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DISTRIBUTION OF SURGICAL SUPPLIES
“INTRODUCTION”
SURGICAL SUPPLIESSurgical supplies involves all the instruments tools or devices that
perform functions such as dissecting, holding, retracting, or
suturing.
WHAT DOES IT INCLUDE??
DISSECTINGDifferent types of scissors, blades and
scalpels.
HOLDINGAll types of forceps.
RETRACTINGBone or skin hookers, self-retaining and
hand-held retractors
SUTURING/ LIGATINGSuture needles and clips, ligating
instruments
All those tools or instruments that performs different functions like…..
SURGICAL SUPPLIESSurgical
DressingsPrimary wound
dressing
Secondary wound
dressing
Adsorbents
Bandages
Adhesive tapes
Combined primary
and secondary
wound dressing
Operating Room
SuppliesHaemostatic products
Thrombin solution
Disposable sterile packs
Face masks
Sutures and ligatures
Absorbable sutures
Non absorbable
Surgical needles
Eyed needles
Eyeless needles
THE NEED OF SURGICAL SUPPLIES SERVICES FROM HOSPITAL
PHARMACY
Enhancing the prestige of hospital pharmacist
Promotion of Economy within the hospital
Sterlity
Provision of high quality + appropriaite product
Quick Access
“TYPES OF SURGICAL DRESSINGS”
DRESSING“Materials used for covering and protecting a
wound.”
SELECTION OF DRESSING
ADEGREE OF EXUDATION
SURGICAL DRESSING TYPES
PRIMARY WOUND DRESSING
PLAIN GAUZE
FILM DRESSIN
G
IMPREGNATED GAUZE
SECONDARY WOUND DRESSING
ABSORBENTS
SURGICAL COTTON
ABSORBENT
NON
ABSORBENTB
LEACHED
UN-BLEACHED
RAYON
PRIMARY WOUND DRESSING
“Primary dressing directly contacts the wound and may prevent wound
dryness.”
• Used as a primary dressing to reduce infected wounds
• Its removal is painful often cause removal of new epithelium
PLAIN GAUZE
• Its adherence to wound is reduce due to subs such as petroleum, paraffin, vaselline
• It prevent entrance of pathogen in wound
IMPREGNATED GAUZE
• Transparent film dressings provide a moist, healing environment
• Protect the wound from mechanical trauma
FILM DRESSING
Plain gauze Impregnated gauze
Film gauze
Non absorbent unbleached cotton:It is raw cotton fibers,
mechanically clean from dirt
and carded into layers
Non absorbent bleached cotton:
It is prepared from raw cotton by bleaching process, wherein
the natural oil n
waxes are retained. It
is water repellent
Absorbent cotton:
It is prepared from raw
cotton fiber by
removal of impurities. It is pure and white cellulose
fiber
Rayon: It is
known as regenerated celluloseIt is softer
than cotton
“SURGICAL GAUZES”
SURGICAL GAUZES“Medical Gauze, A Bleached White Cloth Or Fabric Used In Bandages, Dressings, And Surgical Sponges.”
PREPARATION OF SURGICAL GAUZES
RAW COTTON
PREPARATION OF SURGICAL GAUZES
OPEN MESH CLOTH AFTER BLEACHING(White colour)
CLASSIFICATIONGauzes are classified according to the mesh number.
TYPES OF GAUZES
FILMATED GAUZE
MEDICATED SURGICAL GAUZES
SELVAGE-EDGE GAUZE
STRIPSDRESSING COMBINES
X-RAY DETECTABLE
GAUZE GAUZE
SPONGES
LAPAROTOMY SPONGES
SANITARY NAPKINS
EYE PADS
COTTON-TIPPED
APPLICATOR
FILMATED GAUZEFolded absorbent gauze for quick absorption.
In between these folds, a film of cotton or Rayon is distributed.
MEDICATED SURGICAL GAUZES
Also called antiseptic surgical gauze.Example:
“IODOFORM GAUZE FOR PACKING AND DRAINAGE MATERIAL”
SELVAGE-EDGE GAUZE STRIPS
PACKING STRIPS FOR
NASAL SURGERY
NASAL HEMOSTASI
S
DRAINING WOUNDS
DRAINING OF BOILS
GAUZE SPONGESFolded squares of surgical gauzeAvailable in: Sterile & non-sterile Packages
X-RAY DETECTABLE GAUZE Treated with barium sulphate Contain non-abrasive Vinyl plastic mono filament
that can be detected by x-rays
DRESSING COMBINES
LAPAROTOMY SPONGESAlso called abdominal packs and
Gauze mops
SANITARY NAPKINSUsed for: Obstetrical and gynecological purposes Greater fluid holding capacityAvailable in Sterile & non-sterile packages
EYE PADS
Made up of non-woven fabrics and provides protection to eyes.
Sealed in individual sterile envelops.
COTTON-TIPPED APPLICATOR Used to apply medications & cleanse an area.
“BANDAGES”
BANDAGES
Pressure
Support
Inelastic Elastic
Rigid
TYPES OF BANDAGES1. Gauze roll bandage2. Muslin bandage3. Elastic bandages4. Orthopedic
bandages5. Stockinett
bandages6. Cast bandages
GAUZE ROLLER BANDAGE
One continuous piece
Free from shedding
Tightly rolled
MUSLIN BANDAGE ROLLS
Made of heavier unbleached
material
Used where gauze bandage not
provide support
Hold bulky compression
dressing
ELASTIC BANDAGES
Support, pressure, bandaging
injuries, dressing stability
Woven elastic
bandage
High-bulk bandage
Crepe bandage
TYPES OF ELASTIC BANDAGE
Heavy elastic webbing
containing rubber thread
Special weave allow it to
stretch twice its length
Made of multiple layers
at crimped cotton gauze
TRIANGULAR BANDAGEAlso called ESMARCH BANDAGES
Corner to corner cutting of muslin
Used in first aid
ORTHOPEDIC BANDAGES
FUNCTION• Immobiliza
tion • Support to
broken bones
MATERIAL• Plaster of
Paris• Synthetic
cast material
• Plastic sheets
FABRICATING MATERIAL• Plaster
that firmly bound to fiber
• Polyester• Fiberglass
casting
Use prior to application of plaster of Paris
Provides comfortability
STOCKINETTE
Apply before application of cast
Absorbs moisture and allow skin to breath
CAST PADDIN
G
“ADHESIVE TAPES”
ADHESIVES
Medical adhesives are widely used in hospitals to secure medical dressings,
life support equipments, and
monitoring devices onto skin, which requires careful
consideration and knowledge about
skin and adhesives.
TYPES OF ADHESIVES (MATERIALS)
NATURAL
SEMI SYNTHETIC
SYNTHETICS
NATURAL
Starch Gelatin
Natural rubberResins
SYNTHETIC
VinylAcrylics
Synthetic rubbers
Resins(aldehyde, amine
base, epoxide
etc )
SEMISYNTHETIC
Cellulosics
Cellulose nitrateMethyl
cellulose etc
ADHESIVE TAPES IN PHARMACY
The characteristics of skin composition, construction, and function make the adhesion to skin very challenging
Skin is a self renewable and replenishable surface.
Skin is a low surface tension surface.
Skin is a rough surface with hair, folds, pores for sweat and oil glands, and wrinkles.
•Widely used in surgical dressings where reduced skin trauma is required•Non-woven or fabric backing is used due to hypoallergenic material• Based on adhesion, cohesion and flow properties of monomers used
•Porous backing material used are RAYON TAFFETA CLOTH , well suited for heavy dressings•Paper backed is used for lighter dressings
•Others: cloth backing , elastic cloth or foam• backing
ACRYLATE ADHESIVES
WHY USE IN SURGERIES??
• Not affected by heat, light or air. Thus has excellent shelf life
• Properly stick to skin (long term adhesion)
• Permeable to water vapor so are non-occlusive
• Hypoallergenic• Repeated use with minimal damage
RUBBER BASED ADHESIVES
Used where strength, adhesion, support and economy is requiredCloth backed or plastic backed.
Composed of elastomer (synthetic, natural)
Crepe rubbers (natural)Isobutylene, alkylacrylate
(synthetic)
ADVANTAGES DISADVANTAGES
PHARMACIST’S ROLE:
Advise on reactions caused by tapes consisted of
heterogenous and complex mixtures of organic
compoundsErythema, edema, papules
can occur to patients so firstly patch testing should
be done.
“COMBINED PRIMARY-SECONDARY WOUND
DRESSINGS”
COMBINED PRIMARY-SECONDARY WOUND
DRESSINGS Also called
composite dressing.
Have primary and secondary components.
Degree of occlusion depend upon dressing type.
LAYERS OF COMPOSITE DRESSINGS
Bottom layer
Middle layer
Outermost layer
USES OF COMPOSI
TE DRESSING
S
DRESSING TYPES
Hydrogels Hydrocolloid dressings
Calcium alginate
dressings
These are Cross linked
polymer Ex: PVP.
Non-adherent dressings.
Used as burn treatment.
Useful in hairy areas.
These are hydrophillic
colloid particles.Fluid absorption
occurs.Mass of these
dressings consists of gum-like
materials ex: pectin.
Bound by an adhesive ex: poly
isobutylene.Useful for low to
moderate wounds.
Alginic acid is a naturally occuring
polysaccharide.Derived from
brown seaweeds.
Highly absorbent.
Used on moderate to
highly wound.Used to pack
wounds.
HYDROGEL DRESSING
INDICATION
•Necrotic wounds•Painful wounds
ADVANTAGES
•Reduce wound pain•Non-adherent
DISADVANTAGES
•Macerate wound skin•Secured by a secondary dressing
FORMS OF
HYDROGEL
DRESSING
S
Amorphou
s hydro
gel
Sheet hydro
gel
Im-pregnated
hydrogel
HYDROCOLLOID DRESSINGINDICATIO
N
•Necrotic wounds•As Secondary dressings
ADVANTAGES
•Self-adherent•comfortable
DISADVANTAGES
•Bad odor•Injured the fragile skin
CALCIUM ALGINATE DRESSINGINDICATIO
N•For hemostasis•Surgical incisions
ADVANTAGES
•Non-occlusive•Reduced Frequency of dressing changes
DISADVANTAGES
•Distinctive odor•Secondary dressing needed
“PROTECTIVES”
PROTECTIVES USE FOR WOUNDS
A semi-permeable
dressing can provide the appropriate
oxygen tension for wound repair
to proceed efficiently
Why protectives are used?
To create Moist
Environment
• Moisture suppresses tissue desiccation and decreases the
amount of lost dermis
Ideal Dressing Composi
tion
• Inert material that does not shed fibers or compounds into the wound which may evoke a foreign-body, irritant, or allergic reaction
OPERATING ROOM SUPPLY
Hemostatic products
Disposable sterile packs Face masks
HEMOSTATIC PRODUCTS
Hemostatic are applications designed to stem blood-flow
through the accelerated promotion of clotting.
TYPES OF HEMOSTATI
C PRODUCTS
MechanicalChemical
Thermal
MECHANICAL
CHEMICAL METHODS
Pharmacological Agents
Topical hemostatic agents
•Bovine Thrombin•Epinephrine•Protamine•Vitamin K
DISPOSABLE STERILE PACKS
• The packs and drape sheets are made of disposable fluid‐resistant material, which acts as a bacterial barrier against microbial infiltration.
FACE MASKS• These are available
where control contamination is required.
• These are autoclaved.• They have high
retention of particulate matter.
“SUTURES, LIGATURES &
THEIR MATERIALS”
DIFFERENCE BETWEEN SUTURE & LIGATURE
SUTURE
A strand used to hold wound edges with the help of a needle
LIGATURE
Material,
without a
needle used to stop bleeding by tying off severed blood vessels
SUTURES
HISTORYNEEDLES
Metals
Silver
Copper
Bronze
Bone
SUTURE MATERIAL
Animal
Hair Arteries
Muscles
Tendons
Nerves
Plant
Cotton Hemp
ABSORBABLE SUTURES
Proteolytic Enzymes are responsible for their
Digestion and Disappearence from the wound area.
Proteinaceous in nature
Derived from Collagen rich animal
tissues
2
3
1
ABSORBABLE
SUTURE
Surgical Gut
Synthetic Absorbable
SutureFascia Lata
SURGICAL GUT
These strands are polished and cut for packaging and sterilization.
METHOD NO. 1:
METHOD NO.2:
Collagen derived from Beef Tendon
The Tendons are then dispersed
The dispersed Collagen is extruded, precipitated as
reconstituted as fine strands
Then these strands are twisted, stretched
and treated to give absorbable sutures
TYPES OF SURGICAL GUT
PLAIN SURGICAL GUT
TREATED SURGICAL GUT
SYNTHETIC ABSORBABLE SUTURES
• They are made-up of Polymeric Polyesteres
• Have high Tensile strength• Are packaged without fluid
• They are sterilized with ethylene oxide to avoid degradation
• Suture is broken down by simple hydrolysis as it resides in tissues
FASCIA LATA Fascia lata is obtained
from OX fascia Used as a heavy suture
or repair like hernia Supplied in the form of
sterile strips ½ inches wide 8 inches long and also in sheets about 3×5 inches
“NON-ABSORBABLE SUTURES”
NON ABSORBABLE SUTURESNON ABSORBABLE SUTURES
NATURAL
SILK
DERMAL SILK
SYNTHETIC
NYLON
POLYESTER FIBER
POLYOLEFIN FIBERS
NATURAL NON ABSORBABLE SUTURES
SILK SUTURES
DERMAL SILK
SUTURES
SILK SUTURES
Consists chiefly of protein fibroin as extruded by the silkworm.
Used in eye & lip skin surgeries, intraoral surgeries, vasectomy.
BRAIDED SILK Many fibers are twisted together into a single
strand. Possesses firmness & strength. Braided silk is dyed & treated to make it non
capillary.
FEATURES OF NON CAPILLARY SILK SUTURES
Minimize the rise of tissue fluids to the surface
Impart a degree of stiffness
Minimize the attachment
of tissue cells
Lubricate the implantation & removal of silk
suture
DERMAL SILK SUTURESNatural twisted silk encased in an insoluble coating of tanned gelatin or other protein.
This coating withstands autoclaving.
Prevents in-growth of tissue cells.
DISTINCTIVE FEATURES OF SILK SUTURES
Silk suture is a non-absorbable suture. Braided to improvise the knot security. Coloured black to have a very good visibility
during surgical procedures. Coated with bee’s wax for easy pull out suture. They are classified as non absorbable but they are
subjected to a slow (e.g., two year) process of proteolysis absorption.
ADVANTAGE DISADVANTAGE
SYNTHETIC NON ABSORBABLE SUTURES
NYLON POLYESTER FIBER
POLYOLEFIN FIBERS
NYLONo 1st modern synthetic
fiber.o Synthetic polyamide
obtained from: condensation of adipic
acid & hexamethylenediamide
condensation-polymerization of caprolactam
o Available in the forms of monofilament & multifilament.
o Used as skin sutures & in plastic surgeries.
ADVANTAGES DISADVANTAGES
POLESTER FIBER Synthetic multifilament
fibers braided to make a suture.
Prepared by:• Melt-extruding
polyethylene based derivatives into fine filaments
They are used for prosthetic implantations, face lifts and cardiovascular surgeries
Braided polyester fiber sutures coated or impregnated with non toxic lubricants are commercially available.
ADVANTAGES DISADVANTAGES
POLYOLEFIN FIBERS These sutures are based
on polyolefins & include: polypropylene, polybutylester & polytetrafluoroethylene sutures.
Poly propylene was devloped in 1970 as a first synthetic non-absorbable suture.
It is available as monofilament suture.
Used in subcuticular skin closure, especially in cardiovascular surgeries.
ADVANTAGES DISADVANTAGES
Slippery (requires 4 knot throws to hold)
High plasticity (loose after wound edema
resolves)
Expensive
High tensile strength
Minimal tissue reactivity
Slippery (allows for easy removal from
tissues)
POLYBUTYLESTER SUTURES Monofilament suture Improved pliability
Fabricated from polytetrafluoroethylene.
POLYTETRAFLUORO-ETHYLENE SUTURES
“METALLIC SUTURES, SURGICAL NEEDLES &
OTHER SUTURING TECHNIQUES”
METALLIC SUTURES
SILVER STAINLESS STEEL
SILVER SUTURES
In the form of wire or foil
Readily available
Antiseptic action
Irritation in some tissues
STAINLESS STEEL SUTURESNatural, monofilament/multifi
lament, nonabsorb
able.
Alloy of iron,
chromium and
nickel.
Good TS even in
infection.Difficult to handle
and tendency
to cut through tissues.
Very hard to tie and knot ends
require special
handling.
Potential to corrode or break at points
of twisting, bending
or knoting.
Not to be use with
the prosthesis of another
alloy.
Used in abdominal
wall, sternum closure,
retention, tendon repair etc..
SURGICAL NEEDLESMore traumatic.
Wide opening of tissues.
Eyed Needles
SURGICAL NEEDLESMuch less traumatic.
More expensive suture material.
Eyeless Needles
OTHER SUTURING TECHNIQUESSURGICAL STAPLING
DEVICES
Used for skin closure.
Made up of S.S
Placed uniformly to span the incision line
Minimal tissue reaction
Does not penetrate the skin Excellent cosmetic results.
Speed and efficacy is more as compared to
sutures
Advancement Introduction of
absorbable staples (Lactomer)
SURGICAL STAPLES
Staple Staple Gun
Staple Remover
OTHER SUTURING TECHNIQUES LIGATING CLAMPS AND CLIPS V shaped steel, tantalum or tiatnium clips. Strips of fabric or plastic material coated with
suitable adhesive. Essentially “clips” to replace sutures when
occluding (closing) the lumen (central canal) of a vessel or tubular organ: Blood vessels, Gynecological & Urological (GU) procedures
NEW APPROACHES IN LIGATING CLAMPS AND CLIPS
Absorbable material
polydioxanone and lactomer
Absorb after their function is completed
No interference with X-rays and
CAT scan
STAPLES AND CLIPS VS SUTURES
Speed
Convenience
Reduced infection rate
Lower cost
If done properly, no cosmetic difference
REFERENCES http://www.surgeryencyclopedia.com/St-Wr/Surgical-Instruments.html http://i01.i.aliimg.com/photo/v0/50008272673/
Straight_forcep_handheld_hinged_instrument_used_for.jpg_350x350.jpg https://heateliz.files.wordpress.com/2013/03/needle-driver-basic.jpg http://www.teleflex.com/en/usa/pdf/KMedic_Surgical_Instruments_101.pdf http://www.slideshare.net/DrAyeshaMaxfac/suture-materials-suturing-techniques-drayesha http://www.slideshare.net/UDDent/sutures-materials http://slideplayer.com/slide/4461792/ http://www.pstc.org/files/public/Liu,%20Jacob2012.pdf http://nzic.org.nz/ChemProcesses/polymers/10H.pdf https://en.wikipedia.org/wiki/List_of_adhesive_tape http://www.fpnotebook.com/Surgery/Pharm/Prln1.m http://www.bioline.org.br/pdf?dv09140 http://www.totalskinandbeauty.com/about-us-our-doctors-wound-closure-suture-technique.shtml http://www.fpnotebook.com/surgery/pharm/SlkStr.htm http://blog.wcei.net/tag/disadvantages-of-hydrocolloid-dressings/ https://www.google.com.pk/search?
q=impregnated+hydrogels&biw=1152&bih=725&source=lnms&tbm=isch&sa=X&vd=0ahUKEwjgr9y8tJ7JAhXCMhoKHUPaD2MQ_AUIBigB#imgrc=Q5NRKmXMrHDaBM%3A
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