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C. Riedinger 1Surgical knot notes Surgical knot – 5 min stationTask: - Impersonate medical student on ward - Deal with actor wearing suture pads and act as if he/she is a real patient - Explain to the examiner what you are doingProcedure: - introduce self, gain consent and co-operation - take history: o what happened o how long since incident? o Change of contamination? o Last tetanus shot? - Explain that wound should be clean before starting - Collects and prepares equipment o Sterile field box o Needle + sutures, two types: Braided (for practise) and nylon (absorbable) o Needle-holder scissors and normal scissors o Toothed and un-toothed forceps (toothed are better for viable tissue as they don’t squeeze the tissue so much, use un-toothed for removing contaminants only) o Sterile gloves o Lidocaine syringe and syringe heads o SHARPS BIN - Perform hand hygine and put on sterile gloves QuickTime™see this picture. are needed to and a decompressor - Examine the wound for o Evidence of infection o Neurovascular state o Tendon function (important to test otherwise may snap later) o Inspect depth, length and site of wound o Contamination - Use 1% lidocaine syringe to anaesthetise wound edges o Use yellow or blue needle to inject o If there is risk of hitting a vessel, aspirate back o Inject parallel to cut and pull back while injecting - Dispose of syringe in sharps bin - Holds needle correctly in holder as shown above (1/3 away from thread with needle at 90*) - Support wound edge with toothed forceps - Pass needle through each side of the wound (not both sides with one stroke) and pull through an appropriate length of thread - Tie the knot effectively, no too tight, not too loose: o 2 rolls forwards, grab tip of tail and roll off/pull o 1 roll backwards, slide off o 2 rolls forwards, slide off - cut the threads at an appropriate length to the knot - maintain good aseptic technique throughout - dispose of sharps and leave area clean and tidy - give patient advice card on how to look after their stitches (depending on the location, the sutures remain in the wound for a different number of days) - check patient’s tetanus status
C. Riedinger 2Surgical knot notes - record in notes how many sutures insertedRemoval of sutures: - recall from notes the number of sutures put in - introduce self, gain consent and co-operation - perform hand hygiene blabla - assemble equipment: o sterile gloves o suture cutter o forceps - put on sterile gloves - use aseptic technique - inspect wound: o healing o inflammation o infection - note the correct position to cut - lift up suture with forceps - hold stitch cutter and slide under the suture to cut it on the correct side so that the piece of thread overlying the suture is not cut through the wound - remove one or two sutures (alternating) and reassess - if not healed enough, seal with steristrips and wait for one week before trying again - dispose of sharps - record number of sutures removed in notes - hand hygiene - leave clinical area tidySteristrip notes: - start in the middle of the wound - cover one side of cut and then pull aross - leave 3mm spaces in-between - apply dressing - also check tetanus status