Suture Kit?

[FireGirl_Photo]

I'm curious, what sort of training advocates suturing in the field?

Thanks for the feedback, guys. My work takes me into a host of third-world situations, including disaster response situations and medical aid - of any sort - is often more than five hours away. I'm well aware suturing in the field is not the best idea... trust me, I don't want to wield a needle if I don't have to, but wanted this skill in my repertoire in a worst-case scenario situation. Fingers crossed the equipment will go untouched!

And, as Arclight noted, in third-world situations, often clinic equipment is not the cleanest. I'd rather have a kit I know is sterile if there is stitching going on - for myself or someone else. Saw some very nasty infections recently in rural Russia from unclean equipment.

 

[1leglance]

I am an ICU RN and also work Surgical Recovery....I am around needles and those who use them all the time.

Not sure how I missed this thread way back in March but let me go on record that self use of a suture kit by someone who does not suture regularly is such a bad idea I can't begin to think of a way to explain it.
Oh well maybe this will work.
Order your suture kit, even something simple as a 1 needle thread setup, then get a nice ham round bone in (you know the big Honey baked Ham kind of thing).
Now make a very very deep cut (because anything else would be fine with steri-strips).
Now suture it up but you FAIL if you leave any pockets....but how will you know until it grows an abcess?
You FAIL if you didn't pick the right thread for the muscle, facia, skin...and you do know which is needed for which right?
And you do know the right knots?

Oh and please imagine screaming in pain the entire time, or doing this to someone else who is screaming.

Sure you could take a class, maybe. But if this isn't something you do on a regular basis will you remember?

Direct pressure and tape is your best friend.

The only reason I would carry a sterile suture kit (with a variety of needle shapes and threads) would be if I was traveling in third world countries and wanted something to hand to a TRAINED and PRACTICED profession to use on me instead of the unkown or missing stuff they might have.
Since you mention third world then please carry for someone else to use.

 

[TangoBlue]

Her situation is "special." Just get her the damned sutures and let her go crazy... she's going to ignore experienced professional advice anyway.

Look at the bright side -- job security!

 

[TangoBlue]

So in this third world country with an absence of modern Western medical supplies... who gets the "sterile bits" you've collected in this disaster situation with an anticipated large number of casualties? How do you decide who gets the good stuff?

All these bits of medical kit you've collected... are they within their expiration dates for sterility? Or is expired, questionable medical supply "better than nothing when you have nothing."

Is bringing your own medical kit for host nation providers to use for your own care, because you suspect their aseptic technique or supply inadequate for your medical standards, sending a message of any sort?

I'm certain your intentions are genuine but it's not a very diplomatic strategy to be critical in deed by supplying your own gear for yourself, and sends a clear message of your value over theirs. If you have your own kit, keep it to yourself and know how to use it on yourself. Introducing a standard of care into an area that has little does nothing to contribute to the populations health but instability through setting unrealistic expectations or criminal enterprise.

 

[TangoBlue]

Yeah, Mr. Cartridge, I get the message - I've lived and worked with those host nation medical providers in Southwest and Southeast Asia for much of my career. Politics and judgement have nothing whatsoever with what I mentioned earlier and I'm flabbergasted that's your take away.

My problem? The ignorance of non-clinicians providing a level of care to which they have no comprehension of the results of their actions; their tragically romantic notions of heroically intervening in a medical emergency while only compromising the outcome. Oh, and no one telling them the painful truth that their intentions are specious at best.

Perhaps you've dealt with the sequelae of amputation and sepsis because of a failure to observe what one (military healthcare provider) contributor above so correctly observed, "just because you can doesn't mean you should," therefore you understand full well the experience I cite -- we shouldn't be having this dialog then. Also, We'll just ignore your statement, "It is cheap enough to leave behind as a gift playing it forward."

Is that message simple enough?

 

[TangoBlue]

For those interested in the whole product advertisement beyond a picture that Mr. Cartridge provided, this is extracted from Adventure Medical's website --

"Designed to fit inside the World and Smart Travel kits, the Suture/Syringe Medic is a necessity for any trips to locations where sterile supplies may not be available. Contents are sealed and should not be opened except by a local caregiver for use on a single patient. Packed in a durable, reusable, and lightweight pouch.



BRING TO A LOCAL CAREGIVER IF YOU NEED SUTURES OR INJECTIONS

Supply List

Bleeding
1 Gloves, Nitrile (Pair), Hand Wipe

Suture / Syringe
1 Suture, Nylon, 5-0
1 Needle, Disposable, Sterile, 18G x 1 1/2"
1 Syringe, 1 cc with Needle
1 Syringe, Luer Lok, 3ml
1 Needle, Disposable, Sterile, 21G x 1 1/2"
1 Needle, Disposable, Sterile, 25G x 5/8"
1 Angiocatheter, 18G x 1 1/4"

Wound Care
3 After Cuts & Scrapes Antiseptic Wipe
4 Alcohol Swab
---- end quoted text----

*Note:

This kit contains no instruments (minimally tissue forceps, needle driver, and scissors) or analgesia.
This kit contains no antibacterial cleansing agent for preparing the wound for debridement or closure.
Some lacerations may require subcuticular or intradermal technique for best closure results and no suture material for that procedure is included in this kit.
No dressing material is included for use during the procedure or for application after.

Sigh...

 

[chromisdesigns]

Don't know if they are still offered, but I suspect they are -- classes for offshore sailors in advanced first aid and emergency medical techniques included suturing, giving injections, splinting, reducing dislocations and fractures, etc.

It's all very nice to say "get professional help" but what if that help is not available in any realistic amount of time? I would think some of these same considerations might apply to wilderness exploration, as well.

I never finished the series because our cruising plans changed after my partner was diagnosed with COPD, but I had taken the first course. This was about 25 years ago.

 

[robert]

The class you are talking about is Medical Person in Charge or Medical Care Person in Charge; it's a 45hr course and usually runs around $1500. It follows the 8hr First Aid/CPR and 40hr Medical Care Provider courses. It's geared towards the marine environment where medical help can be a long time coming and the ship's captain/chief mate is the medical provider on board. It includes learning to do clinical exams, suturing, Foley catheter insertion, splinting and bandaging, identification of wound infection, basic pharmacology, airway management etc. There is a clinical aspect to the class and it is renewable every five years.

There are valid reasons to suture in the remote or austere environment and quite frankly, closing simple lacerations of the type that typically occur is not rocket science. For the average traveler who doesn't actually venture far from medical care it's not something they need to be doing, but there are folks who do actually get quite a ways out from actual medical care. Not surprisingly, almost every discussion I've ever seen on this subject on various forums almost always goes the same direction this one has- take that how you will. :snorkel:

 

[Wilbah]

So I have a question and no I'm not going to try suturing myself or anyone else. But I am curious as to when a bandage is more appropriate than super glue and vice versa. I get that super glue might prevent ongoing cleaning while a bandage would allow it. Just curious what the decision matrix would be from your perspective (s). Also curious if the coagulation packets (I'm blanking on what they're actually called but the stuff to stop bleeding) have merit and when/how would you be using it. Hope this isn't too much of a hijack of the thread!

Definitely learning a lot on this thread which is great. Even if the original intent was not where it has turned.

 

[Wilbah]

Thanks John I appreciate it!

 

[Pacific Northwest yetti]

I have an MCPIC cert,

And as others have said- Dont do anything you are not trained, or have the equipment to do. That being said I have a wound closure kit, ENT, etc for clinical albiet field use if and when needed. A lot goes into that, and the decision to do that in the field, with a good follow up plan of care. I wont get into field care debate. Places its used Marine, off shore, oil rigs, remote research camps, long pack trips( We have been multi day horseback ride from the nearest road, let along care, or the ability to get a helo in.) MCPIC we say is 72hr away from definitive care.

I can highly recommend Remote MEdical International for the certs, but its going to cost you. In fact they would be my top choice for any training and certs in this field.

https://www.remotemedical.com/training/remote-emergency-medical-technician-remt/

and if you wanted a pre packaged kit- expensive but-

http://www.adventuremedicalkits.com/medical-kits/professional/suture-syringe-kit.html

 

[Pat Caulfield]

I carry a wound (clotting sponge) kit. Generally don't want to take the chance of closing a wound and trapping something in it. Also don't want to spend the time involved in suturing and distress of no anesthetic. I know there is an acronym for this, but I can't remember it; find, assess, treat, package and evac.

Very much agree; don't carry gear you are not trained on, or authorized to use.

In a backcountry setting, the subject is generally stable, or is exhibiting characteristics "non-conducive to life" (or on that exit ramp) by the time a SAR team arrives. It just takes time; for the subject/partner to make the call (if they can), activate and get to them. If someone is bleeding that badly, and it has not already been controlled before the SAR team arrives, well........

Biggest medical issue I have consistently been dealing with is the "post-rescue collapse", regardless of the subjects condition (non-DRT) when they are found. Keep them warm, reassure that this is a common response to rescue, hydrate and feed (depending on assessment). Once they are through it, get them ready to move.

My two cents, maybe more of a nickle.

 

[Pacific Northwest yetti]

John E-

No it does not. It is a NREMT reciprocity state more or less. You aren't going to find a State that recognises the MCPIC. You'd have to be in a Offshore or remote environment. It teaches you skills like Sutures/ U cath;s/ NGtubes, etc. That you would use in conjunction with telemedicine. But its not something that will allow you to practice those skills in a front country environment in any state outright.

And when you are using those skills, you are doing so( even if by phone/video) under the " direct" supervision of a MD.

 

[Manuel.Sharp]

A wilderness adventure laceration kit is necessary first aid equipment, and cleaning and disinfection tools should be carefully prepared. The Senvok Laceration Kit is an advanced medical device designed to quickly and effectively close wounds, reduce the risk of infection, and accelerate wound treatment. It is very easy to use, convenient and fast, suitable for outdoor activities and provides you with emergency medical treatment.

 

[Pacific Northwest yetti]

A wilderness adventure laceration kit is necessary first aid equipment, and cleaning and disinfection tools should be carefully prepared. The Senvok Laceration Kit is an advanced medical device designed to quickly and effectively close wounds, reduce the risk of infection, and accelerate wound treatment. It is very easy to use, convenient and fast, suitable for outdoor activities and provides you with emergency medical treatment.

This may be a record; I do love the medical sub forum. CPR on a 10yr old thread. It’s a good example, the Senvok Laceration Kit did not exist at least in a commercial form 10 years ago. I have used it, and it’s a great design. It made it easier for very specific type of 9 Laceration) wounds…. although not necessarily a good thing.

And necessary is relative, unless you are days away from definitive care.

That being said: guiding principles still apply.