The LSUHSC New Orleans
Emergency Medicine Interest Group

Presents

The Student Procedure Manual


Basic Suturing

by Charlie Clasen with
Patrick Hymel

Indications
Contraindications
Prerequisites
Equipment
Procedure
Complications
Follow-up
Suture removal
Related procedures/tests

Indications

Contraindications

Prerequisites

Equipment

Procedure

  1. Wear a mask, gloves, and an eye shield (universal precautions).
  2. Explain procedure and expected results - scar.
  3. Check: drug allergies
  4. Consider an X-ray of area-fracture, foreign body.
  5. Prep surrounding area with Betadine solution, apply sterile drapes. Remember: Betadine and hydrogen peroxide are cytotoxic. And should not be poured directly into the wound.
  6. Anesthetize wound (see ED Anesthesia and Nerve
    Blocks): regional block or local infiltration into wound, aspirate slightly before injection to avoid intravascular injection of local anesthetic (symptoms: twitching, restlessness, drowsiness, light-headedness, seizures). Do not use local anesthetic with epinephrine on fingers, toes, nose, ears or penis. Do not exceed the maximum dose of anesthetic. (1% solution= 10mg/ml).
    *To make the injection of local anesthetic less painful:
  7. Needle size 25 G or smaller
  8. Inject slowly
  9. Inject through wound, not through intact skin (only if wound is not heavily contaminated or has been irrigated well beforehand)
  10. Wait several minutes before proceeding to allow anesthesia to take effect
    *Warm anesthesia to body temperature (carry vial around in shirt pocket)
    *Btiffer anesthetic.- 9cc 1% lidocaine + 1cc sodium bicarbonate (44mEq/5Oml)

  11. Debride dead tissue using iris scissors or scalpel.
  12. Irrigate wound using 250-500 ml normal saline directed into wound via an 18 G needle on a 50 ml syringe. Pour the saline into a sterile basin for ease of drawing into the syringe.
  13. Under adequate lighting, carefully inspect the wound, looking for foreign bodies or damage to adjacent structures (tendons, nerves, joints). It may be necessary to have the patient move the tendon or joint as you observe the wound. If any deep structures are visibly damaged or if the wound is in an awkward location or complex configuration, seek consultation.
  14. If necessary, close the subcutaneous fascial layers with interrupted absorbable sutures. Approximate the edges very carefully.
  15. Skin Closure:
  16. Use gauze moistened with saline to cleanse the sutured wound and gently blot it dry with plain gauze
  17. Apply topical antibiotic ointment to the wound.
  18. Dress the wound with a nonadherent pad and gauze with or without tape. You may leave scalp and facial wounds uncovered.
  19. Tell the patient how to care for the wound, describe the signs of infection, arrange for suture removal, and consider tetanus immunization and a prescription analgesic.

Complications

Follow-up

Suture removal

Related procedures / tests

 


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