Suture help

The biggest problem as far as I can see is this surgeon. People who are learning should not be yelled at, ESPECIALLY when you are handling sharps. Next time he yells at you let him know that you are still learning and his aggressive behaviour is not helpful. From my experience the nurses who stick up for themselves earn far more respect than those who just put up with it.

Anyway I have a system I use it's not always accurate because every surgeon is different. Maybe check the preference card of this surgeon.

I'm not really sure what you mean by SH or CT, I just go by tapered or cutting. My specialty is general surgery. I've only seen silk used for drains and for stay sutures.

If I anticipate heavy bleeding I always have a 3-0 and 4-0 tapered prolene ready.

If there is bowel involvement, i.e anastamosis I have a 3-0 PDS or Maxon tapered loaded, if it is small structures being anastamosed such as the CBD then a 4-0 maxon is usually what they want.

For abominal closure it can be anything from a 1 Nylon blunt or tapered, 1 Prolene PB30, 1 Maxon on a loop etc.

For subcuticular closure-usually a 2-0 or 3-0 vicryl tapered.

Skin-usually a 3-0 caprosyn or monacryl, or even staples.

there are some pretty good references available online that discuss and describe various sutures, needles, selection, qualities, characteristics and so on. one of them i found on wikipedia, and it's not too bad. it doesn't address the codes - sh or ct (ct means "cutting" needle) and the like, but it does give some basic background on what goes where and why. the link for it is http://en.wikipedia.org/wiki/suturing.

another one i found is http://emedicine.medscape.com/article/884838-overview.

you can also utilize the surgical supply vendors - they generally have a charts and reference materials that you can use to learn what types of suture needles there are and when and where they are used.

if you have csts in your department, you might ask them if they have the references from school they used for you to look at.

I love mind reading surgeons! Doesn't really matter until he tells you what suture he really wants. If you work routinely with certain surgeons then it is a little easier, but they sometimes will screw you up and want something else. Don't let it bother you, smile and just get what the idiot wants.

if you're asking about needles only - there are two basic kinds - sh types are round through the cross-section and atraumatic to "friable" tissues like inside the bowel, and working inside the bladder. the tissue there is not tough, and doesn't need a cutting - or ct - type needle which actually has sharp edges to cut through tougher tissue like skin, and sometimes eye. there are many variables inside those two major designations, such as size, tightness of the "curve" of the needle, or whether it has one at all, as in the case of straight, or "keith" needles which are used without needle drivers to close skin; and whether or not the cutting edge on a cutting needle is on the outside diameter of the needle curve, or on the inside. there are combinations of characteristics as well, such as:

• 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)
  
• 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
  

then there are the kind that get threaded on open-eyed surgical needles by hand - like a regular sewing needle would be threaded - one at a time, and there are the swaged-on type where the suture is anchored through the base of the needle in line with its axis. if you're using swaged-on needles, and most do, never put the jaws of the needle driver more than 2/3 of the way towards the swage from the point. if you get too close to the suture itself, that can crush and open the swage, and let the suture fall right out in the middle of a stitch. (surgeons tend to get a little cranky if their suture falls away from the needle before they are done sewing with it! lol)

then - there are regular swaged, and "pop-offs", which are generally used in general and gyn procedures where the surgeon wants to run the suture through one time, pop the needle off the end quickly and tie it down, and repeat with a new suture just like it - sort of an "in one side-out the other-pop off-tie-cut-repeat" sequence. or he/she may wait to cut all the suture ends at the same time when all the stitching and tying is done with in that layer.

sizes can be confusing until you know the scale they are using, with all the zeros. the easiest way to remember how big or small a suture is, is to know how many 0's it is away from the middle 0 on an arithmetic number line. one 0 is bigger diameter than 2 0s (2-0, or 00), which is bigger than 3 0's (3-0, or 000), and so on down the line, to the fine, hair-like vascular and neuro sutures in the 10-0 and 11-0 range. if it's in whole numbers on the other side of 0, like 1 or 2, and on up to about a 5, then that's relatively huge heavy suture and is generally used to close abdominal fascia and skin, particularly in larger patients, and for big ortho cases.

this is far from comprehensive - but it's a start. there's plenty more about sutures - absorbable and nonabsorbable, braided and monofilament (like fishing line), natural, silk, catgut and synthetics, and so on and so on, to know.

there are absolutely hundreds of types, styles, variations and combinations, depending on manufacturer and purpose. one thing you can do to help yourself is to consult, and verify with someone who is more experienced, that the surgeon's preference cards are complete and up-to-date. those can be your biggest help if they are done well. making notes immediately after the case, if you have a few moments, can be a good reference for you later on as well. manufacturer's websites, and the information you can get from them on paper, in charts and on diagrams, can also be very helpful.

hope this helps! good luck!

ShariDCST, I just wanted to thank you for taking the time to put together such a helpful post. There's some great info there.

sharidcst, i just wanted to thank you for taking the time to put together such a helpful post. there's some great info there.

it was my pleasure entirely - i hope it will be helpful.

have a wonderful day!

shari

First of all, different suture companies use different names for their needles. A CT needle in Ethicon suture is a general closure taper needle. In Autosuture, the same needle is a GS21. Here is a link to Ethicon's page there is a huge amount of information here about suture and needle types ( http://ecatalog.ethicon.com/general-info#top) I didn't take the time to look up other suture companies like D & G or Autosuture but I'm sure that they also have similar information available. I don't know if they still do, but Ethicon used to have a whole series of booklets explaining their products.