Toilet and Suturing Basics

Toilet and Suturing Basics

• Toilet is a wound cleaning or washing procedure.
• Suture refers to stitches applied to body tissues or wounds.
• Toilet and suture is a procedure where wounds are cleaned and stitched aseptically.

KKM Toilet and Suture Set

• The set includes various tools such as:
  • Gauze
  • Stainless steel containers
  • Forceps
  • Scissors
  • Needle holders

Suture Classification: Absorbable

• Vicryl sutures are absorbable.
• Monocryl sutures are absorbable.
• PDS sutures are absorbable.

Suture Classification: Non-Absorbable

• Nylon sutures are non-absorbable.
• Polyester sutures are non-absorbable.

Suture Needle Parts

• The parts of a suture needle are the point, body and swaged end.

Suture Needle Size

• Suture needles come in different sizes, such as:
  • Ferguson 1/2 circle 1842
  • Ferguson 1 1/2 circle

Preparing and Assisting

• Key steps for preparation and assistance include:
  • Verify the doctor's written prescription.
  • Greet the patient, explain the procedure and its purpose.
  • Assess the patient's level of pain.
  • Assess the size and location of the wound.
  • Wash hands.
  • Prepare the trolley and equipment.
  • Provide privacy.
  • Position the patient comfortably.
  • Place a protective sheet under the area to be stitched.
  • Expose the wound area.
  • Wear a mask and sterile gloves after washing hands.

Preparing to Stitch

• Essential steps in preparing to stitch involve: Prepare swabs for toileting. Choose an appropriate suture (type and size of needle). Thread the needle with suture material if using a traumatic type of suture. Hold the needle with the needle holder at the first 1/3 portion. Give local anesthesia if needed (or analgesics).
• Clean the wound with normal saline, adhering to aseptic principles.

Stitching Wound

• Ensure the correct method of suturing, including these steps:
  • Begin with the edge of the wound further away.
  • Start suturing from the center, using an adequate "bite" to bring the skin edges together.
  • Hold the nearer edge of the wound with tooth dissecting forceps.
  • Insert the needle into the skin and bring out in the middle of the wound.
  • Pick the opposite edge of the wound.
  • Insert the needle from under the skin outwards.
  • Slowly pull the suture, leaving about 1 cm of suture.
  • The material should remain at the skin surface opposite.

Tying and Reinforcing Knots

• Key steps in tying and reinforcing knots include:
  • Make 2-3 forward turns of suture material around the needle holder.
  • Grasp the 1 cm suture material opposite with the needle holder and pull through.
  • Repeat 2-3 backward turns of suture material around the needle holder.
  • Grasp the 1 cm part of the material opposite with the needle holder, and pull through again
  • Reinforce with a minimum of 3 knots, alternating to prevent sutures breaking loose.
  • Straighten the suture to allow for easier cutting.
  • Cut the suture to approximately 0.5-1 cm.
  • Be sure correct distance is maintained evenly between each suture
  • Stitch wound until closed, ensuring adequate and equal tension to close approximation
  • Clean wound with normal saline, and apply antiseptic spray if necessary and apply dressing
  • Examine wound and ensure cleanliness is of a high standard.

Documentation and Patient Comfort

• Documentation of the procedure is essential.
• Create a reassuring atmosphere for the patient, for example:
  • Offer comfort.
  • Offer assistance.
  • Gently pat the shoulder.
  • Use reassuring words appropriate to the situation.
  • Clean all equipment according to hospital guidelines.

Potential Complications

• Complications that may arise include:
  • Bleeding
  • Infection
  • Bacterial growth
  • Inflammation
  • Delayed wound healing