4. Objectives
â˘âŻName the raw materials from which each ETHICON suture is derived
â˘âŻClassify each ETHICON suture as natural/synthetic, absorbable/
nonabsorbable, braided/monofilament
â˘âŻRecall absorption profiles and tensile strength retention profiles of all
ETHICON sutures
â˘âŻIdentify which ETHICON sutures are coated, and the coating material (if
applicable)
â˘âŻIdentify the colors in which each ETHICON suture
is available
â˘âŻIdentify ETHICON sutures by sight and by feel
â˘âŻDescribe antibacterial sutures, how they work and which pathogens they
are effective against
6. Suture Sizing
â˘âŻVariety of sizes ranging from 7 to 11-0
â˘âŻA number 7 size is the largest
â˘âŻAn 11-0 size is the smallest
â˘âŻSizes 6 and 7 are only available in
Surgical Steel
9. Surgical Site Infection
Background Review
â˘âŻAntimicrobial
â˘âŻA substance that kills microorganisms (bacteria, fungus or virus) or
inhibits their growth
â˘âŻCidal â kills i.e. bacteriocidal
â˘âŻStatic â inhibits I.e. bacteriostatic
â˘âŻAntibacterial
â˘âŻAn antimicrobial substance that kills bacteria or inhibits their growth
10. SSI Background Review
â˘âŻAntibiotic
â˘âŻAgent 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
â˘âŻAntiseptic
â˘âŻAgent 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.
11. SSI Background Review
â˘âŻWhich are the two most common pathogens likely to
cause SSIâs?
â˘âŻStaphylococcus aureus
â˘âŻStaphylococcus epidermidis
â˘âŻMethicillin-resistant - Resistance to antibiotics
â˘âŻTreatment options are limited â vancomycin, Sulfamethoxazole-TMP
and teicoplanin
â˘âŻPrevention is best option to protect patients
â˘âŻAntibiotic prophylaxis, scrubbing, gowning, gloving, antimicrobial skin
prep, aseptic technique and âŚ
â˘âŻ ⌠Plus Antibacterial Sutures
13. Absorbable Suture Types
Absorbable
Natural
Synthetic
Twisted/Virtual Monofilament
Monofilament
Braided
Short
Short/Medium
Medium
Short/Medium
Long
Short
Medium
Fast Absorbing Gut
Plain Gut
Chromic Gut
MONOCRYL*
PDS* II
VICRYL RAPIDE*
VICRYL*
MONOCRYL* Plus
PDS * II Plus
VICRYL RAPIDE* Plus
VICRYL* Plus
14. Absorption Process - Defined
â˘âŻTwo types:
â˘âŻHydrolysis â absorbed in water (H20)
â˘âŻThe human body is over 70% water
â˘âŻLess reactive
â˘âŻMore consistent
â˘âŻEnzymatic â digested by enzymes
â˘âŻCan lead to swelling and edema
â˘âŻMalnourished patients digest suture material more quickly (protein)
15. Critical Wound Healing Period (CWHP)
â˘âŻSkin
â˘âŻMucosa
â˘âŻSubcutaneous
â˘âŻPeritoneum
â˘âŻFascia (40%)
5-10 Days
5-7 Days
7-14 Days
7-14 Days
60 Days
0
5
7
14
21
Tissue Healing Times
in Days
28
60
16. Short-term Wound Support
â˘âŻSituation in Short-term Wound Support
â˘âŻSkin & mucosa
â˘âŻTypically emergency procedures
â˘âŻTypically areas with increased blood flow
â˘âŻNeed
â˘âŻFast-absorbing suture
â˘âŻRapid loss of strength/mass
â˘âŻGood knot formation/snug down
17. 1.Plain Gut Suture
Characteristics
Surgical Gut Suture â Plain
Material
Beef Serosa or Sheep Submucosa
Natural/Synthetic
Natural
Construction
âMonofilamentâ Absorbable
Coating
Not Coated
Color
Yellowish - Tan
Available Size Range
3 â 7/0, Fast Absorbing Gut sizes 5/0 - 6/0
Strength Retention Profile
Approximately 7 - 10 days post-op
Fast Absorbing Gut = Approximately 5 â 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.
18. 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 â 7/0
Strength Retention Profile
Strength retention for approximately
21 â 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.
19. 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 â 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
20. Short-Medium-Term
Wound Support
â˘âŻSituation in Short-Medium-term Wound Support
â˘âŻSkin, mucosa, subcuticular
â˘âŻIdeal for subcuticular tissue closure
â˘âŻTypically areas with increased blood flow
â˘âŻNeed
â˘âŻHigh initial strength
â˘âŻGood cosmesis
â˘âŻGood handling & smooth passage through tissue
â˘âŻGood knot formation/snug down
â˘âŻLow reactivity
21. 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.
22. 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.
23. MONOCRYL Plus Suture
â˘âŻBactericidal â kills bacteria
â˘âŻBacteriostatic â inhibits bacteria growth
â˘âŻKills
â˘âŻStaphylococcus aureus
â˘âŻStaphylococcus epidermidis
â˘âŻMethicillin-resistant Staphylococcus aureus (MRSA)
â˘âŻMethicillin-resistant Staphylococcus epidermidis (MRSE)
â˘âŻE. coli
â˘âŻKlebsiella pneumoniae
â˘âŻThe performance, safety and handling are equivalent to
MONOCRYL Suture
24. How Did We Do It?
â˘âŻTyvek patch
â˘âŻContains triclosan which is
absorbed by the suture during
the sterilization process
â˘âŻAs a result, ETHICON, INC.
has an improved claim against
additional pathogens/bacteria
â˘âŻMONOCRYL Suture doesnât
know it is MONOCRYL Plus
Suture until the tyvek patch
is added
25. Medium-term Wound Support
â˘âŻSituation in Medium-term Wound Support
â˘âŻAll tissue layers that align with the critical wound healing period of
21-28 days
â˘âŻAll tissue types
â˘âŻNeed
â˘âŻConsistent strength around the CWHP
â˘âŻGood handling & passage through tissue
â˘âŻGood knot formation/snug down
â˘âŻLow reactivity
26. 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 â 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 â 70 days
Absorption Process
Hydrolysis
Frequent Uses
General soft tissue approximation and/or ligation, including use in ophthalmology
27. 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 â 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 â 70 days
Absorption Process
Hydrolysis
Frequent Uses
General soft tissue approximation and/or ligation
29. Coated VICRYL Plus Suture
â˘âŻFrequently Asked Questions
â˘âŻDoes the triclosan wear off as it passes through the tissue?
â˘âŻAllergic reactions
â˘âŻDoes it affect wound healing?
â˘âŻThe performance and handling are equivalent to Coated VICRYL
Suture.
30. Plus Antibacterial Sutures
â˘âŻCoated VICRYL Plus Suture
â˘âŻ minimum of 7 days
â˘âŻPDS* Plus Antibacterial (polydioxanone) Suture
â˘âŻ 23 days S. aureus
â˘âŻ 17 days E. coli
â˘âŻMONOCRYL Plus Suture
â˘âŻ 31 days S. aureus
â˘âŻ 21 days for E. coli
32. Longer-Term Wound Support
â˘âŻSituation in Longer-term Wound Support
â˘âŻTissue that requires extended support
â˘âŻSlow healing tissue/ compromised patients
â˘âŻTypically fascia tissue
â˘âŻNeed
â˘âŻStrength beyond the CWHP of 21 days
â˘âŻGood handling & passage through tissue
â˘âŻGood knot formation/snug down
â˘âŻLow reactivity
33. 7. PDS II Suture
Characteristics
PDS II Suture
Material
Polydioxanone
Natural/Synthetic
Synthetic
Construction
Monofilament Absorbable
Coating
Color
Not Coated
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
60% of original strength @ 2 weeks post-op
40% of original strength @ 4 weeks post-op
35% of original strength @ 6 weeks post-op
Absorption Time
Absorption Process
182-238 days (6-8 months)
Hydrolysis
Frequent Uses
Soft tissue approximation, including use in pediatric cardiovascular tissue where
growth is expected to occur; ophthalmic surgery, fascia closure
Size 3-0 and larger
80% @ 2 weeks
70% @ 4 weeks
60% @ 6 weeks
34. 8.PDS Plus Suture
Characteristics
Material
PDS Plus Suture
Polydioxanone
IRGACARE MP (triclosan)
Natural/Synthetic
Construction
Coating
Color
Available Size Range
Synthetic
Monofilament Absorbable
Not Coated
Undyed Clear and Dyed Violet
2 through 9/0 dyed
1 through 7/0 undyed
Strength Retention Profile
Size 4-0 and smaller
60% of original strength @ 2 weeks post-op
40% of original strength @ 4 weeks post-op
35% of original strength @ 6 weeks post-op
Absorption Time
Absorption Process
Frequent Uses
182-238 days (6-8 months)
Hydrolysis
Soft tissue approximation, including use in pediatric cardiovascular tissue
where growth is expected to occur; ophthalmic surgery, fascia closure
Size 3-0 and larger
80% @ 2 weeks
70% @ 4 weeks
60% @ 6 weeks
36. PDS II Suture IFU Changes
â˘âŻOld Data
â˘âŻ70% 2 weeks
â˘âŻ50% 4 weeks
â˘âŻ25% 6 weeks
â˘âŻNew in vivo studies
â˘âŻAbsorption at 183 days
â˘âŻBoth PDS II Suture and
showed significant
improvement in the
breaking strength retention
profile of PDS II Suture
PDS Plus Suture
38. 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
Ligation and general closure; general surgery. Ophthalmology, plastic surgery and
neurosurgery
Frequent Uses
39. 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 â 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
40. 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
41. 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
42. 13. MERSILENE Suture
Characteristics
MERSILENE Suture
Material
Polyester
Natural/Synthetic
Synthetic
Construction
Braided and Monofilament Non-Absorbable
Coating
Color
Not Coated
Green and White
Available Size Range
Braided 5 through 6/0
Monofilament 10/0 â 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
43. 14. PROLENE*
Polypropylene Suture
Characteristics
PROLENE Suture
Material
Polypropylene
Natural/Synthetic
Synthetic
Construction
Monofilament Non-Absorbable
Coating
Not Coated
Color
Available Size Range
Blue and Clear
2 through 10/0
Strength Retention Profile
Indefinite
Absorption Time
Absorption Process
Frequent Uses
Non-absorbable suture is encapsulated in tissues
Non-Absorbable
General, plastic, cardiovascular surgery and skin closure; ophthalmology
44. 15. PRONOVA * Poly (Hexafluoropropylene - VDF) Suture
Characteristics
PRONOVA Suture
Material
Polymer blend of poly (vinylidene fluoride) and poly (vinylidene fluoride-cohexafluoropolypropylene)
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
45. ETHICON Suture Material Colors
â˘âŻSUTURES
COLOUR
â˘âŻPLAIN GUT
â˘âŻCHROMIC GUT
â˘âŻMONOCRYL Suture
â˘âŻCoated VICRYL Suture
â˘âŻPDS II Suture
â˘âŻSILK Suture
â˘âŻNUROLON Suture
â˘âŻETHILON Suture
â˘âŻMERSILENE Suture
â˘âŻETHIBOND EXCEL Suture
â˘âŻPROLENE Suture
â˘âŻPRONOVA Suture
YELLOWISH TAN
BROWN
CLEAR or VIOLET
VIOLET or UNDYED (natural)
VIOLET or CLEAR
BLACK
BLACK
BLACK (green or clear)
GREEN or WHITE
GREEN or WHITE
BLUE or CLEAR
BLUE or CLEAR
49. Surgical Needles â Definition
â˘âŻSurgical needles are necessary for the placement of sutures
in tissues, therefore, they must be designed to carry suture
material through tissues with minimal trauma
50. Characteristics of the Ideal Needle
â˘âŻMade of high quality stainless steel
â˘âŻAs slim as possible without compromising strength
â˘âŻStable in the grasp of a needle holder
â˘âŻAble to carry suture material through tissue with
minimal trauma
â˘âŻSharp enough to penetrate tissue with minimal resistance
â˘âŻRigid enough to resist breaking during surgery
â˘âŻSterile and corrosion - resistant to prevent introduction of
microorganisms or foreign materials into the wound
51. Elements of Needle Design
â Strength
â˘âŻDetermined by how it resists deformation during repeated
passage through tissue
â˘âŻTissue trauma can be induced if a needle bends during
penetration
â˘âŻCompromises tissue apposition
â˘âŻGreater needle strength equals less
tissue trauma
52. Elements of Needle Design
â Ductility
â˘âŻRefers to the needleâs resistance to breaking under a given
amount of bending
â˘âŻNeedle breakage can prevent apposition of wound edges
â˘âŻSearching for a part of a broken needle can cause additional
trauma and add to anesthesia time
53. Elements of Needle Design
â Sharpness
â˘âŻRelated to the angle of the point as well as the taper ratio of
the needle
â˘âŻToo sharp and a surgeon may not feel they have adequate
control of needle passage
â˘âŻToo dull and a surgeon will face a less then desirable
cosmetic outcome
54. Elements of Needle Design
â Stability
â˘âŻStability of the needle in the grasp of the needle holder
â˘âŻRocking, twisting and turning gives less desirable cosmetic
outcomes
55. Elements of Needle Design
â The ETHICON Advantage
â˘âŻStrength: ETHALLOY* Needle Alloy/Manufacturing process
â˘âŻDuctility: Ethalloy alloy
â˘âŻSharpness: MULTIPASS* Needles
â˘âŻStability: Ribs/I-Beam
*Trademark
57. Anatomy â The Eye
â˘âŻThe Eye
â˘âŻClosed eye
â˘âŻFrench eye (Split or Spring)
â˘âŻSwaged
â˘âŻDisadvantages
â˘âŻTime consuming
â˘âŻTissue disruption
â˘âŻRepeated use
58. Anatomy â The Eye
â˘âŻSwaged Needles
â˘âŻDrilled
â˘âŻChanneled
â˘âŻAdvantages
â˘âŻHandling and preparation are minimized
â˘âŻMinimal trauma
â˘âŻSecurity
â˘âŻETHICONâs swaged needles
â˘âŻATRALOC* Surgical Needle
â˘âŻCONTROL RELEASE* Needle or Needle Suture - facilitates fast
separation when desired
*Trademark
59. Anatomy â The Body
â˘âŻStraight Needle
â˘âŻHalf-Curved Needle
â˘âŻCurved Needle
â˘âŻCompound Curve Needle (80Âş tip, 45 Âş body)
60. Anatomy â The Body
â˘âŻStraight Needle
â˘âŻPreferred when suturing easily accessible tissue
â˘âŻSkin closure, meniscus repair, tendon repair, nerve repair and
in ophthalmic cases
61. Anatomy â The Body
â˘âŻHalf-Curved Needle (Ski Needle)
â˘âŻSkin closure
â˘âŻLaparoscopic procedures
62. Anatomy â The Body
â˘âŻCurved Needle
â˘âŻAllow predictable turnout
â˘âŻRequires less space
for maneuvering
â˘âŻ1/4 Circle
â˘âŻ3/8 Circle
â˘âŻ1/2 Circle
â˘âŻ5/8 Circle
63. Anatomy â The Body
â˘âŻCompound Curve Needle
â˘âŻOphthalmic Surgery
64. Anatomy â The Point
â˘âŻNeedle Points
â˘âŻConventional Cutting Needles
â˘âŻReverse Cutting Needles
â˘âŻSide Cutting Needles (Spatula Needles)
â˘âŻTaper Point Needles
â˘âŻTapercut Needles
â˘âŻBlunt Point Needles
â˘âŻETHICON Needle Codes
65. Anatomy â The Point
â˘âŻConventional Cutting Needles
â˘âŻ Two cutting edges plus a third cutting edge on the inside concave
curvature of the needle
â˘âŻ Prone to cutout of tissue because the inside edge cuts to the edges
of the incision or wound
â˘âŻ PC PRIME* Needle
(Precision Cosmetic)
â˘âŻ Narrow point
â˘âŻ Fine wire diameter
â˘âŻ Fine taper ratio
*Trademark
66. Anatomy â The Point
â˘âŻReverse Cutting Needles
â˘âŻThe third cutting edge is located on the outer convex curvature
of the needle
â˘âŻMore strength than similar-sized Conventional
Cutting Needles
â˘âŻDanger of cutout is greatly reduced
â˘âŻThe hole left by the needle
leaves a wide wall of tissue
against which the suture
is to be tied
â˘âŻETHICON Needles
â˘âŻMICRO-POINT*
Surgical Needle
â˘âŻOS Needle
â˘âŻFS/PS Series
*Trademark
67. Anatomy â The Point
â˘âŻSide Cutting Needles (Spatula Needles)
â˘âŻFlat on both the top and bottom-eliminates undesirable tissue cutout
â˘âŻDesigned for Ophthalmic procedures to separate or split through the
layers of scleral or corneal tissue
â˘âŻETHICONâs needles
â˘âŻSABRELOC*
Spatula Needles
â˘âŻCS ULTIMA*
Ophthalmic Needles
â˘âŻTG PLUS
*Trademark
68. Anatomy â The Point
â˘âŻTaper Point Needles
â˘âŻRound bodied needles that pierce and spread tissue without cutting it
â˘âŻNeedle point tapers to a sharp tip and the needle body flattens to an
oval or rectangular shape
â˘âŻUsed in easily penetrated tissue when the smallest hole and minimal
tissue cutting is desired.
69. Anatomy â The Point
â˘âŻTapercut needles
â˘âŻCombines the features and benefits of the reverse cutting edge tip
and taper point needles.
â˘âŻThree cutting edges extend approximately 1/32â back from the point.
These blend into a round taper body.
â˘âŻPenetrates 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
â˘âŻEthiconâs needles
â˘âŻV Series
â˘âŻCC Series
70. Anatomy â The Point
â˘âŻBlunt Point Needles
â˘âŻDissect friable tissue rather than cutting it
â˘âŻTaper body with a rounded, blunt point that will not cut tissue
â˘âŻUsed when suturing the kidney, liver or in deep spaces prone to
space and visibility limitations
â˘âŻETHIGUARD* Blunt Point Needles
*Trademark
72. Measurements of a Needle
â˘âŻDetermine the size of a needle
â˘âŻMeasured in inches or in metric units
â˘âŻChord Length â the straight line distance from the point to the swage
â˘âŻNeedle Length â the distance measured along the needle itself from
the point to the end
â˘âŻRadius â 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
â˘âŻDiameter â the gauge or thickness of the needle wire
78. Integral Part of Each Product
â˘âŻProtect content
â˘âŻProvide convenience to the user
â˘âŻSterile products
79. Purpose
â˘âŻProtect and preserve product
â˘âŻPrevent product damage
â˘âŻProvide identifiable product information
â˘âŻConvenient, safe and sterile transfer of the product
â˘âŻMeet the needs of all members of surgical team
81. RELAY Delivery System
â˘âŻDeveloped by ETHICON
â˘âŻStores and delivers sutures
â˘âŻReduces unnecessary handling
â˘âŻProvides control over suture storage, usage, inventory
rotation, needle counting and cost containment
82. Dispenser Boxes
â˘âŻDispenses sutures from opening
at bottom of box
â˘âŻProduct information on side of box
â˘âŻThree most important criteria
â˘âŻSuture size
â˘âŻSuture material
â˘âŻType and size of needle
84. Product Code Number
â˘âŻThe first letter of the product code
denotes the suture type
â˘âŻAbsorbable
â˘âŻ VR â VICRYL RAPIDE Suture
â˘âŻ Y â MONOCRYL Suture
â˘âŻ J â Coated VICRYL Suture
â˘âŻ V â Uncoated VICRYL Suture
â˘âŻ Z â PDS II Suture
â˘âŻNon-Absorbable
â˘âŻ G â Green ETHILON Suture
â˘âŻ X â ETHIBOND EXCEL Suture
â˘âŻ R â MERSILENE Suture
â˘âŻ A â Silk Strands
85. Product Code Number
â˘âŻThe last letter of the code
denotes the number in each box
â˘âŻG â 1 dozen
â˘âŻD â 1 dozen
â˘âŻT â 2 dozen
â˘âŻH â 3 dozen
â˘âŻThe numbers denote suture/
needle combo
â˘âŻLength
â˘âŻColor
â˘âŻNeedle
86. Suture Material
â˘âŻMaterial
â˘âŻSuture materials are designated by
color and construction characteristics
(e.g. undyed, braided, etc.)
â˘âŻLength
â˘âŻSuture length is shown in both inches
and the approximate
metric equivalent
â˘âŻColor
â˘âŻSuture material can be dyed
or undyed
89. Package Insert
â˘âŻThe package insert found inside
of each new box of suture product
is a very valuable tool to find the
following information
â˘âŻDescription â materials used to
make suture
â˘âŻIndication â recommended tissues
where the suture is to be used
â˘âŻActions â how suture acts when used
â˘âŻContraindications â where suture
should not be used
â˘âŻWarnings â important considerations
â˘âŻPrecautions
â˘âŻAdverse Reactions
â˘âŻHow Supplied
90. Primary Packets
â˘âŻIndividual sutures and multiple suture strands
â˘âŻFast and easy opening in a peelable motion
â˘âŻSingle layer over wrap made of foil or coated Tyvek on one
side to polyethylene film on the other
â˘âŻAbsorbable sutures are always
in foil to provide a moisture barrier
â˘âŻMost non-absorbable sutures
are encased in Tyvek
92. Primary Packets
3.⯠One single-strand of material
with single- or double-armed
swaged needle(s)
â˘âŻ One-step RELAY suture
packets
â˘âŻ Allows the needle to be
armed without touching it
â˘âŻ Increases the safety of
handling needles
intraoperatively
â˘âŻ Needle park
â˘âŻ Provides a standard
location for, and easy
access to, the needle
93. Primary Packets
4.⯠Multiple suture strands
â˘âŻ
â˘âŻ
â˘âŻ
â˘âŻ
â˘âŻ
Swaged to a single-needle or double-armed
For procedures requiring numerous interrupted sutures
Saves time
Labeled with the symbol MS
May contain 3 â 10 swaged sutures
94. Expiration Date
â˘âŻDetermined by product stability studies
â˘âŻFDA requires all synthetic absorbable suture products have
an expiration date
â˘âŻSynthetic absorbable sutures continue to meet requirements
even at five years of storage
â˘âŻRELAY System is design as FIFO inventory control system
95. Sterilization
â˘âŻSutures sterilized are either irradiated with cobalt 60 or
exposed to ethyl oxide gas
â˘âŻAlter proteins, enzymes and other components
â˘âŻCold sterilization
97. Gas Sterilization
â˘âŻProducts that cannot withstand the effects of irradiation are
gas sterilized
â˘âŻUses ethylene oxide gas
â˘âŻETHICON replaces CFCs with more environmentally friendly
compounds
98. Resterilization
â˘âŻDO NOT RESTERILIZE
â˘âŻPackaging and product cannot withstand high temperatures or
extreme pressure without affecting integrity
â˘âŻETHICON will disclaim any responsibility for sterilization and/or other
product failures resulting from resterilization
â˘âŻOnly ETHI-PACK* Pre-cut Steel Sutures and spools or card
reels of nonabsorbable materials should be sterilized
100. Factors to consider when deciding on
number of suture packets necessary
â˘âŻMultiple strands of suture material = fewer packets
â˘âŻOpening sufficient packets for timeâs sake
â˘âŻLeftover sutures, must be discarded
101. Hand-off Method
â˘âŻGrasp the two flaps of peelable overwrap
â˘âŻPeel flaps apart 1/3 of the way down
â˘âŻScrub person takes it with gloved hand or sterile instrument
â˘âŻAvoiding contact with the nonsterile overwrap
102. Flipping Method
â˘âŻFlipping 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
103. Suture Preparation
â˘âŻSequence of tissue layers
â˘âŻOrganize sutures in sequence
â˘âŻGoal should be to have no unused strands at the end
of the procedure
104. Preservation of Tensile Strength
â˘âŻAbsorbable sutures
â˘âŻProtect absorbable sutures from heat and moisture
â˘âŻStore at room temp
â˘âŻDo not soak
â˘âŻSurgical gut can be dipped in tepid water
â˘âŻSynthetic absorbable sutures must be kept dry
â˘âŻStraighten strands with a gentle, steady, even pull
â˘âŻDo not âtestâ suture strength
â˘âŻDo not resterilize
105. Preservation of Tensile Strength
â˘âŻNonabsorbable sutures
â˘âŻSilk â store strands in a dry towel. Dry strands are stronger than
wet strands
â˘âŻSurgical Stainless Steel â handle carefully to avoid kinks and bends
â˘âŻPolyester Fiber â unaffected by moisture. May be used wet or dry
â˘âŻNylon â straighten kinks or bends by caressing strand between
gloved fingers
â˘âŻPolypropylene â unaffected by moisture. May be used wet or dry