SUTURE AND NEEDLE TECHNOLOGY

13,070 views

Published on

ideal for surgeons, o.t technicians

Published in: Health & Medicine, Technology

SUTURE AND NEEDLE TECHNOLOGY

  1. 1. Sutures Needles Packaging DR SREEJOY PATNAIK
  2. 2. Sutures
  3. 3. Sutures Module Agenda • Objectives • Suture Overview • Suture Characteristics • Suture Types • Activity
  4. 4. Objectives • Name the raw materials from which each ETHICON suture is derived • Classify each ETHICON suture as natural/synthetic, absorbable/ nonabsorbable, braided/monofilament • Recall absorption profiles and tensile strength retention profiles of all ETHICON sutures • Identify which ETHICON sutures are coated, and the coating material (if applicable) • Identify the colors in which each ETHICON suture is available • Identify ETHICON sutures by sight and by feel • Describe antibacterial sutures, how they work and which pathogens they are effective against
  5. 5. Suture History 1887 1947 1958 1969 1974 1976 1979 1989 1992 1993 1995 1996 1998 2003 2006
  6. 6. Suture Sizing • Variety of sizes ranging from 7 to 11-0 • A number 7 size is the largest • An 11-0 size is the smallest • Sizes 6 and 7 are only available in Surgical Steel
  7. 7. Suture material compared with human hair Suture Sizes
  8. 8. Example • monofilament suture USP 10-0 knotted around human hair
  9. 9. Surgical Site Infection Background Review • Antimicrobial • A substance that kills microorganisms (bacteria, fungus or virus) or inhibits their growth • Cidal – kills i.e. bacteriocidal • Static – inhibits I.e. bacteriostatic • Antibacterial • An antimicrobial substance that kills bacteria or inhibits their growth
  10. 10. SSI Background Review • Antibiotic • Agent produces by microorganisms (bacteria, fungus, virus) or the chemically synthesized equivalent of such an agent that inhibits and/ or kills other microorganisms. Antibiotics have very specific MOA (mechanism of action) that determine their efficacy • Antiseptic • Agent that inhibits and/or kills microorganisms (bacteria, fungus, virus) on living tissue. Antiseptics are typically not derived from microbial sources and have different and less specific MOA (mechanism of action) than antibiotics.
  11. 11. SSI Background Review • Which are the two most common pathogens likely to cause SSI’s? • Staphylococcus aureus • Staphylococcus epidermidis • Methicillin-resistant - Resistance to antibiotics • Treatment options are limited – vancomycin, Sulfamethoxazole-TMP and teicoplanin • Prevention is best option to protect patients • Antibiotic prophylaxis, scrubbing, gowning, gloving, antimicrobial skin prep, aseptic technique and … •  … Plus Antibacterial Sutures
  12. 12. Suture Types Absorbable Natural Synthetic Twisted/Virtual Monofilament Monofilament Braided Short Short/Medium Medium Short/Medium Long Short Medium Non-Absorbable Natural Monofilament Synthetic Braided Monofilament Braided
  13. 13. Absorbable Suture Types Absorbable Natural Synthetic Twisted/Virtual Monofilament Monofilament Braided Short Short/Medium Medium Short/Medium Long Short Medium Fast Absorbing Gut Plain Gut Chromic Gut MONOCRYL* PDS* II VICRYL RAPIDE* VICRYL* MONOCRYL* Plus PDS * II Plus VICRYL RAPIDE* Plus VICRYL* Plus
  14. 14. Absorption Process - Defined • Two types: • Hydrolysis – absorbed in water (H20) • The human body is over 70% water • Less reactive • More consistent • Enzymatic – digested by enzymes • Can lead to swelling and edema • Malnourished patients digest suture material more quickly (protein)
  15. 15. Critical Wound Healing Period (CWHP) • Skin • Mucosa • Subcutaneous • Peritoneum • Fascia (40%) 5-10 Days 5-7 Days 7-14 Days 7-14 Days 60 Days 0 5 7 14 21 Tissue Healing Times in Days 28 60
  16. 16. Short-term Wound Support • Situation in Short-term Wound Support • Skin & mucosa • Typically emergency procedures • Typically areas with increased blood flow • Need • Fast-absorbing suture • Rapid loss of strength/mass • Good knot formation/snug down
  17. 17. 1.Plain Gut Suture Characteristics Surgical Gut Suture – Plain Material Beef Serosa or Sheep Submucosa Natural/Synthetic Natural Construction “Monofilament” Absorbable Coating Not Coated Color Yellowish - Tan Available Size Range 3 – 7/0, Fast Absorbing Gut sizes 5/0 - 6/0 Strength Retention Profile Approximately 7 - 10 days post-op Fast Absorbing Gut = Approximately 5 – 7 days post-op Absorption Time Absorbed in 70 days, Fast Absorbing Gut in 21-42 days Absorption Process Proteolytic enzymatic digestion Frequent Uses Ligation of superficial vessels; suture subcutaneous and tissues that heal rapidly. Ophthalmology. Dermal (skin) suturing only.
  18. 18. 2.Chromic Gut Suture Characteristics Surgical Gut Suture - Chromic Material Beef Serosa or Sheep Submucosa Natural/Synthetic Natural Construction Monofilament Absorbable (with Chromic Salts) to slow absorption Coating Not Coated Color Natural Brown and Dyed Blue Available Size Range 3 – 7/0 Strength Retention Profile Strength retention for approximately 21 – 28 days post-op Absorption Time Absorbed in 90 days Absorption Process Proteolytic enzymatic digestion Frequent Uses Ligation of superficial vessels; suturing of subcutaneous and other rapid healing tissues. Ophthalmology.
  19. 19. 3. VICRYL RAPIDE Suture (coated) Characteristics VICRYL RAPIDE Suture Material Polyglactin 910. Copolymer of 90% glycolide and 10% L-lactide Natural/Synthetic Synthetic Construction Braided Absorbable Coating 50% Polyglactin 370 and 50% Calcium Stearate Color Undyed – Natural Beige Available Size Range 1 through 5/0 Strength Retention Profile 50% of original strength remains @ 5 days post-op 0% @ 14 days post-op Absorption Time Essentially completely absorbed in 42 days Absorption Process Hydrolysis Frequent Uses Superficial soft tissue approximation of the skin and mucosa where short term wound support is required
  20. 20. Short-Medium-Term Wound Support • Situation in Short-Medium-term Wound Support • Skin, mucosa, subcuticular • Ideal for subcuticular tissue closure • Typically areas with increased blood flow • Need • High initial strength • Good cosmesis • Good handling & smooth passage through tissue • Good knot formation/snug down • Low reactivity
  21. 21. 4. MONOCRYL Suture Characteristics MONOCRYL Suture Material Poliglecaprone 25 (copolymer of glycolide and e-Caprolactone) Natural/Synthetic Synthetic Construction Monofilament Absorbable Coating Not Coated Color Undyed - Beige and Dyed - Violet Available Size Range 1 through 6/0 Strength Retention Profile Undyed - 50-60% @ 7 days post-op 20-30% @ 14 days post-op Dyed - 60-70% @ 7 days post-op 30-40% @ 14 days post-op Absorption Time Essentially complete in 91-119 days Absorption Process Hydrolysis Frequent Uses General soft tissue approximation and/or ligation.
  22. 22. 5. MONOCRYL Plus Suture Characteristics MONOCRYL Plus Suture Material Poliglecaprone 25 (copolymer of glycolide and e-Caprolactone) TRICLOSAN Natural/Synthetic Synthetic Construction Monofilament Absorbable Coating Not Coated Color Undyed - Beige and Dyed - Violet Available Size Range 1 through 6/0 Strength Retention Profile Undyed - 50-60% @ 7 days post-op 20-30% @ 14 days post-op Dyed - 60-70% @ 7 days post-op 30-40% @ 14 days post-op Absorption Time Essentially complete in 91-119 days Absorption Process Hydrolysis Frequent Uses General soft tissue approximation and/or ligation.
  23. 23. MONOCRYL Plus Suture • Bactericidal – kills bacteria • Bacteriostatic – inhibits bacteria growth • Kills • Staphylococcus aureus • Staphylococcus epidermidis • Methicillin-resistant Staphylococcus aureus (MRSA) • Methicillin-resistant Staphylococcus epidermidis (MRSE) • E. coli • Klebsiella pneumoniae • The performance, safety and handling are equivalent to MONOCRYL Suture
  24. 24. How Did We Do It? • Tyvek patch • Contains triclosan which is absorbed by the suture during the sterilization process • As a result, ETHICON, INC. has an improved claim against additional pathogens/bacteria • MONOCRYL Suture doesn’t know it is MONOCRYL Plus Suture until the tyvek patch is added
  25. 25. Medium-term Wound Support • Situation in Medium-term Wound Support • All tissue layers that align with the critical wound healing period of 21-28 days • All tissue types • Need • Consistent strength around the CWHP • Good handling & passage through tissue • Good knot formation/snug down • Low reactivity
  26. 26. 5. Coated VICRYL Suture Characteristics Coated VICRYL Suture Material Polyglactin 910 (copolymer of glycolide and L-lactide) Natural/Synthetic Synthetic Construction Braided Absorbable Coating 50% Polyglactin 370 and 50% Calcium Stearate Color Violet and Undyed – Natural Beige Available Size Range 3 through 10/0 Strength Retention Profile 75% of original strength @ 14 days post-op 50% of original strength @ 21 days post-op 25% of original strength @ 28 days post-op Absorption Time Essentially absorbed in 56 – 70 days Absorption Process Hydrolysis Frequent Uses General soft tissue approximation and/or ligation, including use in ophthalmology
  27. 27. 6. Coated VICRYL Plus Suture Characteristics Coated VICRYL Plus Suture Material Polyglactin 910 (copolymer of glycolide and L-lactide) Natural/Synthetic Synthetic Construction Braided Absorbable Coating Polyglactin 370, calcium stearate and IRGACARE MP (triclosan) Color Violet and Undyed – Natural Beige Available Size Range 2 through 5/0 Strength Retention Profile 75% of original strength @ 14 days post-op 50% of original strength @ 21 days post-op 25% of original strength @ 28 days post-op Absorption Time Absorbed in 56 – 70 days Absorption Process Hydrolysis Frequent Uses General soft tissue approximation and/or ligation
  28. 28. Coated VICRYL Plus Suture • Bactericidal – kills bacteria • Bacteriostatic – inhibits bacteria growth • Kills • Staphylococcus aureus • Staphylococcus epidermidis • Methicillin-resistant Staphylococcus aureus (MRSA) • Methicillin-resistant Staphylococcus epidermidis (MRSE) • Different bacteria claim than MONOCRYL Plus Suture
  29. 29. Coated VICRYL Plus Suture • Frequently Asked Questions • Does the triclosan wear off as it passes through the tissue? • Allergic reactions • Does it affect wound healing? • The performance and handling are equivalent to Coated VICRYL Suture.
  30. 30. Plus Antibacterial Sutures • Coated VICRYL Plus Suture •  minimum of 7 days • PDS* Plus Antibacterial (polydioxanone) Suture •  23 days S. aureus •  17 days E. coli • MONOCRYL Plus Suture •  31 days S. aureus •  21 days for E. coli
  31. 31. Triclosan • Is it safe? • Is it being overused and/or misused? • Does triclosan promote antibiotic resistance?
  32. 32. Longer-Term Wound Support • Situation in Longer-term Wound Support • Tissue that requires extended support • Slow healing tissue/ compromised patients • Typically fascia tissue • Need • Strength beyond the CWHP of 21 days • Good handling & passage through tissue • Good knot formation/snug down • Low reactivity
  33. 33. 7. PDS II Suture Characteristics PDS II Suture Material Polydioxanone Natural/Synthetic Synthetic Construction Monofilament Absorbable Coating Color Not Coated Undyed Clear and Dyed Violet Available Size Range 2 through 9/0 dyed 1 through 7/0 undyed Strength Retention Profile Size 4-0 and smaller 60% of original strength @ 2 weeks post-op 40% of original strength @ 4 weeks post-op 35% of original strength @ 6 weeks post-op Absorption Time Absorption Process 182-238 days (6-8 months) Hydrolysis Frequent Uses Soft tissue approximation, including use in pediatric cardiovascular tissue where growth is expected to occur; ophthalmic surgery, fascia closure Size 3-0 and larger 80% @ 2 weeks 70% @ 4 weeks 60% @ 6 weeks
  34. 34. 8.PDS Plus Suture Characteristics Material PDS Plus Suture Polydioxanone IRGACARE MP (triclosan) Natural/Synthetic Construction Coating Color Available Size Range Synthetic Monofilament Absorbable Not Coated Undyed Clear and Dyed Violet 2 through 9/0 dyed 1 through 7/0 undyed Strength Retention Profile Size 4-0 and smaller 60% of original strength @ 2 weeks post-op 40% of original strength @ 4 weeks post-op 35% of original strength @ 6 weeks post-op Absorption Time Absorption Process Frequent Uses 182-238 days (6-8 months) Hydrolysis Soft tissue approximation, including use in pediatric cardiovascular tissue where growth is expected to occur; ophthalmic surgery, fascia closure Size 3-0 and larger 80% @ 2 weeks 70% @ 4 weeks 60% @ 6 weeks
  35. 35. PDS Plus Antibacterial Suture • Bactericidal – kills bacteria • Bacteriostatic – inhibits bacteria growth • Kills • Staphylococcus aureus • Staphylococcus epidermidis • Methicillin-resistant Staphylococcus aureus (MRSA) • Methicillin-resistant Staphylococcus epidermidis (MRSE) • E. coli • Klebsiella pneumoniae
  36. 36. PDS II Suture IFU Changes • Old Data • 70% 2 weeks • 50% 4 weeks • 25% 6 weeks • New in vivo studies • Absorption at 183 days • Both PDS II Suture and showed significant improvement in the breaking strength retention profile of PDS II Suture PDS Plus Suture
  37. 37. Non-Absorbable Suture Types Non-Absorbable Natural Synthetic Monofilament Braided Surgical Stainless Steel PERMA-HAND* Silk Monofilament ETHILON* PROLENE* Braided PRONOVA NUROLON* ETHIBOND EXCEL* MERSILENE
  38. 38. 9.PERMA-HAND* Silk Suture Characteristics PERMA-HAND Suture Material Natural protein fibre of raw silk spun by silkworms Natural/Synthetic Natural Construction Braided Non-Absorbable Coating Bees wax Color Black and White Available Size Range 5 through 9/0 Strength Retention Profile Strength retention for approximately 1 year Absorption Time Non-Absorbable Absorption Process Non-Absorbable Ligation and general closure; general surgery. Ophthalmology, plastic surgery and neurosurgery Frequent Uses
  39. 39. 10.Surgical Steel Suture Characteristics Surgical Steel Suture Material 316L Stainless Steel Natural/Synthetic Metal Alloy Construction Monofilament Non-Absorbable Coating Not Coated Color Metallic Silver Available Size Range 7 – 10/0 Strength Retention Profile Indefinite Absorption Time Non-absorbable suture is encapsulated in tissues Absorption Process Non-Absorbable Frequent Uses Abdominal wall and skin closure; retention; tendon repair; orthopaedic & neurosurgery. Sternum closure in cardiovascular surgery
  40. 40. 11.ETHILON* Nylon Suture Characteristics ETHILON Suture Material Nylon 6 Natural/Synthetic Synthetic Construction Monofilament Non-Absorbable Coating Not Coated Color Black, Green and Clear Available Size Range 2 through 11/0 Strength Retention Profile Approximately 20% loss per year. Absorption Time Non-absorbable suture is encapsulated in tissues Absorption Process Non-Absorbable Frequent Uses Skin closure: retention; Plastic surgery, ophthalmology and microsurgery
  41. 41. 12.ETHIBOND EXCEL Suture Characteristics ETHIBOND EXCEL Suture Material Polyester Natural/Synthetic Synthetic Construction Braided Non-Absorbable Coating Polybutilate Color Green and White Available Size Range 5 through 7/0 Strength Retention Profile Indefinite Absorption Time Non-absorbable suture is encapsulated in tissues Absorption Process Non-Absorbable Frequent Uses General surgery, cardiovascular and plastic surgery; retention
  42. 42. 13. MERSILENE Suture Characteristics MERSILENE Suture Material Polyester Natural/Synthetic Synthetic Construction Braided and Monofilament Non-Absorbable Coating Color Not Coated Green and White Available Size Range Braided 5 through 6/0 Monofilament 10/0 – 11/0 Strength Retention Profile Indefinite Absorption Time Non-absorbable suture is encapsulated in tissues Absorption Process Non-Absorbable Frequent Uses General surgery, cardiovascular and plastic surgery; retention
  43. 43. 14. PROLENE* Polypropylene Suture Characteristics PROLENE Suture Material Polypropylene Natural/Synthetic Synthetic Construction Monofilament Non-Absorbable Coating Not Coated Color Available Size Range Blue and Clear 2 through 10/0 Strength Retention Profile Indefinite Absorption Time Absorption Process Frequent Uses Non-absorbable suture is encapsulated in tissues Non-Absorbable General, plastic, cardiovascular surgery and skin closure; ophthalmology
  44. 44. 15. PRONOVA * Poly (Hexafluoropropylene - VDF) Suture Characteristics PRONOVA Suture Material Polymer blend of poly (vinylidene fluoride) and poly (vinylidene fluoride-cohexafluoropolypropylene) Natural/Synthetic Synthetic Construction Monofilament Non-Absorbable Coating Not Coated Color Blue and Clear Available Size Range 2 through 10/0 Strength Retention Profile Indefinite Absorption Time Non-absorbable suture is encapsulated in tissues Absorption Process Non-Absorbable Frequent Uses Vascular anastomoses and general surgical indications
  45. 45. ETHICON Suture Material Colors • SUTURES COLOUR • PLAIN GUT • CHROMIC GUT • MONOCRYL Suture • Coated VICRYL Suture • PDS II Suture • SILK Suture • NUROLON Suture • ETHILON Suture • MERSILENE Suture • ETHIBOND EXCEL Suture • PROLENE Suture • PRONOVA Suture YELLOWISH TAN BROWN CLEAR or VIOLET VIOLET or UNDYED (natural) VIOLET or CLEAR BLACK BLACK BLACK (green or clear) GREEN or WHITE GREEN or WHITE BLUE or CLEAR BLUE or CLEAR
  46. 46. Needles
  47. 47. Agenda • Objectives • Characteristics of an Ideal Needle • Elements of Needle Design • Anatomy • Measurements of a Needle
  48. 48. Objectives • Describe the characteristics of an ideal needle • Identify the elements of needle design • Explain the anatomy of a needle
  49. 49. Surgical Needles – Definition • Surgical needles are necessary for the placement of sutures in tissues, therefore, they must be designed to carry suture material through tissues with minimal trauma
  50. 50. Characteristics of the Ideal Needle • Made of high quality stainless steel • As slim as possible without compromising strength • Stable in the grasp of a needle holder • Able to carry suture material through tissue with minimal trauma • Sharp enough to penetrate tissue with minimal resistance • Rigid enough to resist breaking during surgery • Sterile and corrosion - resistant to prevent introduction of microorganisms or foreign materials into the wound
  51. 51. Elements of Needle Design – Strength • Determined by how it resists deformation during repeated passage through tissue • Tissue trauma can be induced if a needle bends during penetration • Compromises tissue apposition • Greater needle strength equals less tissue trauma
  52. 52. Elements of Needle Design – Ductility • Refers to the needle’s resistance to breaking under a given amount of bending • Needle breakage can prevent apposition of wound edges • Searching for a part of a broken needle can cause additional trauma and add to anesthesia time
  53. 53. Elements of Needle Design – Sharpness • Related to the angle of the point as well as the taper ratio of the needle • Too sharp and a surgeon may not feel they have adequate control of needle passage • Too dull and a surgeon will face a less then desirable cosmetic outcome
  54. 54. Elements of Needle Design – Stability • Stability of the needle in the grasp of the needle holder • Rocking, twisting and turning gives less desirable cosmetic outcomes
  55. 55. Elements of Needle Design – The ETHICON Advantage • Strength: ETHALLOY* Needle Alloy/Manufacturing process • Ductility: Ethalloy alloy • Sharpness: MULTIPASS* Needles • Stability: Ribs/I-Beam *Trademark
  56. 56. Anatomy • Three basic components • The Eye • The Body • The Point
  57. 57. Anatomy – The Eye • The Eye • Closed eye • French eye (Split or Spring) • Swaged • Disadvantages • Time consuming • Tissue disruption • Repeated use
  58. 58. Anatomy – The Eye • Swaged Needles • Drilled • Channeled • Advantages • Handling and preparation are minimized • Minimal trauma • Security • ETHICON’s swaged needles • ATRALOC* Surgical Needle • CONTROL RELEASE* Needle or Needle Suture - facilitates fast separation when desired *Trademark
  59. 59. Anatomy – The Body • Straight Needle • Half-Curved Needle • Curved Needle • Compound Curve Needle (80º tip, 45 º body)
  60. 60. Anatomy – The Body • Straight Needle • Preferred when suturing easily accessible tissue • Skin closure, meniscus repair, tendon repair, nerve repair and in ophthalmic cases
  61. 61. Anatomy – The Body • Half-Curved Needle (Ski Needle) • Skin closure • Laparoscopic procedures
  62. 62. Anatomy – The Body • Curved Needle • Allow predictable turnout • Requires less space for maneuvering • 1/4 Circle • 3/8 Circle • 1/2 Circle • 5/8 Circle
  63. 63. Anatomy – The Body • Compound Curve Needle • Ophthalmic Surgery
  64. 64. Anatomy – The Point • Needle Points • Conventional Cutting Needles • Reverse Cutting Needles • Side Cutting Needles (Spatula Needles) • Taper Point Needles • Tapercut Needles • Blunt Point Needles • ETHICON Needle Codes
  65. 65. Anatomy – The Point • Conventional Cutting Needles •  Two cutting edges plus a third cutting edge on the inside concave curvature of the needle •  Prone to cutout of tissue because the inside edge cuts to the edges of the incision or wound •  PC PRIME* Needle (Precision Cosmetic) •  Narrow point •  Fine wire diameter •  Fine taper ratio *Trademark
  66. 66. Anatomy – The Point • Reverse Cutting Needles • The third cutting edge is located on the outer convex curvature of the needle • More strength than similar-sized Conventional Cutting Needles • Danger of cutout is greatly reduced • The hole left by the needle leaves a wide wall of tissue against which the suture is to be tied • ETHICON Needles • MICRO-POINT* Surgical Needle • OS Needle • FS/PS Series *Trademark
  67. 67. Anatomy – The Point • Side Cutting Needles (Spatula Needles) • Flat on both the top and bottom-eliminates undesirable tissue cutout • Designed for Ophthalmic procedures to separate or split through the layers of scleral or corneal tissue • ETHICON’s needles • SABRELOC* Spatula Needles • CS ULTIMA* Ophthalmic Needles • TG PLUS *Trademark
  68. 68. Anatomy – The Point • Taper Point Needles • Round bodied needles that pierce and spread tissue without cutting it • Needle point tapers to a sharp tip and the needle body flattens to an oval or rectangular shape • Used in easily penetrated tissue when the smallest hole and minimal tissue cutting is desired.
  69. 69. Anatomy – The Point • Tapercut needles • Combines the features and benefits of the reverse cutting edge tip and taper point needles. • Three cutting edges extend approximately 1/32” back from the point. These blend into a round taper body. • Penetrates dense, tough tissue without exceeding the diameter of the suture material. The taper body portion provides smooth passage through tissue and eliminates the danger of cutting into surrounding tissue • Ethicon’s needles • V Series • CC Series
  70. 70. Anatomy – The Point • Blunt Point Needles • Dissect friable tissue rather than cutting it • Taper body with a rounded, blunt point that will not cut tissue • Used when suturing the kidney, liver or in deep spaces prone to space and visibility limitations • ETHIGUARD* Blunt Point Needles *Trademark
  71. 71. ETHICON Needle Codes
  72. 72. Measurements of a Needle • Determine the size of a needle • Measured in inches or in metric units • Chord Length – the straight line distance from the point to the swage • Needle Length – the distance measured along the needle itself from the point to the end • Radius – the distance from the center of the circle to the body of the needle if the curvature of the needle were continued to make a full circle • Diameter – the gauge or thickness of the needle wire
  73. 73. Measurements of a Needle
  74. 74. Packaging
  75. 75. Agenda • Packaging Overview • Relay System • Modular Suture Storage Racks • Dispenser Boxes • Primary Packets • Expiration Date • Suture Sterilization • Anticipating Suture Needs • Sterility • Handling
  76. 76. Objectives • Identify each part of the product code • Identify product boxes • Explain what product is each dispenser box
  77. 77. Packaging Overview
  78. 78. Integral Part of Each Product • Protect content • Provide convenience to the user • Sterile products
  79. 79. Purpose • Protect and preserve product • Prevent product damage • Provide identifiable product information • Convenient, safe and sterile transfer of the product • Meet the needs of all members of surgical team
  80. 80. RELAY* Suture Delivery System
  81. 81. RELAY Delivery System • Developed by ETHICON • Stores and delivers sutures • Reduces unnecessary handling • Provides control over suture storage, usage, inventory rotation, needle counting and cost containment
  82. 82. Dispenser Boxes • Dispenses sutures from opening at bottom of box • Product information on side of box • Three most important criteria • Suture size • Suture material • Type and size of needle
  83. 83. Additional Information • Surgical application • Product code number • Suture size • Metric equivalent • Shape and quantity of needles • Needle point geometry • Lot number • Expiration date
  84. 84. Product Code Number • The first letter of the product code denotes the suture type • Absorbable •  VR – VICRYL RAPIDE Suture •  Y – MONOCRYL Suture •  J – Coated VICRYL Suture •  V – Uncoated VICRYL Suture •  Z – PDS II Suture • Non-Absorbable •  G – Green ETHILON Suture •  X – ETHIBOND EXCEL Suture •  R – MERSILENE Suture •  A – Silk Strands
  85. 85. Product Code Number • The last letter of the code denotes the number in each box • G – 1 dozen • D – 1 dozen • T – 2 dozen • H – 3 dozen • The numbers denote suture/ needle combo • Length • Color • Needle
  86. 86. Suture Material • Material • Suture materials are designated by color and construction characteristics (e.g. undyed, braided, etc.) • Length • Suture length is shown in both inches and the approximate metric equivalent • Color • Suture material can be dyed or undyed
  87. 87. Needle Types
  88. 88. Color Code Information
  89. 89. Package Insert • The package insert found inside of each new box of suture product is a very valuable tool to find the following information • Description – materials used to make suture • Indication – recommended tissues where the suture is to be used • Actions – how suture acts when used • Contraindications – where suture should not be used • Warnings – important considerations • Precautions • Adverse Reactions • How Supplied
  90. 90. Primary Packets • Individual sutures and multiple suture strands • Fast and easy opening in a peelable motion • Single layer over wrap made of foil or coated Tyvek on one side to polyethylene film on the other • Absorbable sutures are always in foil to provide a moisture barrier • Most non-absorbable sutures are encased in Tyvek
  91. 91. Primary Packets • Product information • Color code information • Product code number • Material • Size • Needle type • Number of needles per packet
  92. 92. Primary Packets 3.  One single-strand of material with single- or double-armed swaged needle(s) •  One-step RELAY suture packets •  Allows the needle to be armed without touching it •  Increases the safety of handling needles intraoperatively •  Needle park •  Provides a standard location for, and easy access to, the needle
  93. 93. Primary Packets 4.  Multiple suture strands •  •  •  •  •  Swaged to a single-needle or double-armed For procedures requiring numerous interrupted sutures Saves time Labeled with the symbol MS May contain 3 – 10 swaged sutures
  94. 94. Expiration Date • Determined by product stability studies • FDA requires all synthetic absorbable suture products have an expiration date • Synthetic absorbable sutures continue to meet requirements even at five years of storage • RELAY System is design as FIFO inventory control system
  95. 95. Sterilization • Sutures sterilized are either irradiated with cobalt 60 or exposed to ethyl oxide gas • Alter proteins, enzymes and other components • Cold sterilization
  96. 96. Irradiated Sterilization • Exposes products to ionizing radiation • Beta rays produced by high energy electron accelerators OR • Gamma rays from radioisotopes
  97. 97. Gas Sterilization • Products that cannot withstand the effects of irradiation are gas sterilized • Uses ethylene oxide gas • ETHICON replaces CFCs with more environmentally friendly compounds
  98. 98. Resterilization • DO NOT RESTERILIZE • Packaging and product cannot withstand high temperatures or extreme pressure without affecting integrity • ETHICON will disclaim any responsibility for sterilization and/or other product failures resulting from resterilization • Only ETHI-PACK* Pre-cut Steel Sutures and spools or card reels of nonabsorbable materials should be sterilized
  99. 99. Anticipating Customer Needs • Maintain quality standards while lowering costs • Anticipate surgeon’s needs • Surgeon preference cards • Surgeon’s suture routine • Suture materials • Sizes • Needles • Product code numbers
  100. 100. Factors to consider when deciding on number of suture packets necessary • Multiple strands of suture material = fewer packets • Opening sufficient packets for time’s sake • Leftover sutures, must be discarded
  101. 101. Hand-off Method • Grasp the two flaps of peelable overwrap • Peel flaps apart 1/3 of the way down • Scrub person takes it with gloved hand or sterile instrument • Avoiding contact with the nonsterile overwrap
  102. 102. Flipping Method • Flipping is a rapid and efficient method of ejecting sterile product from its overwrap onto the sterile field without contacting the unsterile outer packet or reaching over the field
  103. 103. Suture Preparation • Sequence of tissue layers • Organize sutures in sequence • Goal should be to have no unused strands at the end of the procedure
  104. 104. Preservation of Tensile Strength • Absorbable sutures • Protect absorbable sutures from heat and moisture • Store at room temp • Do not soak • Surgical gut can be dipped in tepid water • Synthetic absorbable sutures must be kept dry • Straighten strands with a gentle, steady, even pull • Do not “test” suture strength • Do not resterilize
  105. 105. Preservation of Tensile Strength • Nonabsorbable sutures • Silk – store strands in a dry towel. Dry strands are stronger than wet strands • Surgical Stainless Steel – handle carefully to avoid kinks and bends • Polyester Fiber – unaffected by moisture. May be used wet or dry • Nylon – straighten kinks or bends by caressing strand between gloved fingers • Polypropylene – unaffected by moisture. May be used wet or dry
  106. 106. • THANK YOU ALL • THANKS TO ETHICON, INC • A JOHNSON & JOHNSON COMPANY

×