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?

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