SUMMARY OF INSTRUMENTS - YARN AND NEEDLES

INTRODUCTION The use of surgical instruments is planned according to the type of

surgery and surgical time. Surgical procedures are carried out in four stages:
• • • • Diaeresis (opening) itself Hemostasis Surgery (resection) Summary (sutur
e)
The surgical instruments are grouped according to surgical time and for didactic
purposes, classified into seven groups, but this work will emphasize only the g
roup III with regard to synthesis tools. HISTORY Throughout the history of manki
nd, are episodes that depict surgical attitudes to the maintenance of life. Init
ially, the surgeries were directed deferrals for correction and control traumati
c bleeding. Pain control intra-and postoperative anesthesia and the initial step
s of the control of surgical infection also transformed the history of surgery,
contributing to its development. In principle, the surgery was aimed at cripplin
g and extipar part of the patient or the organ affected. After the discovery of
narcosis and asepsis in the nineteenth century, the surgeries began to be restor
ative and conservative. From there then, there is an accelerated advance in deve
lopment, both scientific and surgical techniques more specific, less mutilating
and more cures. It is noteworthy that the relief of pain, cotrol bleeding and in
fection are aspects that remain focused as indicators of surgical success. Anoth
er point to be considered in the evolution of surgery was the challenge of trans
forming the surgery on a scientific activity and a safe therapeutic choice. Alli
es surgical outcome, many instruments were developed and used by surgeons in all
periods of history. Over time many of these instruments, especially the synthes
is tools have been reworked, adapted, removed or replaced by more practical and
specific to a particular procedure. Surgical instruments are essential for the d
evelopment of the sequence that makes up the surgical times.
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SURGICAL TIME
The term surgical times characterizes the sequence of procedures used in handlin
g of tissues and organs during surgery, and identified four basic tenses. Dieres
is: consists of separating tissues, or anatomical planes, to reach a region or o
rgan. The diaeresis can be accomplished by several methods: mechanical, thermal,
cryotherapy and laser, and the most used is the mechanic, using sharps, such as
electric scalpels, scissors, knife, saw burr, needles and others. Hemostasis: I
t is to determine or prevent bleeding. It can be done by clamping and ligation o
f vessels, electrocoagulation and compression. These methods can be used simulta
neously or individually. Surgery itself or Excision: This is the moment when the
surgeon reaches the desired point and performs the surgery in order to diagnose
, control or resolution of the events, reconstructing the area and leaving it as
physiological as possible. Synthesis or Suture: It is the union of the tissues,
the synthesis can be classified as: bloody: suture is permanent or removable un
bloody: suture through plaster, adhesive bandage or Immediate: after incision me
dia: some time after the incision track: in the entire length of the incision in
complete: it maintained a small opening for the placement of drains. In summary
of the plans must be respected hierarchy tissue, its stratification, making the
constitution for the synthesis of tissue identical to each other. The conditions
necessary for a good summary are: antisepsis local vascularization perfect the
edges of incision. Sharp edges, perfect hemostasis, ie, no bruises or other coll
ections, because the success of organic synthesis depends on hemostasis correct
coaptation without compression of tissues, absence of foreign bodies and necroti
c tissue, appropriate choice of yarn for each tissue, implementation with correc
t technique.
Surgical Instruments
The surgical instruments are grouped according to surgical time, as previously d
escribed, this paper will give emphasis to group III, ie, instruments used in th
e synthesis. But it is extremely important we discuss other tools used during su
rgery and how they are grouped. For teaching purposes the surgical instruments a
re divided as follows:
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Group I: Diaeresis of Group II: Group III of Hemostasis: Overview of Group IV: S
pecial Group V: Support Group VI Group VII Field: Afastadores or exposure
Group I: This group is composed almost sharp instruments such as scalpels and sc
issors in various sizes and types,€and others like knife, saw, drill bit needles
. Group II: This group consists of instruments for the clamping of bleeding vess
els, and these hemostatic forceps, straight or curved, with or without tooth, va
rious types and sizes. In general they are called by the name of its creator. Gr
oup III: This group is composed of instruments of suture needles as straight or
curved, triangular or traumatic or atraumatic round-bottom fixed or false. This
group has the needle holder and suture materials. This group will be detailed in
the sequel, to be the main theme of this work. Group IV: This group consists of
instruments whose appointment is determined by the type of surgery. These instr
uments are only used in surgery itself, so take the place apart economies at the
table of instruments. It read like the clamps exmeplo: Duval, Satinsky and Alli
s. Group V: It is composed of auxiliary instruments hold. As its name indicates,
is intended to assist in using other instruments. Basically this group makes up
the tweezers and tooth anatomy of the rat. Group IV: This group consists of cla
mps designed to fix the barren fields for defining the operative field. Basicall
y part of this group calipers Backhaus. Group VII: This group consists of instru
ments that allow exposure to better visualize the operative cavity ..
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SUMMARY OF MANUAL INSTRUMENTS WITH YARN AND NEEDLES
The manual suture, popularly known as "points" and performed using the following
instruments, yarn, needles, forceps and needle holder. The manual synthesis Wir
ed and needles is the most used in surgical procedures, then we detail the main
instruments. Needles are used to in order to transfix the tissues, serving as a
guide for the suture. Material: are usually produced in stainless steel division
: the needle is divided into three parts: • Tip: It is part of the suture needle
that facilitates penetration of the tissue, causing as little trauma as possibl
e. • Body: This is the central portion of the needle, which enables adequate fix
ation to portaagulha. With that provides easy maneuvering of release and redempt
ion of the needle into the tissue during the surgical process of synthesis. • Ba
ckground: This is the point of a union of the needle with the suture. There are
needles and fixed false floor.
The needles are classified as: Shape: Can be straight and curved. The curves can
be 90 °, 135, 180 and 225 º circle. Diameter can be thin or thick Length in inc
hes: the curved needles varies from 3mm to 9 cm and straight 5-6 cm. Type or tip
section: it can be cylindrical, triangular, diamond, tool or blunt. The sharps
are called traumatic and non-cutting to atraumatic. The cylindrical geometry of
the needles and allows for a minimum of trauma when their penetration into the f
abric, place a better seal between the fabric and yarn. The cutting needles are
designed to sever the fibers of the tissue pierced by them, through one or more
sharp edges. No background: No background - the wire is inserted into the needle
- this type is called atraumatic. When there is needle at both ends of the wire
is called a double. 6
Background, and false: Background regular, elongated, square Fund, Fund rounded,
Benjamin Fund, Fund French, fork or false - when the wire can be inserted under
pressure without being stuffed. Parts of a needle
forms needles
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Type of traumatic and atraumatic ends
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Funds Needle
Indications: The suture needle, cylindrical in shape, is indicated for sutures i
n the intestine, peritoneum, vessels and other tissues of easy penetration. The
triangular, for suturing skin and aponeurosis, because the cutting tip enables p
enetration into tissues more resistant. The diamond tip of traumatized unless cy
lindrical, and its power of penetration is higher than the triangular needle. Th
e spatula, by the power of penetration is indicated for ophthalmic surgery. The
blunt shape to organ suturing friable, such as liver, kidney and others.
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Suture
From about 2000 BC There are references indicating the use of strings and tendon
s of animals for suturing. Through the centuries, a variety of materials have be
en used in the manufacture of wire for surgical procedures, such as silk, linen,
cotton, horsehair, tendons and intestines of animals. However, some of these ar
e still used today. The development of suture materials brought us to a point of
refinement that includes the development of sutures and specialty yarns for spe
cific types of procedures. Therefore, to eliminate some of the difficulties enco
untered in the past by surgeons, and also€decreased substantially the potential
for postoperative infection. The suture thread concept is a flexible structure w
ith circular shape and has a reduced diameter. Can be of synthetic material of v
egetable fiber or organic material. Despite being a simple structure is a major
element in the surgery because it is an essential part of surgical sutures and k
nots. Sutures are already within the medical practice since the ancient Greeks a
nd egípsios being used and known by men long before the surgery as we know it to
day. Always important to remember that all the sutures are seen as foreign in ou
r bodies, so they will produce a type of local reaction. But there are peculiari
ties of each wire and thus cause a greater reaction and some other minor reactio
n. The sutures are composed of many different types and classified as: • absorpt
ion • Origin • • Number of filament diameter. As for absorption: Absorbable x no
nabsorbable Absorbable: Are you, some time after the suture, are absorbed by org
anic action, may be of animal origin or synthetic. Catgut simple: it is of anima
l origin, received that name originated from the English translation which is "c
at gut." During the manufacturing process does not undergo any specific treatmen
t to change their time of absorption when in contact with body tissues. The simp
le catgut is indicated for the following surgeries: 10
• • • • • •
Closing General: peritoneum, subcutaneous and bandages. Ob-Gin: anastomoses, epi
siorrafias. Gastrointestinal: anastomoses, omentum. Urology: bladder, prostate c
apsule, ureter, links arteries vesicles, urethra. Ophthalmology: Conjunctival. E
NT: tonsillectomy. Serous natural intestinal submucosa and bovine intestine of s
heep 70-10 days 70 days By cobalt 60 6-0 1
Type of material composition tensile strength of absorption Sterilization Time P
resentation
Catgut chrome: This type of wire is the same source as simple catgut, but was im
pregnated with chromium salts or tannic, to give it more time tensile strength a
nd therefore increasing the absorption time to sue. The simple chrome catgut wir
es are kept in isopropyl alcohol, to maintain their properties. Material type Se
rous natural composition of bovine intestine and intestinal submucosa of sheep t
ensile strength 21 to 28 days 90 days time to absorb Sterilization For cobalt-60
Presentation to a 5-0 catgut The chrome is indicated for the following surgerie
s: • • • • • • Closing General: peritoneum, subcutaneous and bandages. Ob-Gin: a
nastomoses, episiorrafias. Gastrointestinal: anastomoses, omentum. Urology: blad
der, prostate capsule, ureter, links arteries vesicles, urethra. Ophthalmology:
Conjunctival. ENT: tonsillectomy.
Caprofyl. Type of material composition tensile strength Time Synthetic absorptio
n Poliglecaprone 25 (copolymer glycol and caprolactone) 21 91 a 119 days
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Sterilization Presentation
Ethylene oxide to 1 5-0
The caprofyl is indicated for the following surgeries: • • • • Closing General:
peritoneum, subcutaneous tissue. Gastrointestinal: anastomoses, omentum. Ob-Gin:
tubal ligation, vaginal vault, uterus, vaginal wall. Urology: bladder, ureter,
artery ligation vesicular, urethra.
Monocryl type composition material tensile strength of absorption Sterilization
Presentation Time Synthetic Poliglecaprone 25 (copolymer glycol and caprolactone
) 21 91 a 119 days of ethylene oxide 5-0 to 3-0
The monocryl is indicated for: • Plastic (skin) Vicryl type composition material
tensile strength of absorption Sterilization Presentation Time Synthetic Polygl
actin 910, covered with Polyglactin 370 + stearate calcium. 28 56 to 70 days of
ethylene oxide to 2 10-0
The vicryl is indicated for: • • • • • • • Closing General: peritoneum, aponeuro
sis, serosa, submucosa and skin. Neurology: dura, fascia and aponeurotic muscle.
Ophthalmology: sclera, conjunctiva. Gastrointestinal: anastomoses, omentum. Ob-
Gin: bandages, vaginal vault, uterus, bladder, vaginal wall. Orthopedics: synovi
al membrane and knee cap. Urology: bladder, ureter and urethra.
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Vicryl Rapid type composition material tensile strength of absorption Sterilizat
ion Presentation Time Synthetic Polyglactin 910, 370 + Polyglactin covered with
calcium stearate. 10 to 14 days 42 days 60 6-0 1 Cobalt
The rapid vicryl is indicated for: • • • Closure of skin and mucous Plastic Surg
ery Episiorrafias
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Vicryl absorbable suture Vicryl Plus Plus has the same composition, characterist
ics and construction confident that the Vicryl suture. The difference between th
em is that the Vicryl Plus contains IRGACARE MP€the purest form of triclosan, a
broad-spectrum antibacterial agent at a concentration of 0.003 mg / kg. The IRGA
CARE MP is an antiseptic. It is not an antibiotic, and is not toxic at the conce
ntration used. The IRGACARE MP is effective against most common pathogens associ
ated with surgical site infections: Staphylococcus Aureos and Staphylococcus epi
dermidis, both methicillin resistant. This feature promotes protection against b
acterial colonization around the suture line, minimizing the risk of infection
Pds II type composition material tensile strength of absorption Sterilization Pr
esentation Time Synthetic polydioxanone 42 days 180 days EO 7-0 2
The wire PDs II is indicated for: • Closing General: peritoneum and aponeurosis.
• Transplantation: kidney and liver. • Gastrointestinal: serosa, submucosa. 14
• • •
Ob-Gin: bandages, vaginal vault, uterus, bladder, vaginal wall. Orthopedics: syn
ovial membrane and knee cap. Cardiopediatric: coarctation of the aorta.
Nonabsorbable: are those that are permanently in the body, even suffering the ac
tion of exculpatory evidence organic is not disposed, are involved for some time
by fibrous tissue. May be animal, vegetable, mineral, synthetic and blended. Mo
nonylon type composition material tensile strength Sterilization Uses frequent P
resentation: • • • • Closing General: aponeurosis. Microsurgery: anastomoses. Pl
astic: skin. Ophthalmology: cataract extraction, penetrating queroplastia, detac
hed retina, cornea, sclera. Synthetic Fibres of flax Loss of 20% per annum of et
hylene oxide at 0 11-0
Polycot type composition material tensile strength Sterilization Uses frequent P
resentation: • Closing General: bandages and skin. Synthetic Filament Polyester
(70%) and cotton fibers (30%). Permanent Cobalt 60 4-0 0
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• Flax
Gastrointestinal: mucosa, submucosa.
Type of material composition tensile strength Sterilization Uses frequent Presen
tation: Silk • • Type of material composition tensile strength Sterilization Use
s frequent Presentation: • • • • •
Natural linen fibers Undetermined (loses most of the tensile strength in less th
an a year) Cobalt 60 3-0 1
General: bandages Gastrointestinal: mucosa, submucosa.
Natural cocoon silkworm silk (70% Protein + 30% gum) - fibroin (Protein Organic)
1 year 60 8-0 1 Cobalt
Closing General: bandages. Gastrointestinal: mucosa, submucosa. Neurology: dura,
fascia aponeurotic muscle. Ophthalmology: Cataract extraction, queroplastia per
manent strabismus (sclera), retinal detachment. Plastic: skin.
Prolene type composition material tensile strength Presentation Synthetic polypr
opylene permanent sterilization ethylene oxide 10-0 to 2
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Uses frequent: • Closing Overall: aponeurosis. • Gastrointestinal: anastomosis •
Plastic: skin. • Cardiovascular: bypass graft coronary artery, proximal and dis
tal anastomoses, aortomia, aorto-abdominal aneurysm (AAA). • Ophthalmology: Scle
ral fixation. Mersilene type composition material tensile strength Sterilization
Presentation Frequent Use: • • Ophthalmology: Strabismus, Corneal Transplantati
on. Closing General: bandages. Synthetic Polyester (8 careers). permanent 10-0 e
thylene oxide at 0
Ethibond type composition material tensile strength Sterilization Uses frequent
Presentation: • • • Gastrointestinal: laparoscopy. Orthopedics: synovial membran
es. Cardiovascular catheterization, sternal closure, fixation of prostheses, rep
lacement of the valve. Synthetic Polyester (16 rows). Permanent ethylene oxide 5
-0 5
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Aciflex type composition material tensile strength Sterilization Uses frequent P
resentation: • • • Cardiovascular: Closure of the sternum. Oral and Maxillofacia
l: Fixation of the mandible. Orthopedics: bone fixation. Synthetic Stainless Ste
el 316L (low carbon) permanent ethylene oxide 2-0 to 6
Sternumband issues related to consolidation of the sternum is one of the most se
rious complications in heart surgery. Treatment is complex and requires long hos
pitalization resulting desgastefísico and emotional for the patient. " The atern
umband aims to: • Make sternum closure after medial sternotomy in cardiac or tho
racic surgeries. • Promote adequate stabilization of the sternum, favoring the f
ixation. • Prevents the instability of the sternum postoperatively. Why Use Ster
numband? Band width steel (six times that of steel wire) contributes to the forc
e is evenly distributed through the bone, high stability and promoting rapid hea
ling.
The quantity of filaments: There is a monofilament X Multifilamentary subdivisio
n of monofilament and multifilamentary wires.€A monofilament consists of just a
"filament", and is less resistant but more delicate and suffers less resistance
passing through the tissues. A multifilament yarn consists of multiple "strands
of material woven or braided to form a single wire. These are tougher and have m
ore comfortable handling. Other
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features described for the suture as the tissue reaction, infection, resulting i
n firm and we among others, are generally under the raw material for its product
ion.
How The Presentation
Almost all types of suture materials are found with or without needles. The sutu
res are presented by numbers that indicate their strength and thickness. The siz
es range from 6 (thickest) to 12 zeros (thinner) and the number 6 the diameter o
f a strand 12 and the number of zeros of a hair of a baby. The wires also have d
ifferent lengths ranging from 0.13 to 2.50 m, each length indicated for certain
surgeries. As Origin: Natural and Synthetic As the source wires are divided into
natural and synthetic. The natural yarns are produced in nature (animal, vegeta
ble and mineral.) As for the synthetic yarns are obtained by chemical processes.
Packaging Description Of The wires should come in packaging grade surgical or a
combination of plastic film Thermosealers properly according to NBR No. 12 496
of 06.30.1994 and repacked in boxes as the practice of the manufacturer in order
to maintain the integrity and sterilization product during storage until ready
to use and labeled according to law. The individual packages should indicate: Nu
mber surgical Cord Length Type Type suture needle size needle Control Number Num
ber Name of manufacturer of yarn (if multiple)
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SAMPLE PACKAGING ETHICON
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NEEDLE HOLDERS
The Mayo-water port Mayo-Hegar needle is similar to conventional hemostatic forc
eps, is stuck to the fingers for the rings present in their rods and have to rac
k lock, progressive pressure. But his part clamp is shorter, wider and its insid
e the grooves form a lattice with a center slot in the longitudinal direction. A
re devices to increase their efficiency in the immobilization of the needle duri
ng suturing, preventing its rotation when the force is applied. If the branches
clamps are coated hard metal (tungsten) will not show longitudinal split. Althou
gh the ease or difficulty in closing and opening may be related to the temper an
d quality of steel that are produced, theoretically its handling is smoother in
the instruments that have longer stems. In this case the application of force is
further from the pivot axis of the branches, making a move to leverage more eff
icient, as we know from physics.
21st
The Needle Mathieu Mathieu differ much from previous, in its way, has no rings o
n the rods is the opening of the clamp part limited because there are a spring-s
haped blade uniting their stems, which makes them automatically open, when not l
ocked. They are used attached to the palm of his hand, which make them open, if
it is inadvertently used excessive force during handling. Your best indication w
ould be to suture structures that offer little resistance to the passage of the
needle. A good indication of this is that they lack the longitudinal split which
increases the support of the needle.
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The Olsen-Hegar needle holder of Olsen-Hegar is characterized together in a sing
le instrument, the functions of tweezers and scissors to cut the wires. Below th
e portion that holds the needle for the blades that cut the wires. During fabric
ation of the node instrumental, sometimes the wire can bring to the blades, bein
g cut accidentally, which is why many people avoid their use.
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The Gillies needle holder GILLIES has rings on the rods, which are asymmetric: t
he longest to the shortest finger and the thumb, which gives it greater ergonomi
cs. It has no rack to hang the rods, which indicates its use be more suitable fo
r suture needles with small, soft fabrics.
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CONCLUSION
In this study, we observed that the principles used for choosing the ideal synth
esis tools for each time of surgery, is extremely important to obtain a positive
prognosis, free of any iatrogenic short and long term. Synthesis tools are used
come in different brands and substances on the market today, so we must emphasi
ze the importance of professional nursing in the choice of synthesis tools for y
our unit, the success of all 25
a team depends on this work,€you should opt for a better quality product possibl
e.
REFERENCES Rebollo, Eliane Covre, Booklet Surgical Nursing, Limeira. São Paulo,
2003.
Sharing service Scribd online texts, Class 6, Available at: http://www.scribd.co
m/doc/7262687/Aula-6-Suturas, accessed the 20/03/2009 16:30:30.
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