surgery/OR questions

Esme12, ASN, BSN, RN · Apr 12, 2012

1. pre-op: the patient had a warming device on top of him. It looked like a clear, inflatable raft or "pillow" that was connected via hose to a device that looks sort of like a large shop-vac, which presumably pumped warm air into the "pillow". What is this thing called?

It has many names but a common one is "Bear Hugger"

Bair Hugger® Therapy

2. types of sutures: It was a total knee replacement. On the inside, the surgeon used long, blue sutures that almost looked like dental floss. On the outer tissue, individual wire sutures were used. What are the names of both of these types of sutures?

The exterior would be staples. The interior suture selection is dependent on the anatomic site, surgeon's preference, and the required suture characteristics. No standardized sizing system or nomenclature is available for needles or needle holders; the main consideration in needle selection is to minimize trauma. The length, diameter, and curvature of the needle influence the surgeon's ability to place a suture. Medscape: Medscape Access This will probably give you your answer. You have to register but it is free.

Stitches Symptoms, Causes, Treatment - How is skin closure achieved? on MedicineNet but I have not done OR per se so I don't know the name

3. type of dressing: After closing the incision, they applied white gauze over the incision and then wrapped the leg in flesh-colored gauze (I think it was a type of gauze, but it looked like an ace bandage but it wasn't as thick - more breathable). Is there a name for this type of dressing? There was a hemovac drain as well, if that's relevant.\

Coban dressing is a self-adhesive wrap used to treat wounds and other injuries. The 3M company manufactures Coban dressing, with the average roll measuring 3 inches wide and 5 feet long. Self-adhesive, Coban dressing sticks only to itself. It doesn't adhere to skin or other materials.

NP Sam · Apr 12, 2012

1. Bair Hugger like Esme12 said. We use them a lot.

2. Might have been Ethibond.

3. I again agree with Esme12 and think it was Coban.

Clovery · Apr 13, 2012

thanks so much for the replies!

they are still "staples" if they're not um, stapled? I always pictured like a staple gun.... these were threaded through the skin.

Clovery · Apr 13, 2012

forgot to say -

Bair Hugger is definitely right, and so is Coban. I read the medscape link about the sutures and still not sure about those. I'm going to poke around on google images and maybe come up with something. Would the internal sutures be dissolvable or not with a total knee replacement?

Editorial Team / Admin · Apr 13, 2012

Are you sure the sutures are blue and not purple? The only blue suture I know of is prolene, but that's mostly vascular. Purple for us is usually vicryl, which a lot of our docs use as a general closure stitch in nearly every specialty. If I remember correctly, vicryl is a disolvable suture. Most internal closure stitches, unless they are holding something like hernia mesh, are supposed to dissolve.

Clovery · Apr 13, 2012

They definitely weren't purple... they were a pastel version of turquoise to teal blue - they really reminded me of mint-coated dental floss, but probably a bit more broad. It was one long string that the surgeon used to stitch together the "meaty part" (muscle I guess?) over the surgical site. Then the metal wires (staples?) were used to close the actual skin.

Basically he dug out the knee, flattened the femur and tibia, glued on metal implants, and replaced the patella with a plastic part. The circulating nurse was really nice and was explaining things to me - she even had the scrub nurse save a piece of femur and the meniscus for me to handle (neat!). But at the end of the surgery, when they were closing the incision everyone was busy cleaning up and I didn't get any details about the incision closure and dressing.

The patient had his other knee done a few months back and told me he was able to "do the stair-climber", walk out of the hospital, and get in his SUV the next afternoon. He was 70 years old and I'm totally amazed that the body can have an entire joint sawed and ripped out of it, replaced with some glue, metal, and plastic and be that functional (without excruciating pain) the next day.

It was a cool experience but I think I learned I don't want to be an OR nurse. The smell of bone really gets to me and I don't think I like seeing people's "innards" that frequently.

Esme12, ASN, BSN, RN · Apr 13, 2012

thanks so much for the replies!
they are still "staples" if they're not um, stapled? I always pictured like a staple gun.... these were threaded through the skin.

I haven't seen threaded metal through anything unless it wa the sternal wires from bypass surgery. Metal threaded thru the skin?? I don't know. Why don't you call the OR where you observed today ans ask..I sure they will be glad to answer.