Download - SUTURE AND NEEDLE TECHNOLOGY
Sutures Needles Packaging
DR SREEJOY PATNAIK
Sutures
Sutures Module Agenda
• Objectives • Suture Overview • Suture Characteristics • Suture Types • Activity
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
Suture History
1887 1947 1958 1969 1974 1976 1979 1989 1992 1993 1995 1996 1998 2003 2006
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
Suture material compared with human hairSuture Sizes
Example
• monofilament suture USP 10-0 knotted around human hair
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
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.
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
Suture Types
ShortShort/Medium
Medium
Twisted/Virtual Monofilament
Natural
Short/MediumLong
Monofilament
ShortMedium
Braided
Synthetic
Absorbable
Monofilament Braided
Natural
Monofilament Braided
Synthetic
Non-Absorbable
Fast Absorbing Gut
Short
Plain Gut
Short/Medium
Chromic Gut
Medium
Twisted/Virtual Monofilament
Natural
MONOCRYL* Plus
MONOCRYL*
Short/Medium
PDS * II Plus
PDS* II
Long
Monofilament
VICRYL RAPIDE* Plus
VICRYL RAPIDE*
Short
VICRYL* Plus
VICRYL*
Medium
Braided
Synthetic
Absorbable
Absorbable Suture Types
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)
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 28 60
Tissue Healing Times in Days
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
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.
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.
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
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
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.
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.
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
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
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
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
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
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
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.
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
Triclosan
• Is it safe? • Is it being overused and/or misused? • Does triclosan promote antibiotic resistance?
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
7. PDS II Suture
Characteristics PDS II Suture Material Polydioxanone Natural/Synthetic Synthetic Construction Monofilament Absorbable Coating Not Coated Color 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 Size 3-0 and larger 60% of original strength @ 2 weeks post-op 80% @ 2 weeks 40% of original strength @ 4 weeks post-op 70% @ 4 weeks 35% of original strength @ 6 weeks post-op 60% @ 6 weeks
Absorption Time 182-238 days (6-8 months) Absorption Process Hydrolysis
Frequent Uses Soft tissue approximation, including use in pediatric cardiovascular tissue where growth is expected to occur; ophthalmic surgery, fascia closure
8.PDS Plus Suture
Characteristics PDS Plus Suture Material Polydioxanone
IRGACARE MP (triclosan) Natural/Synthetic Synthetic Construction Monofilament Absorbable Coating Not Coated Color 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 Size 3-0 and larger
60% of original strength @ 2 weeks post-op 80% @ 2 weeks 40% of original strength @ 4 weeks post-op 70% @ 4 weeks 35% of original strength @ 6 weeks post-op 60% @ 6 weeks
Absorption Time 182-238 days (6-8 months) Absorption Process Hydrolysis Frequent Uses Soft tissue approximation, including use in pediatric cardiovascular tissue
where growth is expected to occur; ophthalmic surgery, fascia closure
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
PDS II Suture IFU Changes
• Old Data • 70% 2 weeks • 50% 4 weeks • 25% 6 weeks
• Absorption at 183 days
• New in vivo studies showed significant improvement in the breaking strength retention profile of PDS II Suture
• Both PDS II Suture and PDS Plus Suture
Non-Absorbable Suture Types
Surgical Stainless Steel
Monofilament
PERMA-HAND* Silk
Braided
Natural
ETHILON* PROLENE* PRONOVA
Monofilament
NUROLON* ETHIBOND EXCEL* MERSILENE
Braided
Synthetic
Non-Absorbable
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
Frequent Uses Ligation and general closure; general surgery. Ophthalmology, plastic surgery and neurosurgery
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
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
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
13. MERSILENE Suture
Characteristics MERSILENE Suture Material Polyester Natural/Synthetic Synthetic Construction Braided and Monofilament Non-Absorbable Coating Not Coated Color 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
14. PROLENE* Polypropylene Suture
Characteristics PROLENE Suture Material Polypropylene 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 General, plastic, cardiovascular surgery and skin closure; ophthalmology
15. PRONOVA * Poly (Hexafluoroprop- ylene - VDF) Suture
Characteristics PRONOVA Suture Material Polymer blend of poly (vinylidene fluoride) and poly (vinylidene fluoride-co-
hexafluoropolypropylene) 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
ETHICON Suture Material Colors • SUTURES COLOUR
• PLAIN GUT YELLOWISH TAN • CHROMIC GUT BROWN • MONOCRYL Suture CLEAR or VIOLET • Coated VICRYL Suture VIOLET or UNDYED (natural) • PDS II Suture VIOLET or CLEAR • SILK Suture BLACK • NUROLON Suture BLACK • ETHILON Suture BLACK (green or clear) • MERSILENE Suture GREEN or WHITE • ETHIBOND EXCEL Suture GREEN or WHITE • PROLENE Suture BLUE or CLEAR • PRONOVA Suture BLUE or CLEAR
Needles
Agenda
• Objectives • Characteristics of an Ideal Needle • Elements of Needle Design • Anatomy • Measurements of a Needle
Objectives
• Describe the characteristics of an ideal needle • Identify the elements of needle design • Explain the anatomy of a needle
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
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
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
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
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
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
Elements of Needle Design – The ETHICON Advantage
• Strength: ETHALLOY* Needle Alloy/Manufacturing process • Ductility: Ethalloy alloy • Sharpness: MULTIPASS* Needles • Stability: Ribs/I-Beam
*Trademark
Anatomy
• Three basic components • The Eye • The Body • The Point
Anatomy – The Eye
• The Eye • Closed eye • French eye (Split or Spring) • Swaged
• Disadvantages • Time consuming • Tissue disruption • Repeated use
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
Anatomy – The Body
• Straight Needle • Half-Curved Needle • Curved Needle • Compound Curve Needle (80º tip, 45 º body)
Anatomy – The Body
• Straight Needle • Preferred when suturing easily accessible tissue • Skin closure, meniscus repair, tendon repair, nerve repair and
in ophthalmic cases
Anatomy – The Body
• Half-Curved Needle (Ski Needle) • Skin closure • Laparoscopic procedures
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
Anatomy – The Body
• Compound Curve Needle • Ophthalmic Surgery
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
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
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
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
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.
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
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
ETHICON Needle Codes
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
Measurements of a Needle
Packaging
Agenda
• Packaging Overview • Relay System • Modular Suture Storage Racks • Dispenser Boxes • Primary Packets
• Expiration Date • Suture Sterilization • Anticipating Suture Needs • Sterility • Handling
Objectives
• Identify each part of the product code • Identify product boxes • Explain what product is each dispenser box
Packaging Overview
Integral Part of Each Product
• Protect content • Provide convenience to the user • Sterile products
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
RELAY* Suture Delivery System
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
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
Additional Information
• Surgical application • Product code number • Suture size • Metric equivalent • Shape and quantity
of needles • Needle point geometry • Lot number • Expiration date
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
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
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
Needle Types
Color Code Information
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
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
Primary Packets
• Product information • Color code information • Product code number • Material • Size • Needle type • Number of needles per packet
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
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
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
Sterilization
• Sutures sterilized are either irradiated with cobalt 60 or exposed to ethyl oxide gas • Alter proteins, enzymes and other components • Cold sterilization
Irradiated Sterilization
• Exposes products to ionizing radiation • Beta rays produced by high energy electron accelerators OR • Gamma rays from radioisotopes
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
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
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
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
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
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
Suture Preparation
• Sequence of tissue layers • Organize sutures in sequence • Goal should be to have no unused strands at the end
of the procedure
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
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
• THANK YOU ALL
• THANKS TO ETHICON, INC • A JOHNSON & JOHNSON COMPANY