture removal may vary slightly depending on various factors - the nature of the operation, the depth of the incision, the health of the patient. When this should be done is decided by the doctor. Self-removal of threads is excluded. It is also important to remember about proper scar care at home. Report any suspicious changes to your doctor.

About the care of the postoperative suture after cesarean section - on the video:

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Suture removal technique

To fix and hold the edges of the wound in surgery, suturing is used. After 5-7 days, the skin sutures must be removed, that is, the suture material must be removed. This manipulation is carried out according to the doctor's prescription and under his control. The technique for removing sutures is not particularly difficult, but requires the nurse to be attentive, dexterous and follow all the rules of asepsis and antisepsis.

The indication for suture removal is wound healing. With an extensive wound, the sutures are first removed through one, and the rest are removed the next day. The main thing for a nurse is to ensure that there is no suture material left in the patient's skin.

Suture removal equipment

• Sterile gloves, mask.
• Sterile kidney tray.
• Auxiliary kidney-shaped tray.
• Waste tray.
• Sterile gauze pads.
• Tupfers.
• Anatomical tweezers.
• Sharp sterile surgical scissors.
• Alcohol 70%.
• Iodonate or iodopyrone.
• Cleol or adhesive plaster.
• Disinfectant containers.

Preparation for suture removal

• The day before, we inform the patient about the upcoming manipulation and its necessity. We explain the essence of the procedure in an accessible way, we create a positive mood in the patient, the desire for recovery.
• Before the procedure, we control the sterility of materials and instruments.
• We wash our hands and put on sterile gloves.
• We place sterile material and instruments on a sterile tray.
• In the auxiliary tray we have cleol, adhesive plaster, if necessary - a bandage.
• We put the tray for the waste material near the place where we will perform the manipulation.

Suture removal technique

• We remove the bandage over the seam, drop it into the prepared tray.
• We examine the wound and count the number of stitches that need to be removed.
• We treat the wound with a solution of iodonate, iodopyrone or 70% alcohol using napkins or tupfers with blotting movements. The dressing material is changed to sterile as the wound is treated. Processing is carried out twice - first wide, then narrow.
• With anatomical tweezers, grab the suture knot and slightly lift it.
• After the appearance of 2-3 mm of a white thread above the skin surface, we bring a sharp branch of scissors under it and cross it.

• We remove the thread with the knot: gently, without applying excessive force, pull the seam with tweezers. The thread lying on the surface should not get under the skin.
• We put the extracted thread on a gauze napkin.
• We check the integrity of the wound. If there is a gap, we ask the doctor about the number of stitches to be removed (most likely, not all will need to be removed).
• Remove as many stitches as needed.
• Count the number of stitches removed.
• We control whether the suture material remains in the skin.
• We treat the wound with an antiseptic solution (alcohol, iodonate).
• Apply a sterile dressing to the wound.
• We fix the napkin with glue or adhesive tape, if necessary - with a bandage.

The final stage

• The spent dressing material and used tools and gloves are immersed in containers with a disinfectant solution.
• We wash and dry our hands.

The correct technique for removing sutures and observing the rules of asepsis can avoid complications such as infection of the wound.

Skin suture removal algorithm

Skin sutures can be removed by a nurse in the presence of a doctor.

A set of tools for removing skin sutures:

1. Anatomical tweezers

2. Scissors or scalpel

3. Sterile wipes, swabs

4. Sterile tray

5. Rubber gloves

6. 1% iodonate solution or (1% brilliant green, 70 0 alcohol)

1. Put on rubber gloves.

2. Take sterile tweezers and grab a sterile swab into it.

3. The seams are treated with 1% iodonate solution, with blotting movements.

4. Having seized the suture knot with tweezers, the subcutaneous part of the thread is pulled out with a slight pull (it is white in contrast to the skin part of the dark color).

5. Bringing the sharp jaw of the scissors under the white part of the thread, it is cut at the surface of the skin.

6. Remove the thread from the tissues with tweezers.

7. Each removed suture is placed on an unfolded sterile napkin, then removed as class "B" waste.

8. After removing the sutures, the suture line is treated with iodonate and a sterile dressing is applied.

A 52-year-old patient addressed a FAP paramedic with complaints of intense paroxysmal pain in the lumbar region, radiating to the inguinal region on the left, lower abdomen, accompanied by frequent, painful urge to urinate, dry mouth, nausea, and there was a single vomiting. Similar attacks of pain in the patient were observed twice during the last three years.

Objectively: state of moderate severity, body temperature 37.4 ° ’ Pulse 68 beats / min. BP 140/90 mmHg The tongue is dry and clean. The abdomen is soft and painless. The kidneys are not palpable. Pasternatsky's symptom is positive on the left.

1. Formulate and justify the presumptive diagnosis.

2.Compose and justify the emergency care algorithm.

3. Demonstrate the technique of using a heating pad.

Algorithm for removing sutures after surgery

Chapter 7

7.1. A set of tools for opening an abscess

1. Forceps straight and curved.

2. Linen hoes.

3. The scalpel is pointed and belly.

4. Farabef retractors.

5. Retractors serrated (2-3-4-x), blunt and sharp.

6. Billroth clamps.

7. Kocher clamps.

7.2. Instrumental dressing of a purulent wound

I. Preparation for the procedure:

1. Obtain informed consent from the patient, tell him about the purpose and course of the procedure

2. Treat hands in a hygienic way, dry

3. Wear gloves

4. Prepare everything you need for dressing

1. Help the patient to undress and ask him to take a comfortable position on the dressing table or chair

2. Place an oilcloth under the dressing area

3. Put on goggles, protective clothing (apron, mask)

II. Execution of the procedure:

8. Remove the fixing bandage carefully and sparingly (plaster or cleol napkin, or bandage) using tweezers, Richter scissors.

9. Remove all three layers of the bandage one by one in the direction from one edge of the wound to the other (traction across the wound increases its gaping and causes pain), the skin should be held with a gauze ball or tweezers when removing the bandage, not allowing it to reach for the bandage. A dried dressing should be peeled off with a ball dipped in a 3% hydrogen peroxide solution (sometimes dried dressings are best removed after soaking if the condition of the wound allows a bath of a warm solution of potassium permanganate 1:3000).

10. Place the used material in a container for disinfection.

11. Remove gloves, place them in a container for disinfection

12. Treat hands with an antiseptic.

13. Put on sterile gloves

14. Examine the wound and its surrounding area (smell, discharge, convergence of the edges of the wound, swelling, soreness)

15. Treat the skin around the wound with sterile gauze balls, changing them after each movement and moving the swab from the least contaminated area to the most contaminated and from the center outward, first dry, then moistened with antiseptic solutions (gibitan, ethyl alcohol, iodonate, iodopyrone).

16. Rinse the purulent cavity with a 3% hydrogen peroxide solution, you can additionally use furatsilin, then dry the wound with dry swabs

17. As prescribed by the doctor, introduce gauze turunda moistened with a hypertonic solution of sodium chloride, or another drug (ointment), into the purulent wound, in accordance with the phase of the wound process. This manipulation is performed either with working tweezers or with a metal probe (button or grooved).

18. Apply a new sterile bandage on top of the wound with tweezers in 3 layers (with the drug and dry).

19. If tubular drainage is introduced into the wound, put a napkin cut to the middle under the drainage.

20. Fix the bandage with a plaster, adhesive bandage or bandage, depending on the location of the wound.

III. End of procedure

21. Place used instruments in a container for disinfection.

22. Remove gloves and place in a container for disinfection

23. Remove goggles, protective clothing (apron or gown, mask) and discard in a container or bag for collecting linen.

24. Treat hands in a hygienic way, dry.

25. Inform the patient about the condition of the wound, instruct him on further actions.

26. Make an appropriate entry about the dressing performed in the medical documentation (dressing journal).

I. Preparation for the procedure:

1. Introduce yourself to the patient, tell him about the purpose and course of the procedure.

2. Help the patient lie down on the dressing table, take a comfortable position for him, expose the bandage.

3. Treat hands in a hygienic way, dry.

4. Put on gloves.

5. Prepare everything you need to remove the sutures in a sterile kidney tray using a sterile forceps.

II. Performing a procedure:

6. Remove the fixing bandage carefully and gently (plaster or cleol napkin, or bandage) using tweezers, Richter scissors.

7. Remove alternately the napkins covering the postoperative suture in the direction along the suture. When removing the old dressing, to reduce discomfort, the skin must be held with a ball on tweezers.

8. Place the used material in a waste container.

9. Remove gloves, put them in a container for disinfection

10. Treat your hands with an antiseptic

11. Put on sterile gloves.

12. Examine the skin and the seam itself.

13. Treat the postoperative suture with sterile gauze balls with an antiseptic, then the skin around it.

14. As directed by the doctor, start removing the sutures: with sterile anatomical tweezers, grab the suture knot and slightly tighten it until the light part of the ligature appears. Bring one sharp end of sterile medical scissors under the ligature in this light part and cut it, and remove this cut ligature with tweezers. Discard the removed ligature into a container for collecting waste material. Do the same with the rest of the seams.

15. Treat the skin scar with sterile gauze balls with an antiseptic, especially those places where there are holes from the removed sutures.

16. Apply a dry sterile napkin, at least two layers.

17. Fix the wipes with strips of adhesive tape, or glue, or a bandage.

III. End of procedure .

18. Place used instruments in a container for disinfection.

19. Remove gloves and place in a container for disinfection

20. Treat hands in a hygienic way, dry.

21. Inform the patient about the condition of the postoperative scar, instruct him on further actions.

22. Make an appropriate entry in the dressing log

Suture removal technique

Technique for removing interrupted sutures

2. The seam is tightened by 2-3 mm so that that part of the thread that was under the skin appears. At the same time, its characteristic whitish coloring is visible.

3. With pointed scissors, the thread is crossed in the area of ​​\u200b\u200bthe characteristic staining under the knot.

4. The thread is removed and placed on a napkin or gauze ball.

2. After crossing the thread with the slightly open ends of the scissors, you can hold the skin while pulling the thread.

Removal of adaptive interrupted sutures

2. Cross at the surface of the skin part of the thread that passes intradermally.

3. Cut the thread passing through the subcutaneous adipose tissue.

4. Having captured the knot, the threads are pulled out.

Intestinal suture is a collective concept that implies suturing wounds and defects in the abdominal part of the esophagus, stomach, small and large intestine. The universal application of this concept is due to the commonality of techniques based on the biological laws of wound healing of the hollow organs of the gastrointestinal tract.

In contrast to the very short-term impact on the edges of the wound with surgical needles, the suture material is in contact with the tissues for a long time. Therefore, high demands are placed not only on the mechanical, but also on the biological properties of surgical threads.

Topographic and anatomical features of the tendons of the flexor muscles and tendons of the extensor muscles are different.

Video about the sanatorium Hunguest Helios Hotel Anna, Heviz, Hungary

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Scientific and medical news about the treatment and prevention of diseases in adults and children.

Foreign clinics, hospitals and resorts - examination and rehabilitation abroad.

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Algorithm for dressing a clean wound

In the treatment of any wound, including a clean one, an important place is occupied by the correct dressing. Each type of injury requires a special approach to dressings and has its own characteristics of this important procedure.

In most cases, clean wounds are postoperative wounds that have undergone proper suture treatment and do not have a purulent-inflammatory process.

General rules for bandaging

For high-quality dressing of a clean postoperative wound, it is important to follow some rules, in particular:

• During the dressing, the patient should be positioned so that the doctor or nurse has free access to the site of injury.
• The wound site should be in a position that is most beneficial from a physiological point of view so that the muscles in this area are relaxed. The only exceptions here are dislocations and fractures, which should be immobilized in the position in which they are located.
• It is important that when applying a bandage (bandage), the part of the body where the wound is located is motionless.
• The person carrying out the dressing should be positioned in relation to the victim so as to be able to simultaneously see not only the site of injury, but also the patient's face.
• The first round of a bandage of any bandage is always a fixing one, while subsequent rounds must be superimposed so as to overlap the previous ones by 2/3 of the width.
• When bandaging a limb, the bandage is applied towards the patient's torso from the distal sections.
• The applied bandage in finished form should tightly fix the dressings located on the wound, while there should be neither displacement nor a feeling of excessive compression of the tissues in the patient.
• The removal of a dirty bandage is carried out by cutting it on the opposite side of the injury or by unwinding the bandage when collecting it into a lump.
• If the bandage was attached with a plaster, then it is removed towards the wound from the edges to the center.
• If a dirty bandage has dried to the surface of the injury, it should be moistened with hydrogen peroxide or some kind of antiseptic solution.
• Dressing materials must be sterile.
• During the dressing, antiseptic solutions should be used to treat the hands of the medical staff, the surface of the damaged area and the skin around it.
• Touching the wounded area with your hands is strictly prohibited. All manipulations are carried out with tweezers.

Clean wound dressing algorithm

A wound is considered clean if it does not have any signs of infection, that is, one in which there is no inflammation, suppuration, redness of the skin around the wound, where normal healing processes are not disturbed.

If the wound is clean, the patient does not experience fever and severe pain. The main task of medical personnel in the presence of a clean injury in a patient is to prevent its possible infection.

Bandaging of a clean wound occurs if there are indications, which are:

• Placement in the damaged area after surgery with a drainage tube or tampon.
• Second day after the operation. In this case, the dressing of the postoperative wound is carried out in order to assess the condition of the sutures and the surface of the future scar.
• Soaking the applied bandage with blood.
• The time has come when it is necessary to remove the stitches.

To carry out the dressing, the following tools and materials should be prepared:

• A sterile tray and a second tray for storing used materials.
• Sterile tweezers.
• Sterile dressing material, consisting of gauze pads according to the size of the wound, gauze swabs for treatment, bandages and plaster.
• Medical gloves and mask.
• Clean fabric.
• Antiseptic solutions intended for the treatment of the skin around the injury and the hands of medical personnel.
• Antiseptics for the treatment of the surface of the wound.
• Special solutions for the treatment of surfaces and materials after dressing.

The process of dressing a clean wound is carried out in three stages. The first of which is preparatory, which consists in disinfecting hands, for which they must be thoroughly washed with soap and then treated with an antiseptic solution. After that, put on sterile gloves, as well as a medical mask. Next, you need to prepare a dressing table, for which it is wiped with a disinfectant solution and covered with a clean sheet. Most dressings are performed with the patient lying down.

During the main stage of the procedure, the dirty dressing is removed from the wound, the injury itself and the skin around it are treated, and a clean dressing is applied.

It is important to remember that all manipulations at this stage must be performed with tweezers. Do not touch the wound and the dressing with your hands, even if they are wearing sterile medical gloves.

The algorithm for dressing a clean postoperative wound is as follows:

• A dirty bandage should be removed from the wound. This is done with tweezers. If the dressing has dried to the wound, for example, in areas where lumps of clotted blood have formed, soak the dressing with an antiseptic or hydrogen peroxide solution, and then carefully remove the dirty dressing.
• Conduct a thorough examination of the wound visually, as well as using the palpation method, but you can not press on the surface of the injury itself and the sutures, the area around the existing wound should be palpated. The condition of the stitches should also be assessed.
• Next, the wound itself and the surface of the skin around it are treated, for which an antiseptic solution is used. In this solution, a sterile gauze cloth is wetted with tweezers and then it is processed. First, you should gently wipe the skin around the wound, not missing a single area of ​​the skin. After that, the napkin must be changed to a clean one, moisten it in an antiseptic and treat the surface of the damaged area and the stitches. The surface of the wound, as well as the sutures, is processed only with blotting movements.
• After treatment, the surface of the skin around the wound and the damage itself should be slightly dried, and then a sterile dressing should be applied. The gauze pad used for the backing should be slightly larger than the injury. The fastening of the napkin is carried out with the help of a shepherd or a bandage.

The last stage of dressing is the processing of the dressing table and all used instruments, as well as work surfaces.

Removal of stitches

It is necessary to remove the sutures when the wound begins to actively heal, its edges grow together, but this should be done before a scar forms at the site of the injury.

You should not carry out such a procedure yourself at home, since there is a serious risk of infection in the wound remaining at the site of the removed suture material.

Before removing the sutures, they, like the skin at the sites of their application, as well as on the surface of the healing wound and around it, are carefully treated with an antiseptic solution. For the procedure, it is necessary to prepare sterile instruments (tweezers and surgical scissors), as well as a tray for placing the removed suture material.

After processing, one of the ends of the seam is lifted with tweezers and retracted in the opposite direction from the seam. The suture should rise slightly above the surface of the wound. Then, surgical scissors are passed under the thread, with the help of which the suture material is cut near the knot. After that, the thread is gently pulled out of the patient's body. Thus, all sutures are removed.

After the suture removal procedure, the surface of the wound and the places where the threads were located must be carefully treated with an antiseptic solution to prevent possible infection. Then an antiseptic dressing is applied to the treatment area from a sterile bandage or gauze, which is fixed with pieces of a patch.

Dressing care and dressing change frequency

A dressing is applied to the wound immediately after the operation, suturing and complete treatment of the surfaces of the injury, the skin around it and the inserted threads.

The dressing is replaced the next day, while the doctor assesses the condition of the sutured injury and the stitches.

If the wound is clean, without signs of inflammation and infection, it is treated with an antiseptic solution and a clean bandage is applied. Outside the treatment schedule, a dressing change can be carried out if the applied dressing is soaked with blood or the dressing has shifted due to improper fixation.

The dressing of a clean postoperative wound is subsequently carried out only if a replacement is necessary, and also on the day when the time comes for the removal of the suture material. If in the process of healing the injury did not become infected, and the inflammatory process did not begin, then the change of dressings from the moment of the operation to the removal of the sutures is carried out only twice, with the exception of cases of soaking of the dressings with blood.

After the sutures are removed from the wound, in most cases the patient is discharged home, where he himself must continue to care for the bandage at home.

Many of the funds are applied under a bandage or compress. In this case, the change of dressings is carried out according to an individual schedule, taking into account the time of the next application of the drugs used.

Digital examination of the rectum

Task for the student: Perform a digital examination of the rectum on the model, commenting on the implementation technique in stages.

Information for the examiner:

Equipment: model for rectal examination, rubber gloves, vaseline.

Basic techniques for bladder catheterization

(elastic rubber catheter)

Task for the student: Perform bladder catheterization on the model, commenting step by step on the technique.

Information for the examiner: to evaluate, according to a step-by-step method, by points, the implementation of a practical skill by an intern.

Equipment: model, urinary catheter (soft silicone, metal), sterile rubber gloves, sterile vegetable oil, tweezers, sterile gauze wipes, 3% boric acid solution, tray, disinfectant.

"4.0" (95-100%) - 9.5 - 10.0 points, "3.67" (90-94%) - 9 points, "3.33" (85-89%) - 8, 5 points, "3.0" (80-84%) - 8 points, "2.67" (75-79%) - 7.5 points, "2.33" (70-74%) - 7 points, "2.0" (65-69%) - 6.5 points, "1.67" (60-64%) - 6 points, "1.33" (55-59%) - 5.5 points, " 1.0" (50-54%) - 5 points, "0" - below 5 points.

The maximum score for the station is 10.0

Pleural puncture

Task for the student: Perform a puncture of the pleural cavity on the model, commenting step by step on the method of execution.

Information for the examiner:

Equipment: fake, puncture needle, rubber adapter-tube, Janet syringe, disposable syringe (10.0 ml), novocaine 0.5%, vocadin 0.5%, alcohol 96%, clamp, sterile gauze wipes, balls

"4.0" (95-100%) - 9.5 - 10.0 points, "3.67" (90-94%) - 9 points, "3.33" (85-89%) - 8, 5 points, "3.0" (80-84%) - 8 points, "2.67" (75-79%) - 7.5 points, "2.33" (70-74%) - 7 points, "2.0" (65-69%) - 6.5 points, "1.67" (60-64%) - 6 points, "1.33" (55-59%) - 5.5 points, " 1.0" (50-54%) - 5 points, "0" - below 5 points.

The maximum score for the station is 10.0

Technique for applying and removing skin sutures

Task for the student: Perform skin suture technique on the model, commenting step by step on the technique.

Information for the teacher: to evaluate, according to a step-by-step method, by points, the implementation of a practical skill by a student.

Equipment: knot tying kit, surgical needles, needle holder, surgical tweezers, suture material.

"4.0" (95-100%) - 9.5 - 10.0 points, "3.67" (90-94%) - 9 points, "3.33" (85-89%) - 8, 5 points, "3.0" (80-84%) - 8 points, "2.67" (75-79%) - 7.5 points, "2.33" (70-74%) - 7 points, "2.0" (65-69%) - 6.5 points, "1.67" (60-64%) - 6 points, "1.33" (55-59%) - 5.5 points, " 1.0" (50-54%) - 5 points, "0" - below 5 points.

Target: removal of nodal sutures.

Indications: stage of wound healing.

Resources: iodonate, alcohol 70%, (brilliant green solution for children); sterile dressing material, sterile wipes; surgical tweezers, anatomical tweezers, forceps, scissors, sterile tray; KBU capacity.

Action algorithm:

1. Decontaminate hands at a hygienic level.

2. Put on rubber gloves.

3. Lay the patient down, explain the manipulation.

4. Remove the bandage, inspect the wound.

6. Treat the skin and stitches with 70% alcohol, iodonate, or brilliant green.

7. Grab and pull the seam by the knot with anatomical tweezers so that the white section of the thread is exposed.

8. Cross the thread with a scalpel or scissors in this area and remove it with tweezers.

9. Remove all existing seams in this way.

10. Treat the postoperative scar with iodonate.

11. Apply an aseptic napkin and fix.

12. Used tools, gloves and dressings should be placed in different KBU containers.

Note:

Sutures are removed on the 7th day after wound healing;

If the rules for removing sutures are violated, a complication may appear - a ligature fistula.

Standard "Technique for conducting cardiopulmonary resuscitation according to the ABC system"

Purpose: revitalization, restoration of breathing and cardiac activity. Indications: clinical death.

Resources: gauze pads.

Action algorithm:

1. Visually verify that there is no breathing.

2. Set the absence of consciousness (hail or gently move the victim).

3. Place your hand on the carotid artery, make sure there is no pulsation.

Note: The last two manipulations are carried out simultaneously.

A - restoration of airway patency.

Apply Safar's triple trick:

1. Lay the victim horizontally on his back, on a hard surface.

3. With one hand, lift the neck from behind, with the other hand, press the forehead from top to bottom.

4. If the cervical spine is damaged, point 3 is not carried out because of the risk of complications.

5. Push the lower jaw forward by pushing behind the lower jaw with both hands or behind the chin with one hand.

6. Open and examine the mouth. Remove blood clots, mucus, vomit with a napkin while turning your head to one side.

C- restoration of breathing.

If, after the restoration of the airway patency, spontaneous breathing has not been restored, start mechanical ventilation:

1. Take a deep breath, tightly covering the mouth of the victim with your lips, exhale, while the nose should be closed. The hands of the resuscitator are located under the neck and on the forehead.

C-maintaining blood circulation by massaging the heart.

1. The victim lies on a solid support, at the level of the knees of the massager.

The point of application of pressure is in the lower third of the sternum, two fingers above the xiphoid process.

2. Place your outstretched arms one on top of the other with the palmar surface on the lower third of the sternum (fingers raised) and perform an energetic push with enough force to displace the sternum by 4-5 cm.

2. Remove the bandage with tweezers.

3. Using another sterile tweezers, treat the sutures with a sterile ball with an antiseptic solution (iodonate, chlorhexidine alcohol solution).

4. Grabbing the suture knot with tweezers, gently pull out the subcutaneous part of the thread (usually white in contrast to the dark skin part).

5. Bringing the sharp jaw of sterile scissors under the white part of the thread, cut it at the surface of the skin.

6. Remove the seam.

7. Each removed seam is placed on a nearby unfolded small napkin, which, after removing all the seams, must be rolled up with tweezers and thrown into a basin with dirty material.

8. Treat the line of seams with an antiseptic solution (iodonate, alcohol solution of chlorhexidine).

9. Put a sterile napkin on the seam line.

10. Secure the bandage with a bandage, glue or adhesive tape.

4. Technique for performing primary surgical treatment of the wound

1. Lay the patient on the couch, operating table.

2. Put on sterile gloves.

3. Take tweezers and a swab moistened with ether or ammonia, clean the skin around the wound from contamination.

4. With a dry swab or a swab moistened with hydrogen peroxide (furatsilin), remove foreign bodies and blood clots loose in the wound.

5. Swab moistened with iodonate (alcohol solution of chlorhexidine) to treat the surgical field "from the center to the periphery."

6. Delimit the operating field with sterile linen.

7. Swab moistened with iodonate (alcohol solution of chlorhexidine) to treat the surgical field.

8. Using a scalpel, cut the wound throughout.

9. Excise, if possible, the edges, walls and bottom of the wound, remove all damaged, contaminated, blood-soaked tissues.

10. Replace gloves.

11. Delimit the wound with a sterile sheet.

12. Replace instrumentation.

13. Carefully bandage bleeding vessels, large ones - stitch.

14. Solve the issue of suturing:

15. a) apply primary sutures (sew the wound with threads, close the edges of the wound, tie the threads);

16. b) apply primary delayed sutures, stitch the wound with threads, do not reduce the edges of the wound, do not tie the threads, bandage with an antiseptic).

17. Treat the surgical field with a swab moistened with iodonate (an alcohol solution of chlorhexidine).

18. Apply a dry aseptic dressing.

We invite you to answer the control questions on the topic

"Anseptic"

1. Definition of the concept of "antiseptic".

2. Types of antiseptics.

3. Mechanical antiseptic.

4. Wound toilet technique.

5. Primary surgical treatment of the wound, stages and technique.

6. Secondary surgical treatment of the wound.

7. Physical antiseptic.

8. Passive drainage in surgery, materials and methods.

9. Active drainage in surgery, equipment and facilities.

10. Modern means of physical antiseptics.

11. Chemical antiseptic.

12. Classification of antiseptics.

13. Characteristics of the main antiseptic preparations.

14. Biological antiseptics.

15. Types of biological antiseptics

16. Means of biological antiseptics.