Suturing Of Perineal Laseration

SUTURING OF PERINEAL LASERATION STEPS / ACTIVITIES tools preparation Hecting set containing; 10 cc syringe 1 pair of Hand Schone Anatomical Tweezers Cirurgis tweezers Nail pouder Nail heacting (1 piece for skin, 1 piece for muscle) Cut gut thread Sterile duct Sterile gauze Lidocaine 1% Betadine Small Comm Plastic apron Boots Face mask Glasses 2 trash cans Washbasin containing 0.5% chlorine solution Implementation 1 Clean gloves in 0.5% chlorine solution, remove them upside down and soak in 0.5% chlorine 2 Prepare equipment for suturing: Prepare a hectating set in a sterile instrument tub Open the 10 ml disposable syringe, insert it into the instrument tubhectating set Break the tube of lidocaine (lidocaine 1% without epinephrine), estimate the volume The lidocaine that will be used, adjust to the size/depth of the tear. If 1% lidocaine is not available, 2% lidocaine can be used diluted 1:1 using sterile distilled water. 3 Position the mother's buttocks at the corner of the end of the bed, in the lithotomy position 4 Turn the spotlight/flashlight towards the mother's vulva/perineum 5 Wear sterile gloves on 1 hand 6 Fill a 10 ml syringe with 1% lidocaine solution without epinephrine 7 Place a sterile drape under the mother's buttocks 8 Completely wear gloves on both hands 9 Use sterile DTT/cotton gauze/cotton to clean the wound area of blood/blood clots, and reassess the extent and depth of the tear in the perineal area LOCAL ANESTHESIA 10 Tell the mother that you are going to have an injection and that you may feel uncomfortable 11 Insert the syringe at the end of the wound/perineal tear, insert the syringe subcutaneously along the edge of the wound 12 Aspirate (pull the plunger of the syringe) to ensure no blood is sucked out. If there is blood, withdraw the needle slightly and reinsert it. Repeat the aspiration (lidocaine fluid entering the blood vessels can cause irregular heartbeat). 13 Inject 1% lidocaine while withdrawing the syringe at the edge of the wound in the perineal area 14 Without pulling the syringe out of the wound, guide the syringe along the edge of the wound on the vaginal mucosa, perform aspiration, inject 1% lidocaine while withdrawing the syringe. (If the tear is large and deep, anesthetize the area inside the tear, the anesthetic injection path will be shaped like a fan, the edge of the perineum, inside the wound, the edge of the vaginal mucosa) 15 Do steps 12 to 15 for both edges of the tear 16 Wait 1-2 minutes before sewing to get results Optimization of anesthesia SUTURING OF LASERATIONS/TORNS IN THE PERINEUM 17 Inspect the vagina and perineum for tears 18 If there is visible bleeding covering the episiotomy wound, place a tampon or gauze into the vagina. (it's best to use thread-tailed tampons) 19 Place the sewing needle in the needle holder, then lock the needle holder 20 Attach sewing thread (chromic 2-0) to the eye of the needle 21 See clearly the boundaries of the episiotomy wound 22 Perform the first suture ± 1 cm above the top of the tear in the vagina, tie the first suture with a dead knot. Cut the free end of the thread (the end of the thread without the needle) until ± 1 cm remains 23 Sew the vaginal mucosa using running stitches until just behind the hymen circle. If using plain cat gut thread, make a dead knot in the running stitch behind the hymen loop 24 Insert the needle into the vaginal mucosa from behind the hymenal circle until it penetrates the perineal tear. If the tear is very deep: Remove the needle from the thread Take new thread and thread it on the needle Place interrupted sutures on the inside tear to avoid cavities free/dead space Cut off the remaining thread Put the needle back on the original sewing thread 25 Continue running stitches over the perineal suture wound until it reaches the bottom of the tear. If using plain cat gut thread, make a dead knot at the bottom stitch 26 Suture the right ‒ left subcutis tissue upwards until it is right in front of the hymen circle 27 Insert the needle from the front of the hymenal loop into the vaginal mucosa behind the hymenal loop. Make a dead knot behind the hymen loop and cut the thread until ± 1 cm remains 28 If you use a tampon/gauze in the vagina, remove the tampon/gauze. Insert your index finger into the rectum and feel the upper wall of the rectum. (if stitches are felt, change gloves and re-stitch) 29 Advise mothers to: Washing the perineum with soap and water, especially after defecating (washing direction from face to back) Return for a follow-up visit after 1 week for examination sutures and rectum (refer immediately if fistula occurs) Continue steps/activities for cleanliness and safety in accordance with normal childbirth activities