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CRCST Self-Study Lesson Plan
Lesson No. CRCST 145 (Technical Continuing Education - TCE) by Carla McDermott, RN, ACE, CRCST
Clinical Nurse III
Sponsored by: South Florida Baptist Hospital
Plant City, Fla.
SUTURE MATERIALS
LEARNING OBJECTIVES URGEONS HAVE LONG BEEN CONFRONTED WITH CHALLENGES AS
1. Review basic background information they consider the best method of closing incisions. In early surgical history,
about sutures suture selection included very few options; however, modern suture selection
2. Discuss alternative types and sizes of Sdecisions relate to several factors, some of which are physician-driven and
needles with which sutures are used others based on specific patient needs. Central Service (CS) professionals must be familiar
with the types of sutures and needles used in their facility. With this familiarity, they can
then consistently provide requested items in their ongoing efforts to provide excellent
customer service to the patients, physicians and surgical team members.
Suture materials are available in ties of a required suture material may be
numerous sizes, packaging and delivery requested with a specific and separate
styles. For example, common “ties” are “free needle” (one with an eye through
suture material provided without a needle which the chosen suture material is
attached or without a needle included threaded). The surgeon can then meet
in the package that are used to ligate (tie patient-specific needs when similar
off) smaller blood vessels not closed by “swedged-on” sutures (those in which
electrosurgical cautery (burning). Ties the suture is molded onto the needle as a
may be packaged separately in lengths of continuous unit) are unavailable.
18” and 30” to accommodate the working
depth of the procedure being performed. SWEDGED-ON SUTURES
Note: Typically, surgeons prefer shorter Most sutures are available in multiple
sutures unless longer ones are required. sizes and with a wide variety of needle
Ties are also available in several types types. For example, swedged-on
of material preloaded onto a plastic reel needles can be “pop-off,” which means
(dispenser), which provides a continuous the slightest tug between the suture
length of suture to prevent the need to and the needle causes the needle to be
repeatedly hand off sutures. Alternately, immediately and permanently detached
This series of self-study lessons on CS topics was de- Purdue University, Stewart Center Room 110, 128 For More Information:
veloped by the International Association of Healthcare Memorial Mall, WestLafayette, IN 47907-2034. IAHCSMM provides online grading service for
Central Service Materiel Management (IAHCSMM). any of the Lesson Plan varieties. Purdue University
Purdue University’s Extended Campus and IAHCSMM Scoring: Each 20-question quiz graded online at provides grading services solely for CRCST and
both offer grading opportunities. www.iahcsmm.org or through Purdue University, with a CIS lessons. Direct any questions about online grading
passing score of 70% or higher, is worth two points (2 to IAHCSMM at 312.440.0078. Questions about
Earn Continuing Education Credits: contact hours) toward CRCST re-certification (12 points). written grading are answered by Purdue University at
800.830.0269.
Online: Visit www.iahcsmm.org for online Subscription Series: From January 1 to June 30 each
grading at a nominal fee. year, Purdue Extended Campus offers an annual mail-in
or online self-study lesson subscription for $75 (six
By mail: For written grading of individual lessons, specific lessons worth 2 points each toward CRCST
send completed quiz and $15 to: PEC Business Office, re-certification of 12 CE). Call 800.830.0269 for details.
www.iahcsmm.org NOVEMBER / DECEMBER 2015 Communiqué
CRCST Self-Study Lesson Plan
Suture Sizes
SMALLEST SIZE – 10-0 9-0 8-0 7-0 6-0 5-0 4-0 3-0 2-0 0 1 2 3 4 5 – LARGEST SIZE
this is not the preferred method of suture
requisition for surgeons or surgical staff.
Gentle guidance from CS staff about the
benefits of including the identification
number will help best ensure superior
service.
MORE ABOUT SUTURES
Suture is produced from a wide variety
of animal-based and synthetic materials.
The simplest categories are “absorbable”
and “non-absorbable.” Absorbable sutures
will eventually dissolve, absorb into the
tissue and become non-identifiable. The
speed at which this occurs is determined
by the specific material, tissue condition,
over-all patient health and size of the
suture utilized. Non-absorbable sutures
are permanent fixtures in the body and,
when properly tied or secured, will
remain intact indefinitely.
Disposable suture set Sutures can be made of monofilament
(single strand) and braided (multiple
from the suture material. Pop-off sutures those previously outlined in this lesson, strand) materials. Those made from
allow placement of an interrupted suture have a needle swedged onto only one end; chromic gut, plain gut and stainless
stitch, which secures tissue approximation these are sometimes referred to as single- steel are monofilament. Nylon can be
by knotting or tying off each individual arm sutures. By contrast, double-arm purchased as either a monofilament or
suture. Sutures with pop-off needles are sutures have a needle swedged onto each braided suture. Silk and polymers (tiny
packaged with eight individual sutures end of the suture material; however, any molecules in long repeating chains) are
and needles. suture request is presumed to be single- used to make polyglycolic acid (PGA)
A second type of swedged-on needle arm, unless a specific request is made for sutures from multiple strands of material
provides a permanent attachment a double-arm suture. braided to form a single strand. Surgeons
between the suture and needle, and The variety of sutures available can select the type of sutures they wish to use
allows the surgeon to place a continuous seem almost endless and confuse those based on tissue condition, potential for
running or locking suture line. The who are new to the surgical environment; wound infection and the patient’s overall
needle is cut from the suture prior to however, every variation has a unique health.
securing the suture knot. This swedged- reorder/catalog number prominently Suture sizing is based on a scale where
on needle is available in packages of displayed on each suture package and zero (0) is the common indicator. A
one, three or five individual sutures with storage box. CS professionals should size zero suture is the same thickness,
needles. Note: The same suture material encourage the use of the specific suture regardless of the type of material from
swedged onto the same type of needle may number on all surgeon preference cards which it was made. Note: The zero
be provided in packages of different suture (electronic or manual) and with each distinction does not relate to the material’s
lengths. individual suture request from the sterile tensile strength (the stress it can bear
The majority of sutures, including core. Unfortunately, in many facilities, without tearing apart). All other suture
Communiqué NOVEMBER / DECEMBER 2015 www.iahcsmm.org
CRCST SELF-STUDY LESSON PLAN
requested suture. As previously stated
in this lesson, each variation of suture
material, suture size, needle type and
needle size has a unique reorder/catalog
number. Needle size and type are noted
on the dispensing box and on individual
suture packets.
Needles can be tapered, cutting, trocar
or blunt. Some needles are straight and
generally do not require use of a needle
holder. The amount of desired needle
curvature relates to the location and type
of tissue that the needle is designed to
approximate (close). Tapered needles
are curved and round bodied and are
of two basic types. One type is a small
delicate needle used to suture bowel tissue
and ligate larger blood vessels or other
thin tissue; they are often referred to as
gastrointestinal (GI) needles. They may
be used, for example, if a blood vessel
This suture rack groups sutures by material (color of box) and size (numeric). It also demonstrates top/back loading capability which is cut during surgery and the surgeon
facilitates proper stock rotation (first in, first out). must place a suture ligature to control
bleeding. These GI needles are available
sizes are measured from zero. Suture is required. Sizes 2-0 through 5 sutures in different sizes of the same shape,
materials thicker or heavier than zero are can be placed with standard Mayo-Hegar style and thickness (CS personnel may
indicated by a number larger than zero; needle holders. receive a STAT request for a “3-0 silk GI
the larger the number, the thicker the Storage and arrangement of suture to OR #2”). This requisition would be
suture material. When suture material material will depend greatly on the for a single swedged-on, 3-0 silk suture
is smaller than zero, the size is indicated facility and the surgical service lines on a delicate tapered needle. Alternate
by a number, minus zero. Sutures are being offered. Staff may find all general specialty needles vary in size, thickness
available from a size 10-0 (smallest size) or commonly-used suture of a single and curvature, depending upon the
to a 5 (largest size). material and/or type grouped together type of procedure for which they will be
When discussing/verbalizing suture and arranged by size (such as 1-0, 2-0, used (e.g., Ophthalmology, plastic and
sizes, they are referred to as number 1, 2, 3-0, etc.). Manufacturers utilize a color cardiovascular).
3, 4 or 5 and 0 (zero or “oh”), 2-(“oh”) and code on the box and package for easy The second type of tapered needle is
so on. Note: One will not hear anyone ask identification. Specialty sutures may heavier and used when the tissue being
for a 1-0 (“oh”) suture. be stored separately (e.g., Ophthalmic approximated is thicker or denser. It is
Here is a recap of suture sizes: Suture and cardiovascular sutures could be on often referred to as a general closure
sizes 10-0, 9-0, and 8-0 require a separate racks or carriers). It is critical to (GC) or Mayo needle. GC needles also
microscope and the use of microscopic- know where and how sutures are stored, come in graduated sizes, with needle size
style needle holders. Suture sizes 7-0, so optimal service can be provided to the designations differing by brand of needle.
6-0, and 5-0 usually require the surgeon surgical team. These needles they are available attached
to wear magnifying glasses and use to a variety of suture materials. Figure 2
microscopic needle holders. Sizes 4-0 SUTURE NEEDLES shows examples of GI and GC needles.
and 3-0 do not require magnification CS technicians recognize the need to Cutting needles can be straight or
to effectively place the suture, but a know basic information about needle curved, and they have a three-point
smaller or lighter weight needle holder types and sizes, so they can select the diamond-shaped tip that blends into a
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