After how many days the stitches are removed after the operation, the sequence of actions. Surgical sutures

a) Single seam. For many patients, a skin suture is a brand name. The principle underlying all skin sutures is to achieve healing by first intention and with minimal scarring. A prerequisite for this is an exact alignment of the edges of the skin and subcutaneous tissue without tension.

The edges of the skin should be well supplied with blood; formation of cavities and pockets should be avoided. The general rule is that the distance between the seams should correspond to the width of the fabric in the seam (that is, the distance between the seams and the width of the seam should form a square). Single sutures are the most commonly used and are the simplest of all threading techniques. The thread is sequentially passed through the edges of the wound, held by tweezers.

To do this, the needle is passed perpendicularly through the skin and obliquely through the subcutaneous tissue. The distance from the injection to the edge of the wound and the depth of the stitch should be the same on both sides of the wound. The threads should be tied with slight tension to avoid ischemia of the tissues (the tissues under the suture should not turn pale).

b) continuous seam. A continuous suture saves time, but is technically more difficult because it requires good matching of the wound edges and suture guidance by an assistant. A continuous seam can be applied as a simple Kirchner seam (a) or as a "marine" seam with an overlap (b).

Other video tutorials on the topochka are located:

in) . The mattress suture gives excellent matching of wound edges.

In the Donati vertical mattress suture, the thread is visible on both sides of the wound. However, the best matching is achieved only when the width and depth of the forward and reverse stitches are absolutely symmetrical, and if all four injection and injection points lie on the same straight line perpendicular to the wound. The closer to the skin surface the reverse stitch is, the better the closure of the wound.

G) . With this modification of the mattress suture, the thread is visible only on one side of the wound. On the other hand, the thread captures the subcutaneous layer and part of the skin. Thus, in order to achieve a good cosmetic result, the same conditions are necessary as for the Donati suture. However, removing this suture is more difficult, especially if the puncture and puncture sites are close enough to each other, and the thread is tied too tight.

e) Continuous subcutaneous suture. With a continuous subcutaneous suture, the thread enters the skin only at the beginning and at the end of the wound. The suture passes completely through the skin and gives excellent matching by precise butt-joining suture travel through both edges of the wound. At each end of the wound, the thread is fixed with a plastic clip.

Video lesson of imposing a mattress seam

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e) Individual subcutaneous sutures. Separate subcutaneous sutures with 5-0 or 6-0 PGA suture give good skin matching, especially in children. Removal of stitches is not required. However, it is recommended that these sutures be relieved of any tension on the wound by the additional application of surgical self-adhesive tapes.

and) Surgical adhesive tapes (Steri-Strips). Modern surgical tapes are able to match wound edges and hold them together without tension. They are rarely indicated as a stand-alone wound closure, as they easily peel off when wet. Most often they are used as an additional measure for superficial wounds.

h) . To remove stitches, the thread is slightly lifted with a clamp, cut close to the skin on one side, and then removed. This prevents the contaminated outer part of the thread from being pulled through its subcutaneous canal. The best time to remove sutures is determined by the condition of the wound, as well as the location of the suture.

Skin sutures on the face and neck can be removed on day 5, while skin sutures in other areas of the body should be left in place for 6 to 14 days, depending on their location.

and) . The fastest way to close a wound is to use an automatic staple device that inserts and flexes square metal staples at the edges of the wound. The edges of the wound should be symmetrically grasped by the clamps with teeth and slightly twisted at the moment the bracket is applied. The imposition of such a suture requires good interaction between the surgeon and the assistant.

to) Removing brackets. The brackets are removed with appropriate special forceps, which bend the closed brackets in the shape of the letter M, as a result of which their subcutaneous parts release the scar.

Buyanov V.M., Egiev V.N., Udotov O.A.
Chapter 2. Surgical sutures.

The most general principle for performing any suture is to respect the edges of the wound to be sutured. In addition, the suture should be applied, trying to accurately match the edges of the wound and the layers of the organs to be sutured. Recently, these principles have been commonly referred to as "precision".

Skin suture
When applying a skin suture, it is necessary to take into account the depth and extent of the wound, as well as the degree of divergence of its edges. The following types of sutures are most common: Continuous intradermal cosmetic suture is currently the most widely used, as it provides the best cosmetic result. Its features are good adaptation of the wound edges, good cosmetic effect and less disturbance of microcirculation compared to other types of sutures. The suture thread is carried out in the layer of the skin itself in a plane parallel to its surface. With this type of seam, to facilitate thread pulling, it is better to use monofilament threads. Absorbable sutures are often used, such as Biosyn, Monocryl, Polysorb, Dexon, Vicryl. From non-absorbable threads, monofilament polyamide and polypropylene are used. If you use polyfilament threads, then after every 6-8 cm of the suture, you need to poke out on the skin. The thread is subsequently removed in parts between these punctures.

The second most common skin suture is metal staples. Metal staples are widely used by Western surgeons as they provide a cosmetic result comparable to cosmetic sutures. Why does using parentheses give such a cosmetic result? The bracket is designed in such a way that when it is applied, the back of the bracket is over the wound. During healing, the volume of the tissue connected by the bracket increases, but the back does not press on the tissue and does not give a transverse strip (unlike a thread).

No less common is a simple nodal suture. The skin is most easily pierced with a cutting needle, and it is believed that it is better to use a reverse cutting needle. When using such a needle, the puncture is a triangle, the base of which faces the wound. This shape of the puncture holds the thread better. Injections and incisions should be located on the same line, strictly perpendicular to the wound, at a distance of 0.5-1 cm from its edge. The optimal distance between the stitches is 1.5-2 cm. More frequent stitches lead to impaired blood supply in the suture area, with rarer stitches it is difficult to accurately match the edges of the wound. To prevent screwing of the wound edges, which prevents healing, deeper layers should be captured more "massively" than the skin. The knot should be tightened only until the edges are aligned, excessive force leads to a violation of the trophism of the skin and the formation of rough transverse stripes. In addition, these sutures are recommended to be removed as early as possible (3-5 days after the operation) for the same purpose - to prevent the formation of rough transverse bands. The tied knot should be located at the injection or injection points, but not over the wound itself.

If it is difficult to match the edges of the skin wound, a horizontal mattress U-shaped suture can be used. When applying a conventional interrupted suture to a deep wound, it is possible to leave a residual cavity. In this cavity, wound discharge can accumulate and lead to wound suppuration. It is possible to avoid suturing the wound in several floors. Floor-by-floor suturing of the wound is possible with both nodal and continuous sutures. In addition to floor suturing of the wound in such situations, a vertical mattress suture (according to Donatti) is used. In this case, the first injection is made at a distance of 2 cm or more from the edge of the wound, the needle is inserted as deep as possible to capture the bottom of the wound. The puncture on the opposite side of the wound is done at the same distance. When holding the needle in the opposite direction, the injection and injection are performed at a distance of 0.5 cm from the edges of the wound so that the thread passes through the layer of the skin itself. Threads should be tied when suturing a deep wound after all sutures have been applied - this facilitates manipulations in the depth of the wound. The use of the Donatti suture makes it possible to compare the edges of the wound even with their large diastasis.

The skin suture must be applied very carefully, since the cosmetic result of any operation depends on it. This largely determines the authority of the surgeon in patients. Inaccurate comparison of the edges of the wound leads to the formation of a rough scar. Excessive efforts when tightening the first knot are the cause of ugly transverse stripes located along the entire length of the surgical scar. This can cause patients not only moral, but also physical suffering.

Aponeurosis suture
In recent years, there have been major changes in the technique of aponeurosis suturing. The most widely used is a continuous twisting suture with synthetic absorbable sutures, such as Polysorb, Biosyn, Vicryl. In this case, threads of nominal diameter 1, 2 are used, and double threads (loop) are often used. After the initial stitching, the needle is threaded into the thread loop and tightened. Then a suture is applied. At the end, one of the threads is cut off and stitched in the opposite direction, after which both threads are sewn together. If any problems in wound healing are suspected, non-absorbable sutures such as polypropylene can be used for such a suture.

No less frequently used interrupted aponeurosis suture using non-absorbable materials such as lavsan. A general requirement for all methods of suturing the aponeurosis is thoroughness in matching the edges, excluding fat interposition. This ensures the formation of a strong scar, that is, the formation of postoperative hernias is prevented. The use of absorbable materials has led to the fact that in recent years we have practically not observed the formation of ligature fistulas.

Seam of adipose tissue and peritoneum.
Currently, among surgeons, the question of the need for a suture of fatty tissue and a suture of the peritoneum is being discussed. The peritoneum heals well even without its precise adaptation. Moreover, the use of catgut for the suture of the peritoneum causes an inflammatory reaction. Therefore, now the wounds after median laparotomy are sutured without a peritoneal suture. There are disagreements about the need for a seam of fatty tissue. As you know, the seam disrupts the blood supply and increases the likelihood of suppuration. Therefore, in the presence of adipose tissue fascia (as is the case with inguinal hernia repair), it is advisable to sew only it. With unexpressed fiber, it is not recommended to stitch it. Aspiration drainage of the residual cavity is possible.

If you consider it necessary to sew fatty tissue, then it is better to use a continuous suture with absorbable suture materials for this (monocryl material is just designed for the suture of fatty tissue and peritoneum).

Intestinal suture
Despite the fact that the intestinal suture is very diverse, only a few types of suture are most widely used. We strongly recommend that you use a single-row continuous seam as a method of choice.

The technique of applying this seam is quite simple and of the same type. The suture is used to make anastomoses and suture incisions of the gastrointestinal tract. The distance between the stitches is 0.5 - 0.8 cm, depending on the wall thickness of the organs to be sutured, the distance from the edge of the organ to be sutured to the needle insertion is 0.8 cm for the intestine, 1.0 cm for the stomach (Fig. 3) . For operations on the stomach and small intestine, we use threads with a conditional diameter of 3/0-4/0, for operations on the large intestine, threads with a diameter of 4/0-5/0. Of the other types of sutures, single-row nodal serous-muscular-submucosal sutures are used with the location of the node on the serosa (Pirogov's suture).

The Mateshuk seam is different in that the node is located on the side of the intestinal lumen. The idea of ​​the Mateshuk suture is to facilitate the migration of the thread into the intestinal lumen. This type of suture has been widely recommended when non-absorbable materials are used, in addition to giving a reaction to body tissues. With the use of synthetic absorbable threads, the problem of knot location ceases to be fundamental.

Another single row suture, the Gambi suture, is used in colon surgery. This suture resembles the skin suture according to Donatti. In this case, the intestine is initially pierced at a distance of at least 1 cm from the edge of the wound with a puncture of the mucous membrane. After the puncture of the second intestine, both lumen of the intestine are pierced in the opposite direction at a distance of 2-3 mm from the edge. When the suture is tightened, an accurate comparison of the serous layers of the intestinal wall occurs over a sufficiently large extent.

In this manual, we do not describe the technique of applying two- or three-row sutures, since, firstly, they are described in numerous manuals. Secondly, we believe that all methods other than single-row seam methods have no future. Staplers are often used for gastric and intestinal sutures. In this case, two methods of anastomosis are used - the first involves the imposition of an inverted anastomosis, the second - the imposition of an everted anastomosis. How it's done? When applying an inverted anastomosis, the branches of the GIA apparatus are inserted into the lumen of the organs to be sutured, which, when used, stitches the tissues with two rows of staple sutures and dissects in the middle. In this case, a ready-made superimposed anastomosis is obtained. Depending on the length of the working part of the device, an anastomosis with a length of 5, 6, 7 and 8 cm can be applied.

In the second method, the walls of the organs are turned out in such a way that the mucous membranes of the organs to be stitched are compared. After that, the anastomosed organs are sutured using linear suture devices, such as UO-40, TA-55. Suture of hepaticocholedochus. The sutures of the bile ducts are used after choledochotomy, in case of accidental damage to the ducts. Where possible, a precision continuous overlapping suture should be used, assuming an accurate matching of the layers of the duct wall without trapping the mucosa. Particular care should be taken to suture a thin-walled choledoch. For this, monofilament absorbable threads (biosyn) are used, with a nominal diameter of 5/0 - 7/0. This technique differs from the traditional one by increased tightness of the seam, a minimum number of complications in the early and late periods. We use this seam as a method of choice.

When applying biliodigestive anastomoses, only a single-row continuous suture is also used, which is the easiest to use and gives fewer complications. For anastomosis, absorbable monofilament or polyfilament sutures with two needles are used. Initially, the posterior lip of the anastomosis is stitched, both threads with needles are located on both sides of the future anastomosis. After that, the right and left parts of the anastomosis are alternately superimposed on the right and left, until the threads meet on the anterior lip of the anastomosis. The threads are connected to each other and after that the anastomosis is imposed.

Liver suture
To date, liver suture remains a very difficult problem. The most modern methods for preventing postoperative hemorrhage and bile leakage from the liver are ultrasonic cavitation, treatment of the hepatic parenchyma with hot air, and application of fibrin glue to the liver tissue. With this technique, the suture of the liver is not expected. However, due to the insufficient distribution of the necessary equipment, the liver suture is currently used very widely.

Basically, various methods of U- and 8-shaped seams are used. When suturing the gallbladder bed, it is more convenient to use a continuous overlapping suture. When suturing the liver, it is advisable to use absorbable suture materials (Polysorb, Vicryl, Dexon) of large diameters with large atraumatic blunt needles.

Vascular suture
The main requirement for a vascular suture is its tightness. The simplest technique is to apply a continuous seam without overlap. More reliable, but at the same time more complex, is a continuous mattress seam. A common disadvantage of both seams is the possibility of corrugating the vessel wall when tying the thread. Therefore, in the case of microsurgical restoration of a small-diameter vessel, the technique of a single-row interrupted suture is used. To sew the prosthesis to the vessel (if it is a polytetrafluoroethylene prosthesis), use the same thread, which allows you to get a "dry" anastomosis due to the fact that the thread completely fills the suture channel.

Tendon suture
When suturing the tendon, one should refuse to use coarse clamps, surgical tweezers. Directly for stitching the tendon, strong threads on atraumatic needles of round cross section are needed. Of the many techniques for tendon suture, the most widely used methods are Cuneo and Lange. Particular attention during the restoration of the tendon should be given to the conditions of regeneration of its sliding surface. To do this, the edges of the tendon are adapted with separate sutures using absorbable threads with a conditional diameter of 6/0-8/0. It is especially important to observe this rule when restoring the tendons of the hand. To prevent divergence of seams, an external

Surgical sutures are performed in two ways: manual and mechanical.

For suturing, suture material is used, which can be biological absorbable - catgut or synthetic non-absorbable - nylon, nylon.

The sutures that are applied immediately after the operation are called primary. If the wound after the operation granulates, then a suture is applied to it, which is called secondary.

There are also provisional sutures, it is applied to the wound, but the threads do not tighten. This is done if there is a risk of an inflammatory process in the wound. These sutures are tightened after three to four days, according to indications.

A suture that is applied on the third day after surgical treatment of the wound is called a delayed primary suture.

Types of seams by type of execution

If the wound is shallow and located on the surface of the skin, then a removable suture made of non-absorbable material is applied to it; after the wound has healed, the suture is removed. Wounds that have deeply injured soft tissues are sutured with absorbable suture material. The threads of this seam are not removed.

According to the method of suturing wounds, the seams are divided
- on the nodal
- for continuous
- for purse-string,
- for wrapping,
- on Z-shaped

For manual suture, needle holders are used, which can be straight or curved. A needle is inserted into the needle holders. Needles can be of various configurations. At the top of the needle is an eye through which the suture thread is threaded.

Currently, the mechanical stapler, in which tantalum staples are used instead of a thread, has received increasing use. If the wound is superficial and soft tissues are not affected, then the wound can also be sutured, which conducts an independent reception. With a deep, soft tissue wound that requires surgical treatment, the suture is applied only by a practicing physician.

Removal of sutures depends on the condition of the wound, the general condition of the patient and provided that the skin around the wound is not stretched. Particular attention should be paid to wound healing in the elderly.

Specific seams

For suturing some organs and tissues of the human body, specific surgical sutures are used: intestinal, nervous, vascular and tendon sutures.

In all cases and types of surgical suture, all surgical instruments, suture and dressing materials must be strictly sterile.

Surgical sutures- the most common way to connect biological tissues (wound edges, organ walls, etc.), stop bleeding, bile leakage, etc. using suture material. In contrast to the stitching of tissues (bloody method), there are bloodless methods of their connection without the use of suture material (see. Seamless connection of fabrics ).

Depending on terms of imposing Sh. x. distinguish between: the primary suture, which is applied to an accidental wound immediately after the primary surgical treatment or to the surgical wound; delayed primary suture is applied until the development of granulations in terms of 24 h up to 7 days after surgery in the absence of signs of purulent inflammation in the wound; provisional suture - a kind of delayed primary suture, when the threads are carried out during the operation, and they are tied after 2-3 days; an early secondary suture, which is applied to a granulating wound cleared of necrosis after 8-15 days; a late secondary suture is applied to the wound after 15-30 days or more with the development of scar tissue in it, which is previously excised.

Sutures can be removable, when the suture material is removed after fusion, and submerged, which remain in the tissues, absorbing, encapsulating in the tissues, or erupting into the lumen of a hollow organ. The sutures placed on the wall of a hollow organ can be through or parietal (not penetrating into the lumen of the organ).

Depending on the tools used and the execution technique, manual and mechanical seams are distinguished. For manual sutures, ordinary and atraumatic needles, needle holders, tweezers, etc. are used (see. Surgical instruments ), but as suture material - absorbable and non-absorbable threads of biological or synthetic origin, metal wire, etc. Mechanical suture is performed using staplers, in which metal staples are suture material.

Depending on the technique of stitching fabrics and fixing the knot, manual Sh. x. subdivided into nodal and continuous. Simple knotted sutures ( rice. one ) is usually applied to the skin at intervals of 1-2 cm, sometimes more often, and with the threat of suppuration of the wound - less often. The edges of the wound are carefully compared with tweezers ( rice. 2 ). The sutures are tied with surgical, marine or simple (female) knots. To avoid loosening the knot, the threads should be kept taut at all stages of the formation of seam loops. For tying a knot, especially ultrathin threads during plastic and microsurgical operations, an instrumental (apodactyl) method is also used ( rice. 3 ).

Silk threads are tied with two knots, catgut and synthetic - with three or more. By tightening the first knot, the stitched tissues are matched without excessive force to avoid cutting through the seams. A properly applied suture firmly connects the tissues without leaving cavities in the wound and without disturbing blood circulation in the tissues, which provides optimal conditions for wound healing.

In addition to simple knotted sutures, other types of knotted sutures are also used. So, when suturing the wall of hollow organs, screwing sutures according to Pirogov - Mateshuk are used, when the knot is tied under the mucous membrane ( rice. four ). To prevent tissue eruption, looped interrupted sutures are used - U-shaped (U-shaped) eversion and screw ( rice. 5, a, b ), and 8-shaped ( rice. 5, in ). For a better comparison of the edges of the skin wound, a nodal adaptive U-shaped (loop-shaped) suture according to Donati is used ( rice. 6 ).

When applying continuous seams, the thread is kept taut so that the previous stitches do not weaken, and in the last one a double thread is held, which, after being punctured, is tied to its free end. Continuous Sh. x. have different options. Often a simple (linear) twist stitch is used ( rice. 7, a ), a twisting seam according to Multanovsky ( rice. 7b ) and mattress seam ( rice. 7, in ). These sutures turn the edges of the wound inside out if they are applied from the outside, for example, when suturing a vessel, and screw in if they are applied from the inside of the organ, for example, when forming the posterior wall of the anastomosis on the organs of the gastrointestinal tract.

Along with linear, various types of circular seams are used. These include: a circular suture, which aims to fix bone fragments, for example, with the patella with a divergence of fragments; the so-called cerclage - fastening with wire or thread of bone fragments with oblique or spiral e or fixation of bone grafts ( rice. 8, a ); block pulley suture for bringing the ribs together, used when suturing a chest wall wound ( rice. 8, b ), a simple purse-string suture ( rice. 8, in ) and its varieties - S-shaped according to Rusanov ( rice. 8, g ) and Salten Z-shaped ( rice. 8, d ) used for suturing the stump of the intestine, immersing the stump of the appendix, plastics of the umbilical ring, etc. A circular suture is applied in various ways when restoring the continuity of a completely crossed tubular organ - a vessel, intestine, ureter, etc. With a partial intersection of the organ, a semicirculatory or lateral suture is performed.

When suturing wounds and forming anastomoses, sutures can be applied in one row - a single-row (single-story, single-tier) suture or in layers - in two, three, four rows. Along with the connection of the edges of the wound, the sutures also provide a stop of bleeding. For this purpose, specially hemostatic sutures are proposed, for example, a continuous chain (chopping) suture according to Heidenhain-Hakker ( rice. 9 ) on the soft tissues of the head before their dissection during craniotomy. A variant of the interrupted chain suture is the Oppel hemostatic suture for liver injuries.

Overlay technique Sh. x. depends on the operating methods used. For example, in hernia repair and in other cases when it is required to obtain a strong scar, they resort to doubling (duplicating) the aponeurosis with U-shaped sutures or Girard-Zik sutures ( rice. 10, a ). When suturing eventration or for deep wounds, removable 8-shaped sutures are used according to Spasokukotsky ( rice. 10, b, c ). When suturing wounds of complex shape, situational (guiding) sutures can be used, which bring the edges of the wound together in places of greatest tension, and after permanent sutures are applied, they can be removed. If the seams are tied on the skin with great tension or they are supposed to be left for a long time, the so-called lamellar (lamellar) U-shaped seams are used to prevent eruption, tied on plates, buttons, rubber tubes,

gauze balls, etc. ( rice. eleven ). For the same purpose, secondary provisional sutures can be used, when more frequent interrupted sutures are applied to the skin, and they are tied through one, leaving the other threads untied: when the eruption of the tightened sutures begins, provisional sutures are tied, and the first ones are removed.

Skin sutures are most often removed on the 6-9th day after their application, however, the timing of removal may vary depending on the location and nature of the wound. Earlier (4-6 days) sutures are removed from skin wounds in areas with good blood supply (on the face, neck), later (9-12 days) on the lower leg and foot, with a significant tension of the wound edges, reduced regeneration. The sutures are removed by pulling the knot so that a part of the thread hidden in the thickness of the tissues appears above the skin, which is crossed with scissors ( rice. 12 ) and the entire thread is pulled by the knot. With a long wound or a significant tension of its edges, the sutures are removed first after one, and the rest in the following days.

When applying III. X. various types of complications may occur. Traumatic complications include an accidental puncture of a vessel with a needle or a suture through the lumen of a hollow organ instead of a parietal suture. Bleeding from a punctured vessel usually stops when the suture is tied, otherwise it is necessary to apply a second suture in the same place, capturing the bleeding vessel into it; when a large vessel is punctured with a coarse cutting needle, it may be necessary to apply a vascular suture. If an accidental through puncture of a hollow organ is detected, this place is additionally peritonized with serous-muscular sutures. Technical errors in suturing are poor alignment (adaptation) of the edges of the skin wound or the ends of the tendons, the lack of the effect of screwing in with an intestinal and eversion with a vascular suture, narrowing and deformation of the anastomosis, etc. Such defects can lead to suture failure or obstruction of the anastomosis, bleeding , a, intestinal, bronchial, urinary, etc. Suppuration of the wound, the formation of external and internal ligatures and ligatures occurs due to violations of asepsis during sterilization of the suture material or during surgery. Complications in the form of delayed-type allergic reactions (see.

I N S T R U K T I A

TECHNIQUE OF SUITATION AND REMOVAL.

Indications: treatment of wounds.

Contraindications: purulent processes in the wound, PST was not performed.

Equipment:

Sterile:

1. anatomical tweezers -1, surgical - 2.
2. Gegar needle holder - 1,
3. Cooper scissors - 1,
4. silk,
5. triangular needles - 2,
6. sterile wipes,
7. iodine sticks (or optional tweezers),
8. 1% solution of iodonate,
9. cleol,
10. trays,
11. mask, oilcloth apron, rubber gloves,
12. containers with solutions for disinfection.

SUITATION

1. Examine the medical appointment (for paramedics, self-record the appointment).
2. The patient is invited to the dressing room. Have a conversation with him, answer questions, reassure.
3. Wear a mask, oilcloth apron.
4. Wash hands and put on sterile gloves.
5. Cover the microtable.
6. Load the needle with silk thread (length 10-12 cm) using tweezers and a Hegar needle holder.
7. Treat the edges of the wound with iodonate (from the center to the periphery).
8. Grab the edge of the wound with tweezers, pierce the skin and subcutaneous tissue with a needle, stepping back from the edge of the wound 5 mm. Stitch the bottom of the wound. Sew the second edge from the inside to the outside, piercing the needle at the same distance.
9. Bring the edges of the wound together (with two tweezers if they work together).
10. Tie the ends of the thread to the side of the wound edge and cut at a distance of 0.5 cm from the knot.
11. Apply the next seam with an interval of 1-2 cm.
12. Treat the seam with iodonate with blotting movements.
13. Apply a sterile bandage.
14. Disinfect used equipment.

SEAM REMOVAL TECHNIQUE.

Indications: formed wound scar (6-16 days)

Equipment:

• dressing room standard equipment,
• suture removal kit: Cooper scissors - 1, anatomical tweezers - 1, surgical tweezers -1 (sterile in kraft packaging),
• sterile wipes, balls in bix in kraft packaging,
• solutions: 1% iodonate, cleol,
• tweezers - 3,
• tray,
• protective equipment for the health worker: apron, mask, gloves,
• containers for disinfection.

Execution sequence:

Actions of the health worker

Rationale

1. Study the medical prescription. 2. Invite the patient to the dressing room. 3. Sit or lay the patient in a comfortable position. 4. Carry out hygienic treatment of hands, put on protective equipment. 5. Set up the necessary equipment and soft material. 6. Remove the bandage with surgical tweezers (Keep the tweezers like a writing pen, scissor blades with curvature upwards) 7. Treat the scar and sutures with 1% iodonate with anatomical tweezers with a gauze ball. 8. Remove Stitches: hold anatomical tweezers in the left hand, scissors in the right, we pull the suture thread by the knot, shifting it to the scar, after the appearance of an undyed white thread - cross it in this place. 9. Visually check the presence of 4 ends of the thread. We put the threads in a tray on a napkin. 10. Treat the scar with 1% iodonate. 11. Apply an aseptic bandage. 12. Disinfect the used material and tools, as well as the workplace and protective equipment. Take the patient to the ward, recommend 30-60 minutes. rest, explain the rules for caring for the postoperative scar 13. Make a record of the completed medical appointment.

Elimination of error Creation of psycho-emotional balance. For the convenience of the patient and the health worker EN-1500 Ensuring the course of manipulation Compliance with asepsis. Ensuring the course of manipulation Elimination of leaving the thread in the tissues. Fulfillment of assignment. Compliance with asepsis Infectious safety Continuity of nursing care.

Sources used:

1. Obukhovets T.P. , Sklyarova T.A., Chernova O.V. Fundamentals of nursing. – Rostov-on-Don, 2002

2. Gritsuk I.R., Vankovich I.K. – Minsk, 2000.

Compiled by:Martishevskaya L.A.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

ON CARRYING OUT TRANSPORT IMMOBILIZATION IN FRACTURE OF THE BONES OF THE FOREARM

INDICATIONS: forearm fracture

CONTRAINDICATIONS: No

PATIENT PROBLEMS:

Valid Key words: pain, fear, limitation of movements, physio-atrogenicity

Potential: traumatic shock

Equipment: solution of novocaine 0.5% - 50.0 ml, solution of promedol 2% - 1.0 ml, sterile syringe, needle, skin antiseptic, cotton balls

transport tire Cramer medium (wrapped),

roller in a brush, cotton-gauze pads in the area of ​​​​bone protrusions,

medium bandages - 3 pieces, scarf, pin:

No. p / p	STAGES	RATIONALE
1.	Establish contact with the patient, comfortably lay or seat, inspect the injury site	Assessment of the patient's condition
2.	Produce anesthesia
3.	Model the Cramer splint on a healthy limb: the splint should protrude 3 cm beyond the fingertips, bent at the elbow joint by 90 degrees and reach the middle third of the shoulder	Ensuring the course of manipulation
4.	Give the limbs a position between pronation and supination, bend at the elbow joint at a right angle, the hand is in a grasping position	Correct physiological position of the limb, ease of immobilization
5.	On your own or with the help of an assistant, attach the modeled splint to the injured limb, place rollers in the arm and axillary region, protruding gauze pads under the bone protrusions	Rules for splinting, prevention of soft tissue trauma
6.	Start bandaging from the injury site for 2-3 circular rounds, then descend with a creeping bandage to the wrist joint and tightly fix the hand with a cruciform bandage. Next, apply a spiral bandage on the forearm, “turtle” on the elbow joint, and again apply a spiral bandage to the middle third of the shoulder.	Adequate fixation of the splint to the limb for transport purposes
7.	We fasten the bandage with a pin or tie it on the shoulder	Bandage fixation
8.	Putting on a bandage	Supportive immobilization
9.	Transportation to hospital or emergency room	Nursing Process Continuity

The instruction was considered at the meeting of the CMC No. 4

Minutes No. ___ dated _____________ 2007

Chairman of the Central Committee No. 4_____________ A.A. Lisov

Compiled by: Valutov V.A.

Sources used:

3. Syromyatnikova A.V. Brukman M.S. Guide to practical manipulations in surgery

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

ON BANDAGE DESO

INDICATIONS: 1. Injuries of the upper limb

2. Fractures and dislocations of the collarbone

3. Condition after mastectomy

CONTRAINDICATIONS: No

PATIENT PROBLEMS:

Valid: pain, aggravation of the consequences of trauma or surgery, egogeny

Potential: traumatic shock, displacement of fragments, traumatization of soft tissues, nerve trunks and large vessels

MATERIAL SUPPORT: wide bandages - 3 pcs., cotton-gauze pads, an ampoule with an anesthetic (1 ml of 2% promedol solution, 2 ml of 50% analgin solution), syringe, sterile balls, 70% alcohol, pins - 8 pieces

No. p / p	STAGES OF PERFORMANCE	RATIONALE
1.	Establish contact with the patient, seat him or lay him down
2.	Examine the injured limb	Making a preliminary diagnosis and drawing up an action plan
3.	Perform anesthesia (intramuscularly inject 1 ml of a 2% solution of promedol or 2 ml of a 50% solution of analgin)	Prevention of traumatic shock
4.	Give the arm a physiological position: bend at a right angle in the elbow joint, take the elbow back a little, and slightly lift the shoulder up, put a roller in the axillary region	Prevention of complications
5.	If the clavicle is damaged, apply a cotton-gauze pad to the fracture area	To avoid injury to soft tissues by sharp bone fragments
6.	Become facing the patient and slightly to the right	Monitoring the patient's condition, work convenience
7.	Start bandaging from the healthy side to the injured	Bandaging rules
8.	With the 1st round, bandage the shoulder to the chest of the middle third	Precise fixation of the limb
9.	2nd round, hold it obliquely up the front of the chest on the shoulder girdle of the injured side and lower it vertically down the back of the shoulder	Shoulder fixation
10.	3rd round to withdraw from under the elbow joint obliquely upward through the wrist joint to the axillary region of the healthy side	Fixation of the elbow and wrist joints
11.	4th round lead from the axillary region of the healthy side to the shoulder girdle of the damaged one, then lower it along the shoulder on the forearm and picking up the elbow joint, return to the first round	Final and precise fixation of the limb
12.	The 5th round is fixing and coincides with the first. The bandage is fixed with a pin in front	Bandaging rules
13.	Each round is repeated 3-5 times, the bandage crosses are fastened with pins	Clear fixation of the limb, the possibility of long-term transportation
14.	Transportation of the patient to the emergency room	Continuity of nursing care

Compiled by: Valutov V.A.

Sources used:

1. Gritsuk I.R., Vankovich I.K. Nursing in surgery. – Minsk, 2000.

2. Buyanov V.M., Nesterenko Yu.A. Surgery. – Moscow, 1990.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

Compiled by: Valutov V.A.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

Compiled by: Martishevskaya

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

Compiled by: Valutov V.A.

Sources used:

1. Gritsuk I.R., Vankovich I.K. Nursing in surgery. – Minsk, 2000.

2. Buyanov V.M., Nesterenko Yu.A. Surgery. – Moscow, 1990.

3. Syromyatnikova A.V. Brukman M.S. Guide to practical manipulations in surgery. Moscow, 1987.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

Compiled by: Valutov V.A.

Sources used:

1. Gritsuk I.R., Vankovich I.K. Nursing in surgery. – Minsk, 2000.

2. Buyanov V.M., Nesterenko Yu.A. Surgery. – Moscow, 1990.

3. Syromyatnikova A.V. Brukman M.S. Guide to practical manipulations in surgery. Moscow, 1987.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

INSTRUCTIONS

"The role of the nurse in monitoring patients during blood transfusion (after a biological test)"

1. Evaluation of the recipient's condition: establishment (support) of psychological contact with him (appearance, P, blood pressure, respiratory rate, complaints - every 10-15 minutes), it is necessary to reassure the patient: "Everything is going well!"

2. Interpretation of the obtained data, informing the doctor.

3. Nursing plan: stay with the patient at all times

PATIENT PROBLEMS	WAYS OF SOLUTION
Valid: fear of carrying out (outcome) of blood transfusion,	constant monitoring of its functioning, informing the doctor
	constant psychological contact with the patient, informing him about the course of the operation (how much blood was transfused, indicators of P, blood pressure), information support by the doctor (emphasize the positive effect of blood
	on the body - detoxification, replacement, stimulating, hemostatic, nutritional, immunobiological)
- physical activity	is a temporary state
Potential: - nutrition - drinking - physiological administration initial signs of incompatibility: - pain in the lower back, abdomen, behind the sternum - feeling of heat, redness of the face - shortness of breath - tachycardia - itching of the skin, allergic rashes	feed water give the duck, the vessel immediately stop the blood transfusion, turn off the system without removing the needle from the vein. Connect the system with 0.9% sodium chloride solution. immediate cessation of blood transfusion, without removing the needle from the vein, switch to physical. rr, call a doctor immediately! (behavior m / s is calm, movements are confident). It is necessary to calm the patient (explain the temporary nature of discomfort)
- thrombosis of the infusion system	turn off the system with blood without removing the needle from the vein, make sure it is patency, connect the system with physical. p-ohm, if the needle is thrombosed, call a doctor!

At the end of the operation:

Leave in a bottle of 10-15 ml. blood

As prescribed by the doctor, inject intravenous CaCl10% -10.0

Warn the patient about the need for bed rest after blood transfusion

Evaluate the effectiveness of the measures taken:

PATIENT STATUS:

improved

worsened

Without changes

Instruction reviewed

at CMC surgery

Minutes No. ____ dated "____" _______________ 2005

Chairman of the Central Medical Committee of Surgery: V. N. Rozhko

Compiled by: teacher Lisov A. A.

Used sources:

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

"PUTTING THE NURSE IN STERILE CLOTHES AND GLOVES"

Indications: nurse operation preparation

Equipment: operating room --

* towel (napkin), balls, bathrobe (sterile in bix);

hand skin antiseptic

a sterile tray

forceps (tweezers) in solution,

a basin for discarding waste

preoperative -

cap, mask (in bix or in packages);

shoe covers,

forceps (tweezers) in an antiseptic solution;

Sterile wipes, towels;

warm running water, soap (Ph-neutral, preferably liquid)

Tray, basin, antiseptic for hand treatment (depending on the method of processing, the equipment can be expanded), watches, etc.

Technique:

Preparatory stage: in the preoperative.

Main stage: in the operating room.

STAGES	RATIONALE
PREPARATORY STAGE
1. Take a hygienic shower, put on a surgical suit, shoes made of leather or leatherette	Compliance with the sanitary and epidemiological regime
2. Put on a preoperative cap, mask, shoe covers.
3.Check the readiness of the operating room, preoperative room (make marks on the tags of the autopsy tags, release the ties from the ties).	Ensuring the operation of the operating room
4. Wear an apron. Prepare an antiseptic solution for hand treatment, depending on the method	Ensuring the sequence of manipulation
5. Wash hands according to EN-1500, treat in one of the ways	Ensuring subsequent sterility of manipulation

Compiled by: Rozhko V.N.

Literature: 1. Obukhovets T.P. , Sklyarova T.A., Chernova O.V. Fundamentals of nursing. – Rostov-on-Don, 2002.2. Order of the Ministry of Health of the Republic of Belarus No. 165 dated November 25, 2002 “On disinfection and sterilization by healthcare institutions”.3. Sanitary rules for the arrangement, equipment and operation of medical institutions, No. 71 dated 11.07.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

I N S T R U K T I A

"UNIVERSAL INSTALLATION OF MATERIAL IN BIX"

INDICATIONS: dressing preparation for surgery.

EQUIPMENT: KSK-18 (KF-18) sheet or diaper for lining bix, surgical gown (5 pieces), belts (5), medical caps (5), masks (5), towel (10),

sheets (5), dressings:

* gauze napkins of 3 sizes - 30 pieces

*tampons of 3 sizes - 30 pieces

* turundas - 1 skein

* gauze balls in a bag - 50 pieces

* hygroscopic cotton wool - 390 grams

* brushes - 10 pieces

* bandages -900 grams

Sterility control indicator - 3 pcs., external indicator - 1 pc., napkin - 4 pcs., kidney-shaped tray, disinfectant solution, medical oilcloth for the tag 13x10 cm, a piece of bandage for the tag, a pencil.

No. p / p	STAGES OF PERFORMANCE	RATIONALE
PREPARATION
1.	Wash hands, dry. Wear gloves, mask	Ensuring safety in the workplace
2.	Check the correctness of the bix	Ensuring tightness after sterilization
3.	Treat the bix with closed holes from the inside moistened with disinfectant in the following sequence: bottom, wall, lid, in a circular motion from the center to the periphery. Then outside, starting from the lid in a circular motion and going down. After 15 minutes, repeat the treatment with a second napkin moistened with disinfectant.	Compliance with the principle of processing "from clean to dirty"
5.	Wash hands, wipe dry	Personal hygiene
6.	Open windows.
PERFORMANCE
1.	Line the bottom and walls of the bix with a napkin so that it hangs down two-thirds of the bix height	Ensuring the tightness of packaging in bix, prevention of reinfection
2.	Place a sterility indicator on the bottom of the bix (at the control point)
3.	Lay the dressing loosely, vertically, sectorally and in layers: bottom layer: gauze napkins in sizes of 10 pieces, tampons of 3 sizes in 10 pieces, a skein of turundas, balls - 50 pieces, absorbent cotton - 390 grams and shaving brushes - 10 pieces; middle layer: sheets - 5 pieces (folded in four layers and rolled into a roll on both sides), towels - 9 pieces (folded twice perpendicularly, then rolled up), bandages - 900 g, 4 bathrobes (folded lengthwise into 4 layers with ribbons inside, roll up into a roll from the bottom up), 4 hats (usually), 4 masks (with ribbons inside), 4 belts (in the right pocket of the robe).	Convenience of sterilization and use of material
4.	Place a sterility indicator in the middle of the 2nd layer	Sterility quality control
5.	Wrap the edges of the napkin lining the bix one on top of the other. Put the top layer on top of the sheet: 1 bathrobe, 1 belt, 1 cap, 1 mask, 1 towel	Ensuring that the dressing room of the operating room nurse is prioritized
6.	Place the sterility indicator on the top	Ensuring visual quality control of sterility
7.	Close the lid with a padlock	Ensuring the tightness of the sterile bix
8.	Tie a tag to the bix handle	Ensuring continuity in working with Bix
9.	Indicate the date of laying, put the signature of the person responsible for laying	Personal responsibility
10.	Stick an external indicator on the bix cover.	Temperature control
11.	Deliver biks to the CSO in a dense moisture-proof bag

I N S T R U K T I A

Compiled by: Rozhko V.N.

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

INSTRUCTIONS

Compiled by: Lisov A.A.

Used source

1.Yaromich I.V., "Nursing"

2. "Medical knowledge" 2004

3. "World of Medicine" 2004

4. Pasheva N.R., "Handbook of m / s care" 2000

APPROVE

Director of EE "Borisovsky

state medical

college"

Khorova T.I.

"___" _________________ 2007

BANDAGE OF A PURULENT WOUND

Indications: - soaking the bandage with purulent discharge, blood

Another dressing

Bandage displacement

Contraindications: No

Patient problems:

Valid: fear of pain, discomfort.

Potential: psychogenic nausea, dizziness, fainting, an increase in the area and depth of the wound.

Equipment: bathrobe, hat, mask, gloves, apron, armlets,

sterile dressing material

tweezers - 4,

bulbous probe - 1,

scissors - 1.

rubber strip - 2,

1% iodonate, 3% hydrogen peroxide solution, furatsilin 1:5000, 0.9% sodium chloride.

No. p / p	STAGES OF PERFORMANCE	RATIONALE
	PREPARATORY STAGE
1.	Inform the patient about the upcoming manipulation, obtain consent Invite the patient to the dressing room after 10 minutes.	Ensuring the patient's right to information.
2.	Put on a surgical gown, mask, put on an apron, perform surgical treatment of hands - put on sterile gloves.	Compliance with the sanitary and anti-epidemic regime.
3.	Put everything you need on the table.
4.	Invite the patient to the dressing room
5.	Sit or lay the patient in a comfortable position, explain the course of manipulation.	Creation of physiological comfort.
	MAIN STAGE
1.	Treat your hands with an antiseptic.	Compliance with the rules of asepsis
2.	Remove the upper bandage (sticker) from the set with tweezers, using furatsilin for soaking (1st tweezers). Monitor the patient's condition, suggest not to look at the wound.	To reduce pain sensitivity
3.	Treat the wound with a ball with 1% iodonate solution using the second tweezers from the set, then remove the rubber drainage (with the same tweezers) (2nd tweezers).	Ensuring the course of manipulation
4.	Wash the wound with 3% hydrogen peroxide solution, dry with a sterile dry ball (3rd tweezers).	Wound decontamination
5.	Take a rubber strip with the same tweezers and insert it into the wound with a button probe, leaving the tip outside (1-2 cm), then treat with 1% iodonate solution. (4th tweezers).	Ensuring the course of manipulation.
6.	Close the wound with a sterile napkin with hypertonic sodium chloride solution, apply an aseptic dressing or sticker on top.	Compliance with the sterility of the wound, prevention of bandage displacement
	THE FINAL STAGE
1.	Will provide accompaniment of the patient, if necessary, to the ward, provide him with peace, explain the rules for caring for the bandage.	Ensuring the continuity of nursing care Ensuring the continuity of nursing care
2.	Disinfect used equipment.
3.	Make an entry in the register of procedures.
4.	Evaluate nursing intervention.

INSTRUCTIONS

"DETERMINATION OF THE RH FACTOR EXPRESS - METHOD"

(IN THE TUBE WITHOUT HEATING)

Indications: transfusion of blood and its components.

Equipment: universal reagent anti-rhesus anti-RHD; serum (to determine the Rh factor in a test tube without heating); test blood (in a vial); isotonic sodium chloride solution; Pasteur pipettes; hourglass for 5 minutes; syringe with a needle; test tube in a rack; soft material; antiseptic solution; protective equipment (mask, gloves, apron, sleeves, goggles); disinfectants in labeled containers; first aid kit in case of an accident when working with blood (Order No. 351 of the Ministry of Health of the Republic of Belarus).

No. p / p	STAGES	RATIONALE
	PREPARATORY STAGE
1.
2.
3.
4.	Mark a clean, dry tube, indicate: patient's full name (indicated on the vial).
	MAIN STAGE
1.	Introduce a large drop of anti-Rhesus anti-RHD serum into the test tube with a Pasteur pipette, add a drop of test blood here (with a disposable syringe) - a ratio of 2-4: 1.	Ensuring the progress of the procedure.
2.		Ensuring the clarity and efficiency of the procedure.
3.	Connect the serum with blood by shaking, turning, tilting the test tube to a horizontal position so that the contents spread along its walls in the lower third.
4.	After 5 min. add 2-3 ml to the test tube. physiological saline, continue to gently mix the contents, NOT SHAKING!
5.	Carefully examine the contents of the test tube, evaluate the results in transmitted light.	Evaluation of results.
6.	Invite a doctor to read the result: · if there is agglutination – RH+ blood to be tested; If there is no agglutination, the test blood is RH-.	Evaluation of results.
7.
8.	If the result is doubtful, repeat the blood test using the serum of a different series.	Ensuring the reliability of the results obtained.
	THE FINAL STAGE
1.		Compliance with infectious safety.
2.	Soak a test tube, Pasteur pipettes, a syringe with a needle, soft material, gloves in a 1% solution of polydez for 45 minutes.	Compliance with infectious safety.
3.	Treat the tripod, manipulation table, protective equipment (sleeves, glasses, apron) with 1% polydez solution 2 times with an interval of 15 minutes.	Compliance with infectious safety.

INSTRUCTIONS

"DETERMINATION OF BLOOD GROUPS ON STANDARD SERUM"

Conducted by a doctor, and a nurse - a technical assistant-performer.

Indications: transfusion of blood and its components, the establishment of the hereditary properties of the organism.

Equipment: standard hemagglutinating sera of four groups O(I), A(II), B(III), ABO(IV) of two series; test blood in a vial; plates (faience or covered with white enamel); glass slides; Pasteur pipettes; hourglass for 5 minutes; syringe with a needle; soft material; antiseptic solution; protective equipment (mask, gloves, apron, sleeves, goggles); disinfectants in labeled containers; first aid kit in case of an accident when working with blood (Order No. 351 of the Ministry of Health of the Republic of Belarus).

No. p / p	STAGES	RATIONALE
	PREPARATORY STAGE
1.	Prepare your workspace. Wear protective equipment: gown, mask, goggles, apron, sleeves, gloves.	Ensuring the clarity and efficiency of the procedure; use of personal protective equipment.
2.	Wash gloved hands under running water and soap. Dry with a disposable towel.	Compliance with infectious safety.
3.	Expose sterile equipment, put the date, time of opening, signature.	Control of expiration dates.
4.	Mark a clean dry plate, indicate on its upper edge: the name of the patient (indicated on the vial).	Ensuring the clarity and efficiency of the procedure.
	MAIN STAGE
1.	According to the designations of blood groups, apply one large drop (0.1 ml) of standard isohemagglutinating sera O (I), A (II), B (III), ABO (IV) blood groups of two series to the plate, each drop is applied with a separate pipette.	Ensuring the progress of the procedure.
2.	From a vial of blood, draw some blood with a syringe and apply to a glass slide.	Ensuring the progress of the procedure.
3.	Place on the signed plate, next to the serum, a drop of blood (0.01 ml), the ratio of serum and blood is 1:10.	Ensuring the progress of the procedure.
4.	Mix serum and blood with an angled glass slide (each cell on a separate angle) until homogeneous staining.	Ensuring the progress of the diagnostic reaction.
5.	Set the time control on the hourglass - 5 min.	Ensuring the clarity and efficiency of the procedure.
6.	Take the plate in your hands and, periodically shaking, observe the onset of the agglutination reaction.	Evaluation of results.
7.	After 3 min. add 1 drop (0.05 ml) of saline to each well.	Prevention of the appearance of false agglutination; ensuring the reliability of the results.
8.	Observe the reaction until 5 minutes have elapsed.	Ensuring the clarity and efficiency of the procedure.
9.	Invite a doctor to read the result: in the absence of agglutination in all drops - blood type O (I); In the absence of agglutination in the second drop (in two series), and the presence of such in the first and third drops - blood type A (II); In the absence of agglutination in the third drop (in two series), and the presence of such in the first and second drops - blood group B (III); In the presence of agglutination in all drops - blood type ABO (IV). An additional control study should be performed with standard ABO(IV) serum. The absence of agglutination in this drop will allow us to consider the reaction as specific (true) and to attribute the blood under study to the ABO(IV) group.	Evaluation of results.
10.	Make appropriate entries in the medical records.	Maintaining continuity in the nursing process.
	THE FINAL STAGE
1.	Disinfect used equipment.	Compliance with infectious safety.
2.	Soak a plate, glass slides, Pasteur pipettes, a syringe with a needle, soft material, gloves in 1% polydez solution for 45 minutes.	Compliance with infectious safety.
3.	Treat the manipulation table, protective equipment (armlets, glasses, apron) with 1% polydez solution 2 times with an interval of 15 minutes.	Compliance with infectious safety.

SCORE SCORE

When performing a manipulation

"Performing emergency prophylaxis of tetanus with toxoid"

No. p / p	Possible mistakes	The amount of points deducted
1.	Stage I of the nursing process has not been completed (psychological contact with the patient, assessment of his condition).
2.	The indications for the administration of the drug have not been determined.
3.	The indications for the administration of the drug are not fully listed.
4.	Indications for the administration of the drug are not listed.
5.	The patient's problems are not specified.
6.	The equipment for the manipulation is not fully prepared.
7.	The suitability of the drug and the syringe for use has not been verified.
8.	Ampoule not treated with antiseptic.
9.	Gloves not treated with antiseptic.
10.	The injection site has not been treated with an antiseptic or has not been properly treated.
11.	Nursing process not completed during and after manipulation
12.	Documentation on the administration of the drug is not completed.

APPROVE

Director of the EE "Borisov State

Medical College

T.I. Khorova

"___" __________________ 2007

INSTRUCTIONS

SCORE SCORE

When performing a manipulation

« Temporary stop of bleeding by overlay method

Compiled by: Valutov V.A.

SCORE SCORE

When performing a manipulation

"Imposition of a medical pneumatic splint".