Application of Absorbable Suture in Strabismus Correction and Nursing Management Advantage of Watson Care Theory in Perioperative Period.

Objectives: The article is aimed at investigating the suture effect of absorbable suture in strabismus correction and the advantage of Watson care theory. Methods: 148 children with strabismus were enrolled in this study and divided into two groups. The control group received routine nursing, and on this basis, the observation group was given Watson care theory nursing and eye muscle suture with absorbable sutures. The degree of cooperation (induction compliance checklist (ICC) score), negative emotion (modified Yale preoperative anxiety scale (m-YAPS) score), pain (face pain scale (FPS) score), quality of nursing management, parents' satisfaction, clinical efficacy, and adverse reactions were compared. Results: After nursing and surgical treatment, all children's strabismus symptoms were improved, and the improvement of strabismus and visual function in the observation group was more obvious. Watson care nursing can effectively improve the nursing management quality, parents' satisfaction, children's negative emotions, and treatment compliance. Conclusions: As a result, Watson care theory nursing is of great significance for improving the relationship between nurses and patients and building a harmonious hospital.

Success rate of nurse-led everting sutures for involutional lower lid entropion.

PurposeTo evaluate safety and long-term recurrence rate of entropion in patients having everting sutures (ES) for involutional entropion by ophthalmic nurses in a real clinical setting.Patients and methodsRetrospective notes review of all patients who had an outpatient ES by our trained ophthalmic nurses over 2 year's time period. Outcome measures were complication and recurrence rates. Those with less than 3 years' recorded follow-up were contacted by paper questionnaire.Results90 lids of 82 patients analysed. Mean age was 78 (range 54-97). In total, 82% had no entropion surgery before, whereas 13% had previous ES and 5% one or more other procedures. Questionnaires were sent to 38, with return rate of 81%. Recurrence rate was 21.1% after 36-60 months follow up from nurse-performed ES, with mean time to recurrence of 15 months (SD 13 months). A total of 32% of patients died during the follow-up period. Mean time between the procedure and death is 20.5 months. When ES were repeated twice (11 patients), recurrence rate was still 20%. No patients had any complications.ConclusionES can be safely performed by ophthalmic nurses, with success rate comparable to the same technique performed by ophthalmologists.

Five ways to learn to love suturing.

Suturing can be a daunting midwifery skill to learn, as it's complex and carries great responsibility. There are lots of excellent texts on suturing available in midwifery literature, but perhaps not much on the emotional side of learning. This light-hearted article addresses the anatomy and physiology of the perineum in an engaging and easy to understand way; looks at the current evidence around the decision to suture; and shares ways the author progressed from being apprehensive about suturing to being passionate about the topic and enjoying the skill.

Gestación a término tras cesárea y B-Lynch / Term pregnancy after cesarean section and B-Lynch suture

La sutura hemostática uterina de B-Lynch es una alternativa quirúrgica indicada para el tratamiento de la hemorragia posparto secundaria a atonía uterina que no responde a tratamiento médico. Presentamos el caso de una aplicación de sutura de B-Lynch durante el puerperio inmediato de una paciente a la que se le realizó una cesárea por fracaso de inducción tras rotura prematura de membranas a término, que presentaba hemorragia puerperal no controlada con tratamiento médico. Su evolución posterior fue favorable. Tras 5 años, presentó nueva gestación. El curso del embarazo fue normal. En la semana 39 + 5 se le realizó una cesárea electiva por historia obstétrica + ligadura tubárica bilateral, sin incidencias. El puerperio transcurrió sin complicaciones importantes. Concluimos que, en nuestra experiencia, la B-Lynch es una técnica quirúrgica sencilla, con baja morbilidad y con ventajas claras para la preservación de la fertilidad posterior

The B-Lynch hemostatic suture is a surgical alternative indicated for the treatment of postpartum haemorrhage due to uterine atony unresponsive to medical treatment. We describe the application of B-Lynch suture during the early postpartum period in a patient who had a cesarean section for induction failure after premature rupture of membranes complicated by postpartum haemorrhage not controlled by medical treatment. Outcome was favorable. The patient became pregnant again 5 years later and there were no complications during the gestation. At week 39 + 5, an elective cesarean section with bilateral tubal ligation was performed due to the obstetric history. There were no major complications during the postpartum period. We conclude that B-Lynch suture is a simple technique with low morbility that allows fertility to be preserved in women with uncontrolled postpartum haemorrhage

The decision to suture after childbirth: cues, related factors, knowledge and experience used by midwives.

OBJECTIVE: to present critical cues, related factors, knowledge and experience used by midwives when deciding whether or not to suture perineal and associated trauma after childbirth. DESIGN: an exploratory descriptive study using in-depth interviews to collect data using the Critical Decision Method. SETTING: birth units in Greater Western Sydney. PARTICIPANTS: 19 volunteer midwives experienced in deciding whether or not to suture or in making referrals to suture childbirth trauma. FINDINGS: the main findings were the cues of bleeding and trauma with their accompanying specific attributes, and woman- and midwife-centred factors considered when deciding whether or not to suture perineal and associated trauma. Furthermore, the knowledge and experience that supported decision-making, such as detailed knowledge of anatomical structures, workshops and observing highly skilled clinicians, were identified. CONCLUSION: the cues and related factors can be formed into an inventory and tested for content validity using a panel of expert midwives. IMPLICATIONS FOR PRACTICE: such an inventory has the potential to minimise inappropriate intervention and alleviate unnecessary discomfort, thus increasing safety and quality of care for women following childbirth. In addition, midwifery educators and those coaching less-experienced midwives can use the collected clinical information to aid the development of students' and midwives' decision-making skills regarding whether or not to suture childbirth trauma.

Postpartum perineal repair performed by midwives: a randomised trial comparing two suture techniques leaving the skin unsutured.

OBJECTIVE: To compare a continuous suture technique with interrupted stitches using inverted knots for postpartum perineal repair of second-degree lacerations and episiotomies. DESIGN: A double-blind randomised controlled trial. SETTING: A Danish university hospital with more than 4800 deliveries annually. POPULATION: A total of 400 healthy primiparous women with a vaginal delivery at term. METHOD Randomisation was computer-controlled. Structured interviews and systematic assessment of perineal healing were performed by research midwives blinded to treatment allocation at 24-48 hours, 10 days and 6 months postpartum. Pain was evaluated using a visual analogue scale and the McGill Pain Questionnaire. Wound healing was evaluated using the REEDA scale and by assessment of gaping wounds >0.5 cm. Analysis complied with the intention-to-treat principle. MAIN OUTCOME MEASURES: The primary outcome was perineal pain 10 days after delivery. Secondary outcomes were wound healing, patient satisfaction, dyspareunia, need for resuturing, time elapsed during repair and amount of suture material used. RESULTS: A total of 400 women were randomised; 5 women withdrew their consent, leaving 395 for follow up. The follow-up rate was 98% for all assessments after delivery. No difference was seen in perineal pain 10 days after delivery. No difference was seen in wound healing, patient satisfaction, dyspareunia or need for resuturing. The continuous suture technique was significantly faster (15 versus 17 minutes, P = 0.03) and less suture material was used (one versus two packets, P < 0.01). CONCLUSION: Interrupted, inverted stitches for perineal repair leaving the skin unsutured appear to be equivalent to the continuous suture technique in relation to perineal pain, wound healing, patient satisfaction, dyspareunia and need for resuturing. The continuous technique, however, is faster and requires less suture material, thus leaving it the more cost-effective of the two techniques evaluated.

What are the views of midwives in relation to perineal repair?

PURPOSE: To determine the views of midwives towards perineal repair and the most effective way to teach and support midwives in developing this skill. PROCEDURE: A questionnaire was distributed to 111 midwives who attended a 1-day seminar. Information was sought on a range of views relating to perineal repair, including experience, confidence, education and accreditation, attitudes and trends. FINDINGS: One hundred and six (96%) questionnaires were returned. All respondents (100%) believed midwives should be taught to undertake perineal repair. The most important reason was to provide continuity of care for women. Experience increased confidence and enjoyment in undertaking perineal repair as well as lessening fears over the impact of suturing on women. Experience did not significantly impact on concerns regarding legal implications associated with perineal repair. Three quarters of respondents reported that midwifery students should have practical experience of perineal repair. There was strong support for doctors and midwives to undertake perineal repair education together (96%), preferably in a 1-day workshop format (56%); for standards to be set by the professional colleges (midwifery and obstetrics) (66%); for midwives and doctors to be accredited as competent before performing perineal repair independently (>90%) and for regular updates in perineal repair (93%). The majority of midwives (73%) felt that they were more likely to suture than 5 years ago, due mainly to a greater appreciation of woman centred care (35%). Over 60% of midwives said they would not suture a first-degree tear more than half of the time and 13% would not suture a second-degree tear more than half of the time. PRINCIPLE CONCLUSION: A desire to provide continuity of care appears to be a major motivator for midwives to learn to undertake perineal repair. There is need for standards to be set for perineal repair to encourage consistency in education. Perineal repair programs that involve midwives and doctors training together have strong support from midwives but it is unclear if doctors would also support this. Further research is needed to support or refute the trend for midwives to not suture some perineal trauma.

Suturing as an advanced skill for registered nurses in the emergency department.

OBJECTIVE: Many patients present to emergency departments (EDs) for wounds that require repair by suturing. This study looked at ascertaining the efficacy of Advanced Clinical Nurses' (ACN) suturing dermal lacerations in tertiary, regional and rural ED settings. DESIGN: Convenience sample; prospective questionnaire. SETTING: Three mixed adult and paediatric EDs. These departments were tertiary, regional and rural regional EDs. PARTICIPANTS: Eighty patients requiring sutures for dermal lacerations that were repaired by an ACN. Of them 24 were men and seven were women. Mean age was 40.5 years, with a range of 21-58 years. Ten results from rural ED; six from regional ED; 15 from tertiary ED. MAIN OUTCOME MEASURE(S): Any differences between suturing standards in rural, regional and tertiary EDs; clinical results of suturing performed by ACNs; local medical officers' satisfaction with wound repair. RESULTS: A total of 31 responses were received. The lacerations were located on the face in 13 patients (42%), the scalp in 10 (32%), an extremity in 2 (6%), and on the trunk in 6 (20%). A total of 196 sutures were required. Local medical officers graded wound repair as 'good' in 24 cases (77%) and adequate in seven cases (23%). There were no wound healing complications reported. CONCLUSIONS: Nurses who complete a standardised training program in wound management and repair are capable of providing high-quality, definitive care for patients who present to EDs with dermal lacerations. This is true irrespective of whether the Registered Nurse is working in a rural, regional or tertiary ED.

Let's get it straight: the nursing implications of adjustable sutures in the adult strabismus patient.

The objective of this paper is to highlight the important nursing interventions and clinical implications in the care of the strabismus patient treated with adjustable sutures. Nurses must use their assessment skills in monitoring the strabismus patient for vagal responses, bleeding, and anxiety during the suture adjustment period. Following adjustment, pain, nausea, vomiting, infection, and safety should be monitored and treated appropriately. Awareness of these nursing implications and human behavioral responses empowers the ophthalmic nurse to provide appropriate and effective care to the strabismus patient treated with adjustable sutures.

Procedures for cleansing, closing and covering acute wounds.

Every wound and patient is different so there is no single method for the management of acute wounds. However, there are some guiding principles that can assist in the decision-making process. Most wounds are suitable for primary closure, for example with sutures, while for other wounds closure is either delayed or not attempted (healing by secondary intention). Atiyeh et al (2002) provide a list of the principles of wound care that must always be observed in order to avoid sepsis and to achieve optimal wound healing (Box 1).

Cirugía en lesiones dérmicas superficiales (III de III). Procedimiento: realización de la técnica / Surgery in superficial skin lesions (III). Procedure: How to perform this technique

En este tercer artículo se cierra la serie sobre cirugía en lesiones dérmicas superficiales. Se describe la realización de la técnica de sutura (suturas discontinuas y continuas), así como la técnica de anudado. También se tratan los aspectos de seguimiento de la herida y educación al paciente y la retirada de la sutura. El artículo finaliza con la bibliografía correspondiente a toda la serie (AU)