Suturing for Medical Student OSCE
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Introduction + ‘I understand that you have an open wound. To help the healing process and prevent gross scar formation the wound needs to be stitched closed using a needle and special thread. It should not be painful as we will be using local anaesthetic.’ Consent.
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Inspect wound: debris + dirt ? cleaning + debridement.
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X-ray: mention it would be needed if there is any potential of a foreign body
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Examine distal motor and sensory function
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Set up equipment on trolley
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Wash hands!
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Open suture pack using sterile technique. Drop pair of sterile gloves, syringe, sutures and both a green and a blue needle into sterile field. Pour antiseptic solution into receptacle, and drop swabs into solution
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Suture selection: 3-0 larger than 6-0. 4-0 suitable for limbs, and can be removed after 10 days.
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Absorbable sutures (deep wounds): Monocryl, Vicryl, Dexon
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Monofilament nonabsorbable sutures (superficial wounds): Nylon (Ethilon), Prolene
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Put on sterile gloves using sterile technique. Clean the wound from centre outwards, using swabs held with forceps. Cover the wound using a drape, leaving a hole over the region to be stitched.
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Anaesthetic:
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Select syringe, attach 21G green needle. Seek assistance for drawing up 10ml of 1% lignocaine
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Dispose of green needle, attach 25G blue needle.
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Inject blebs of lignocaine encompassing wound approx 0.5-1cm from edge. Aspirate needle on inserting to make sure a vessel has not been entered. Dispose of needle.
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Wait 5-10 min for anaesthetic to work, then test by prodding wound.
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Check for lignocaine toxicity: tingling in mouth, metallic taste, dizziness / light headedness, ringing in ears, difficulty in focussing eyes
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Use forceps and needle holders to make the sutures. Use rule of halves: 1st is half way along wound; next is half way between suture and end of wound, etc.
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Closing up:
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Dress wound appropriately
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Mention tetanus immunisation should be given if wound contaminated, or if no booster in last 10 years
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Document procedure in notes
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Dispose of sharps and clinical waste appropriately
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Inform sutures can be removed in 10 days
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Thank patient, check for questions
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Date: Fri, 22 Jan 2010 Time: 4:14 PM
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