Simple Interrupted Demonstration


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    00:05 In this video, I'm going to demonstrate the simple interrupted stitch. We start by loading the instrument in such a way that the needle is about halfway down the length of the instrument.

    00:15 Okay, we're right at the tip of the instrument.

    00:17 Very close to the end here.

    00:19 The teeth on the instrument will hold just as well out here as they do down here. And you'll have much more control.

    00:24 I have mine just a little bit over 90 degrees.

    00:27 If you have it less than 90 degrees and an angle that's inward, that's going to be detrimental to you outward is okay, but pretty much get close to 90.

    00:35 You'll find it's much easier now.

    00:37 I have a good balance of radius to work with and leverage.

    00:40 If I get really far back to the edge here, I may find that I start popping off the needle just because I'm crimping it and may come loose there. If I get out here, then obviously I'm right by the tip of it. It's sharp where I'm going to be dulling it up.

    00:51 At the same time, I may be potentially causing trauma to my suture, but I also won't have much travel to get into the tissue.

    00:58 So if I'm like, right out here, I can't really poke it in very well.

    01:01 So if you're really far back, the opposite is true.

    01:04 I can poke it really far, but I don't have a lot more leverage.

    01:06 I'm going to bend my needle, so get kind of in the middle.

    01:10 Let's go right to the middle of our incision.

    01:12 Okay. Use your tissue forceps and your non-dominant hand to lift it up and drive it through.

    01:19 I reset it, get ready to go.

    01:22 And then on the opposite side here, I'm going to kind of think in your mind like a pendulum. There's a spot where you can tell this is going to line up really nice.

    01:29 Your non-dominant hand can hold this with your tissue force up. No matter what I do, I can use that tissue force up as a guidance of where to go.

    01:38 I can poke right past it.

    01:40 There we go. People ask how far should I have my bites apart? How big should they be? Well, realize that you want to have them enough to hold the tissue, but typically about half centimeter, just slightly less than that on each side is a great way to do this for the simple interrupted. Okay, now that's the first part of this movement.

    01:58 Get that part down and we'll continue on.

    02:00 Feel free to pause this if you need to at this point until you're comfortable with the first step moving forward.

    02:07 Let's do the second step where we actually secure this into a knot.

    02:10 What we're going to do is take this long strand that has the needle on it, and the opposite side has the little tail that we've pulled through. So there's only about an inch or so of it left.

    02:19 We're going to separate the long strand and the little tail with our instrument, with our needle driver. Okay.

    02:24 We're going to go over once over it twice, and then we're going to grab the tail and then bring it back towards us.

    02:32 And doing that, you create this nice spiral.

    02:35 Okay? That spiral is that friction you get from tooth rows as opposed to one throw. It helps you approximate the wound.

    02:42 It's called a surgeon's throw.

    02:44 Okay, cinch it up.

    02:45 And then instrument's going to separate the long strand from the little tail. Okay.

    02:49 What was far initially was my little tail, and now it's in the near position. They're going to switch back and forth every time.

    02:56 Okay. So long, Strand with the needle rolls over top.

    03:00 Of the instrument towards the tail.

    03:03 Grab the tail.

    03:04 And then we're going to send it away.

    03:08 Okay. And then repeat.

    03:12 And again, instruments going to separate the long strand and the tail once over top towards the tail, grab the tail, bring it back. Instruments can separate the long strand from the tail.

    03:25 Long strand rolls over top towards the tail.

    03:27 Same thing every time. It just changes directions back.

    03:32 And fourth. Okay.

    03:34 The entire movement will be done.

    03:36 A total of let's do it five times just to practice it in real life, you can get away with about 3 or 4 times if it's a multifilament, which this is. If it's a monofilament, you would not want to do it that many times.

    03:48 Okay? You would want to do more times.

    03:50 You would want to do probably six times.

    03:52 If you're doing five times with a with the multifilament you always want more with the monofilament because it has memory and it wants to unwind itself.

    04:00 Okay, so that's our first movement of the simple interrupted stitch.

    04:07 Let's proceed with our simple interrupted stitch.

    04:10 I zoomed in a little bit so you can see what we're doing here.

    04:13 And this is what we should see.

    04:14 We should see this back and forth snaking like this is a square knot that we've created. Okay? So as you can see that we have gone to the middle of our wound. Now, the easiest way to do this, we've taken a long wound and created it into two smaller wounds.

    04:32 Now we have one here and we have one here.

    04:34 So the most common thing that I would see done is go right to the middle of one or the other and then deal with them all individually. So we're going to create two wounds now.

    04:44 We're going to have four wounds, then we're going to have eight wounds and then we're going to have on we go.

    04:48 So the purpose of this is to keep dividing it equally until we get to the place where we have a very nicely closed and symmetrical wound. Closure to throws over top, grab your tail, bring it towards you.

    05:04 Okay. And send it away.

    05:09 Bring it back.

    05:13 Send it away.

    05:20 Now you'll notice that I kept a hold of my tail.

    05:24 If you keep the tail in there, it's a lot easier for you to come by with your scissors and cut them both.

    05:29 One movement, save all the extra movements again.

    05:33 Extra movements equals slowing you down.

    05:35 People that are really fast at suturing aren't doing anything special. They're just doing fewer extra movements.

    05:41 Okay, let's go to the middle on the right side, riding the curve of that needle, which means we're kind of gliding it through the tissue. We're not bending the needle.

    05:50 We're making a smooth movement.

    05:55 Okay, We get to the spot where we're happy with it.

    05:58 Trying to have it symmetrical on both sides.

    06:00 Now, if I have my tail really long when I tie this, I'm going to have a lot more work on my hands.

    06:05 And I'm also going to be cutting a whole bunch of extra tail off and burning through suture.

    06:09 So try to do it in such a way that you don't waste suture.

    06:12 One to grab the tail down there, cross over back.

    06:26 Just going back and forth.

    06:27 Okay.

    06:35 All right. So as you can tell, we're getting more of these done.

    06:39 We'll keep on dividing and conquering until they're all the way done. Now, the first thing we've noticed is there was no tension on this wound.

    06:46 It closed without any difficulty.

    06:47 Right. If we make a laceration and close it, not a big deal.

    06:51 But if we have a lot of depth to the wound, we may find that it's much easier to deal with each layer individually as we're closing it and going higher and higher.

    06:59 Every single layer should be closed uniquely, otherwise you run the risk of having areas that aren't approximated effectively.

    07:05 This wound were to pull apart.

    07:07 Then we would say, Oh, we got a problem on our hands and how do we know that it's tight enough? Well, if you try to pull it apart, you can see that there's certain areas that are still gaping and that's an area that you would want to put more sutures in.

    07:17 But you can see the areas that I've put sutures in have stayed together. So you keep on putting them in there until they're held together. Okay, So keep on going.

    07:25 Every other one and then every other one.

    07:27 And eventually you'll have a nice even row.

    07:29 You're probably about 16 or 20 of them in there.

    07:31 Okay. So give it a try and see how it looks.

    About the Lecture

    The lecture Simple Interrupted Demonstration by John Russell, DNP, APRN, AGACNP-BC, FNP-BC, CCRN, CRNFA is from the course Suturing.

    Included Quiz Questions

    1. 0.5 cm
    2. 1 cm
    3. 0.1 cm
    4. 1.5 cm
    1. Wrapping the long strand around the needle holder twice, then grabbing and pulling the 1-inch tail.
    2. Wrapping the 3-inch tail around the needle holder once, then grabbing and pulling the long strand.
    3. Wrapping the long strand around the needle holder four to five times, then grabbing and pulling the 2-inch tail.
    4. Wrapping the 1-inch tail around the needle holder three times, then grabbing and pulling the long strand.

    Author of lecture Simple Interrupted Demonstration



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