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PRACTICAL SKILLS IN CLINICAL PRACTICE
DR.AVINASH BHONDWEPRESIDENT I.M.A. Pune (2008-09)
Special Skills
Minor Surgeries Stitches- Skin & Mucus Membranes Special Dressings Splints & Plasters I.V . Fluids & Injections ECG Spirometer Physiotherapy Refraction
Injections Ampoules Vials Prefilled Pen
Injection Sites
Injection Sites
Intravenous Injections
17 Jan 2010
I/V injections Salines
Scalp Vein
IV SET
Syringe
Type of Needles
SUTURING
SKIN SUTURESMUCUS MEMBRANEDEEP WITH FACIA, FAT & SKINMUSCLESBLEEDING FROM VESSELS
SUTURINGThere 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)
SURGICAL NEEDLES
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
SURGICAL NEEDLES
Suture Material Types of sutures : Absorbable sutures such as plain,chromic, a
traumatic catgut. Non absorbable or non absorbent sutures.
Reading the Suture Label
Company
Needle
Size Order Code
NameAlso:LENGTHNEEDLE SYMBOLCOLORAbsorbable or Non
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
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.
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
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.
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.
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.
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
SUTURES SIMPLE SUTURES
SIMPLE SUTURES
MATRESS SUTURES
SIMPLE CONTINUOUS SUTURES
Alternative Methods of Wound Closure STERI STRIPS
STAPLES SUTURING
Tissue adhesive Superglues that contain acrylates 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.
Wound Closure Using Super Glue
Minor Surgeries
ABSCESS DRAINAGE- I/D CYST EXCISION LIPOMA EXCISION CORN EXCISION FOREIGN BODY REMOVAL AUROPLASTY NAIL BED ABSCESS I/D – NAIL EXCISION
AUROPLASTY
MINOR SURGERIES
LIPOMA EXCISION CORN EXISION
SPECIAL DRESSINGS
ROLLER BANDAGE
ELASTOCREPPE BANDAGE
Applying a Cravat Bandageto the Head
Place middle of bandage over the dressing and wrap around the head.
Applying a Cravat Bandageto the Head
Cross the two ends snugly.
Bring ends back around and tie knot.
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.
Securing Bandages
Loop method Encircle body part with
the looped and free ends and tie ends together.
Plasters
SPIROMETER
REFRACTION
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
PHYSIOTHERAPY
Cervical Traction Lumbar Traction
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, Circulation Disorder and Incontinence
