8-22
Do not the use the sternal technique in patients with previous sternotomy (heart by-pass), evidence of
sternal skin infection or burns over the insertion site, or fracture or vascular injury that could compromise
the integrity sternum.
Procedure: Suturing
Adapted from 18D Skills and Training Manual with additional information from COL Glen Reside, DC, USAWhen: You must stitch a wound closed without contamination.
What You Need: A large Kelly clamp, a needle holder, tissue forceps, a mosquito clamp, appropriate sutures
and needles or pre-package suture/needle combinations (preferred), four towel clamps, sterile gloves, several
4x8 inch gauze pads, four hand towels, shaving razor, antiseptic solution and sponges, irrigation syringe (may
use attached catheter for increased pressure), sterile saline for irrigation and suture wash, surgical bowl(s), a
22-23 gauge needle with 5-10 cc syringe, and lidocaine anesthesia (with or without epinephrine as appropriate).
What To Do:
- Gather the appropriate equipment. Inspect for damage or tampering.
- Prepare the wound site.
a. Protect the wound with sterile gauze.
b. Shave the skin 3-5 inches around the wound.
c. Perform a surgical scrub.
(1) Clean the wound area with circular motions, making sure not to let antiseptic solution wash into the
wound.
(2) Clean from the wound edges out.
(3) Dispose of the sponges.
(4) Repeat as needed.
d. Irrigate the wound with sterile solution.
(1) Irrigate from one end toward the other, usually from the proximal to distal.
(2) Avoid “suck back” with the syringe. - Drape the patient appropriately with hand towels.
- Check the patient for allergy to medications.
- Administer the anesthesia.
a. Inject anesthetic into the subcutaneous layer.
b. Insert the needle full length.
c. Aspirate for blood.
d. Inject anesthesia upon withdrawal of the needle.
e. Wait for 3 minutes, then test for pain.
WARNING: Do not use Lidocaine with epinephrine to anesthetize the fingers, nose, ears, toes, or penis. - Select the proper suture.
a. Use 5-0 to 6-0 for the face, 3-0 to 4-0 for the arms, legs, and trunk. 2-0 may be used to secure chest
tubes and other high-stress applications. Tend to use smaller sizes in children and in lower stress
areas.
(1) Chromic suture: Use for the bowel, muscle, and peritoneum. Resorbs within 14-21 days.
Packaged in isopropyl alcohol, which is an irritant. Rinse suture with saline prior to use. Causes less
inflammation than plain suture.
(2) Plain suture (gut): Use for subcutaneous tissue and ligation of small vessels. Resorbs within 7-14
days. Packaged in isopropyl alcohol, which is an irritant. Rinse suture with saline prior to use.
(3) Vicryl, Maxon, and Dexon: Strongest absorbable sutures. They are easier to handle and tie than
plain suture, have higher tensile strength, and cause less tissue reaction. Resorb in 4-6 weeks. Vicryl
comes dyed and undyed - avoid using dyed on the face.
(4) Nylon: Most popular skin suture. Not absorbable. Good tensile strength, minimal tissue reaction
(5) Polyester or Polypropylene: Not absorbable. Easier to tie than nylon. High tensile strength,
moderate/ minimal tissue reaction.