Saturday, August 18, 2007

Top 10 List: Terrific Tips for Stupendous Suturing

Today, while shadowing in the ER, I sutured real people for the first time. Twice.

Clearly, this makes me one of the world's leading expert on skin sewing. Ask any doctor.

This, and watching dozens of lacerations put together, and taking part in a suturing workshop with very realistic artificial materials designed to perfectly simulate human skin (those materials being made of box cardboard).

Fortunately, it was the second patient - not the first - who asked, "Have you done this before?"

I answered him truthfully. "Yes," I said.

So, having learned so much from my great wealth of experience, I have decided to benefit you, the reader, with ten terrific tips for stupendous suturing of lacerations.

If you're a medical student, like myself, use these ten tips and you will blow away your classmates.

If you are a nurse or patient, read this list then verbally chastise any physician you see who does not follow these ten tips.

If you are a doctor, verbally chastise yourself right now, out loud, under the assumption that you do not know all of these ten tips.

I request no repayment for this tremendously valuable guide, other than the act of "suturing" be re-named "Vituming." With a capital V.

10. Don't have your stethoscope draped around your neck while you suture. Place it in a pocket or on a desk.
It will get in the way and ruin your sterile field (not good) - very important for emergency department laceration suturing.

(Actually, research has shown that
sterile gloves and sterile saline are not needed for ER suturing, as they don't significantly reduce the rate of infection.)

9. Don't have your ID badge on a lanyard. Use a clip instead.
It will get in the way and ruin your sterile field. So not good.

8. Don't have your lab coat on. Roll up the sleeves or remove it.
The sleeves will get in the way of your sterile field. Like, totally, so not good.

7. If the patient is getting woozy, tell them not to look at the wound.
The patient I saw was very pale.
Research shows that by telling them not to look at the wound, they will not get woozy (research pending). Research also shows verbally demeaning or physically assaulting the patient will help with compliance on this point.

6. Don't bend the needle.
This will make it a pain to get through the wound. This is partially accomplished by grasping the suture needle at the right point with the needledriver - close to the end.

Generally, getting patient blood inside you is something you should try to avoid. Mostly for the pain, I think that's what I was told once, but there are supposedly some blood-borne illnesses that are nasty.

4. Poke the patient.
You can't suture a patient if you don't puncture their skin with the suture needle. Trust me on this one. This is more important than #5; as well, the comedic value is decreased if it is ranked higher than #5.

3. Ignore the fact that the image associated with this post shows suture removal, not suture administration.
Allowing little errors like this to cloud your mind while you suture will distract you from doing a good job. Your patient will complain, and likely sue you.

2. Efface the edges.
For improved wound healing. Or something like that.


Sorry I couldn't come up with a #1. What did you think I was, an expert on the topic? I've only done this twice.

By the way, before you follow any of these, make sure you read the disclaimer below. Especially the part about not listening to any advice on this blog.

(If you actually are an expert, by all means, post your tips.)


incidental findings said...

I think that tip #1 should be the guy that puts em in should be the one to take em out. The ER docs would scream at me about this, but I can't count the # of times I've been cursing to high heaven trying to figure out what kind of inane suturing someone else did.

"Vertical mattress? It's a 2cm superficial cut!"

"OMG, he closed back skin with 5-0 vicryl?! Who did this to you?!"

Anonymous said...

Great list! I'm particularly impressed with your research link. Very well done.

For number one, how about, when possible, injecting a little local into the wound? (you know, the whole pain thing)

Anonymous said...

I have always wondered about the apparent "sloppy" nature of suturing in the ER. The research, however, seems to indicate best practice taking into consideration the risk/benefit ratio. ;)

Nurse B said...

How very David Letterman to have such an anti-climactic #1... ;)

Anonymous said...

Thanx for making me laugh!
Ciao, Ali