The document discusses various practical clinical skills including minor surgeries, injections, intravenous injections, suturing techniques, wound closure methods, dressings, splints, electrocardiography, spirometry, refraction, and physiotherapy modalities. It describes procedures like abscess drainage, cyst excision, and lipoma excision. It also covers topics like types of sutures, needles, bandaging methods, and physiotherapy options like shortwave diathermy, ultrasonic therapy, and interferential therapy.

1. PRACTICAL SKILLS IN
CLINICAL PRACTICE
DR.AVINASH BHONDWE
PRESIDENT I.M.A. Pune (2008-09)

2. Special Skills
 Minor Surgeries
 Stitches- Skin & Mucus Membranes
 Special Dressings
 Splints & Plasters
 I.V . Fluids & Injections
 ECG
 Spirometer
 Physiotherapy
 Refraction

3. Injections
 Ampoules
 Vials
 Prefilled
 Pen

4. Injection Sites

5. Injection
Sites

6. Intravenous Injections
 I/V injections
 Salines
17 Jan 2010

7. IV Presentations

8. Syringe
IV SET
Scalp Vein

9. Type of Needles

10. SUTURING
 SKINSUTURES
 MUCUS MEMBRANE
 DEEP WITH FACIA, FAT & SKIN
 MUSCLES
 BLEEDING FROM VESSELS

11. SUTURING
There are several shapes of surgical needles:
 Straight
 1/4 circle
 3/8 circle
 1/2 circle. Subtypes of this needle shape
include, from larger to smaller size, CT, CT-1, CT-2
and CT-3.[3]
 5/8 circle
 compound curve
 half curved (also known as ski)
 half curved at both ends of a straight segment (also
known as canoe)

12. SURGICAL NEEDLES

13. SUTURING
 Needles may also be classified by their point
geometry; examples include:
 taper (needle body is round and tapers smoothly
to a point)
 cutting (needle body is triangular and has a
sharpened cutting edge on the inside curve)
 reverse cutting (cutting edge on the outside)
 trocar point or tapercut (needle body is round and
tapered, but ends in a small triangular cutting
point)
 blunt points for sewing friable tissues
 side cutting or spatula points (flat on top and
bottom with a cutting edge along the front to one
side) for eye surgery

14. SURGICAL NEEDLES

15. Suture Material
 Types of sutures :
 Absorbable sutures such as plain,chromic, a
traumatic catgut.
 Non absorbable or non absorbent sutures.


16. Reading the Suture Label
Order Code
Size
Also:
Name
LENGTH
NEEDLE
SYMBOL
Needle COLOR
Absorbable
or Non
 Company

17. Suture Material
 ABSORBABLE SUTURES: CATGUT
 A tough thin cord made from the treated and
stretched intestines of certain animals, especially
sheep. This type of suture are commonly used to
suture the inner structure of the body
 Walls of the organs
 Rectal sheath
 Muscles
 Subcutaneous tissue
 Peritoneum
 Intestinal anastomosis


18. Suture Material
 1) Plain catgut :
 These sutures are completely digested &
absorbed by the tissue. Sizes of the absorbable
catgut suture vary from 5/0 which is the finest to
2 which is the thickest.


19. Suture Material
 Chromic catgut : Chromic catgut an absorbable
sterile strand derived from the intestinal submucosa
of sheep.
 It is an absorbable suture
 The chromic catgut is of brown color & is absorbed
slowly


20. Suture Material
 Atraumatic catgut It is another type which is used for
ligating small blood vessels.
 Dexon (Polyglycolic acid) is also an absorbable
suture synthetically prepared. It is available in
various sizes such as 3/0 to 2.
 This suture is used as ties for small blood vessels &
also for suturing peritoneum ,rectal sheath etc.

21. Non absorbable sutures
 These types of sutures are not
absorbed.
 These sutures are used for closing or
suturing outer surface of the body such
as skin.
 These sutures are cheaper, easy to
handle easy to sterile ,have smooth
surfaces & knot securely with the ends
cut short.


22. Suture Material
 Silk suture : these suture are non absorbent. Their
sizes vary from 10/0 to 2 . These are used for skin
closure after abdominal operation.
 Linen suture : these sutures are also non
absorbent .their sizes vary form 3/0 to 2 . These
are used for skin closure in hernia operation.
 Monofilament Nylon suture ( Ethilon) : These are
non absorbable suture. Their sizes vary from 10/0
to 2. these sutures are used as tension sutures in
hernia repair.


23. Suture Material
 e) Prolene –Ethifex merseline : These non
absorbent sutures are used for cardiovascular &
plastic surgery.
 f) Metal Clips : these non absorbent types of
suture are of various types such as : Michael
clips Trazies Van petz
 VICRYL (polyelatine– 916)
 PROLENE (Polypropylene)
 POLYSTER (ethibond)
 POLYDIXONE SUTURE

24. SUTURES
 SIMPLE SUTURES

25. SIMPLE SUTURES

26. MATRESS SUTURES

27. SIMPLE CONTINUOUS SUTURES

28. Alternative Methods of Wound Closure
 STERI STRIPS

29. STAPLES SUTURING

30.  Superglues that contain acrylates Tissue adhesive
may be applied to superficial
wounds to block pinpoint skin
hemorrhages and to precisely
coat wound edges. Because of
their bacteriostatic effects and
easy application, they have
gained increasing popularity. They
have demonstrated either
cosmetic equivalence or
superiority to traditional sutures
in various procedures, including
sutureless closure of pediatric
day surgeries, saphenous vein
harvesting for coronary artery
bypass, and blepharoplasty.

31. Wound Closure Using Super Glue

32. Minor Surgeries
 ABSCESS DRAINAGE- I/D
 CYST EXCISION
 LIPOMA EXCISION
 CORN EXCISION
 FOREIGN BODY REMOVAL
 AUROPLASTY
 NAIL BED ABSCESS I/D – NAIL EXCISION

33. ABSCESS DRAINAGE

34. AUROPLASTY

35. MINOR SURGERIES
LIPOMA EXCISION CORN EXISION

36. SPECIAL DRESSINGS
ELASTOCREPPE BANDAGE
ROLLER BANDAGE

37. Applying a Cravat Bandage
to the Head
 Place middle of bandage
over the dressing and
wrap around the head.

38. Applying a Cravat Bandage
to the Head
 Cross the two
ends snugly.
 Bring ends back
around and tie
knot.

39. Applying a Roller Bandage
 For ankle:
 Make two straight turns around instep.
 Make figure-eight turn across front of foot, around
ankle, and under arch.

40. Securing Bandages
 Loop method
 Encircle body part with the
looped and free ends and
tie ends together.

41. SPLINT & PLASTERS

42. Plasters

43. ECG

44. SPIROMETER

45. REFRACTION

46. PHYSIOTHERAPY
 Short Wave Diathermy (SWD)
 Effective in Inflammation of Shoulder Joint,
Elbow Joint , Cervical Spondylosis,
 Osteoarthritis, Ligament Sprains in Knee
 Joints, Low Back Ache, Heel Pain, Sinusitis
 Ultrasonic therapy:
Ultrasonic waves are useful for treatment of Inflammation of
Elbow Joint (Tennis Elbow), Plantar Fascitis (Heel Pain),
Shortening of Muscle or Ligament, Inflammation of tendons
(Suprasspinatus tendnitis), Ligament Sprain (Lateral
Ligament Sprain of Ankle), Unhealed Scars

47. PHYSIOTHERAPY
Cervical Traction Lumbar Traction

48. Interferential Therapy (IFT)
 Computerized Interferential therapy is most advanced
version; based on solid-state circuitry, extremely light
weight, compact design and portable and user friendly
systems.
 Interferential therapy can relieve pain, reduce swelling,
activate cell function and promote healing &restors
function.
 Choice for the treatment in Rheumatism, Arthritis,
Muscle Strains, Sports Injuries, Neuralgia, Neuritis,