ideal for surgeons, o.t technicians

1. Sutures Needles
Packaging
DR SREEJOY PATNAIK

2. Sutures

3. Sutures Module Agenda
• Objectives
• Suture Overview
• Suture Characteristics
• Suture Types
• Activity

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. Suture History
1887 1947 1958 1969 1974 1976 1979 1989 1992 1993 1995 1996 1998 2003 2006

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. Suture material compared with
human hair
Suture Sizes

8. Example
• monofilament suture USP 10-0 knotted around human hair

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Triclosan
• Is it safe?
• Is it being overused and/or misused?
• Does triclosan promote antibiotic resistance?

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. Needles

47. Agenda
• Objectives
• Characteristics of an Ideal Needle
• Elements of Needle Design
• Anatomy
• Measurements of a Needle

48. Objectives
• Describe the characteristics of an ideal needle
• Identify the elements of needle design
• Explain the anatomy of a needle

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. 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. 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. 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. 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. 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. 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. Anatomy
• Three basic components
• The Eye
• The Body
• The Point

57. Anatomy – The Eye
• The Eye
• Closed eye
• French eye (Split or Spring)
• Swaged
• Disadvantages
• Time consuming
• Tissue disruption
• Repeated use

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. Anatomy – The Body
• Straight Needle
• Half-Curved Needle
• Curved Needle
• Compound Curve Needle (80º tip, 45 º body)

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. Anatomy – The Body
• Half-Curved Needle (Ski Needle)
• Skin closure
• Laparoscopic procedures

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. Anatomy – The Body
• Compound Curve Needle
• Ophthalmic Surgery

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. 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. 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. 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. 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. 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. 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. ETHICON Needle Codes

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. Measurements of a Needle

74. Packaging

75. Agenda
• Packaging Overview
• Relay System
• Modular Suture Storage Racks
• Dispenser Boxes
• Primary Packets
• Expiration Date
• Suture Sterilization
• Anticipating Suture Needs
• Sterility
• Handling

76. Objectives
• Identify each part of the product code
• Identify product boxes
• Explain what product is each dispenser box

77. Packaging Overview

78. Integral Part of Each Product
• Protect content
• Provide convenience to the user
• Sterile products

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. RELAY* Suture Delivery System

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. 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. Additional Information
• Surgical application
• Product code number
• Suture size
• Metric equivalent
• Shape and quantity
of needles
• Needle point geometry
• Lot number
• Expiration date

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. 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. 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. Needle Types

88. Color Code Information

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. 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. Primary Packets
• Product information
• Color code information
• Product code number
• Material
• Size
• Needle type
• Number of needles per packet

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. 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. 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. Sterilization
• Sutures sterilized are either irradiated with cobalt 60 or
exposed to ethyl oxide gas
• Alter proteins, enzymes and other components
• Cold sterilization

96. Irradiated Sterilization
• Exposes products to ionizing radiation
• Beta rays produced by high energy electron accelerators OR
• Gamma rays from radioisotopes

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. 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. 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. 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. 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. 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. 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. 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. 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. • THANK YOU ALL
• THANKS TO ETHICON, INC
• A JOHNSON & JOHNSON COMPANY