After a very great experience with my first job shadow, I was very excited to have this experience again. My job shadow definitely looked different this time, though. For my second job shadow, I was able to participate in a skills lab with a group of Nurse Practitioner students. This skills lab was run by my mentor, Mr. Justin Edmondson. Although he works in the Emergency Department full time, Mr. Edmondson still makes time to help students from his alma mater, The University of South Alabama. He runs various skills lab and case study courses. For my job shadow, Mr. Edmondson gave a presentation on suturing.
Our practice medium for our sutures were pigs' feet, a nice change to any suturing that I had done before on fake skin pads. Before one can ever begin to put a stitch in a patient there are many steps that must be taken. First, one must determine what type of suture to use on the patient. Suture sizes are named by number, for instance 1-0, 2-0, 3-0, etc. Counterintuitively, though, as the suture size increases, the width of the suture itself decreases. Therefore, the suture size 3-0 is actually larger than the suture size 4-0. Smaller sutures are for more detailed-oriented lacerations, such as those to the face or even eye. Larger sutures are for larger surface area wounds. Large sutures can cause more tension on tissue than smaller sutures. This is why choosing the correct size suture is integral. If one was to use too large of a suture in an area where tissue is more fine, the tension would be too great and cause more damage. If too small of a suture was used, then the stitches would not hold long enough to heal at all. Once the suture size is determined, the patient needs to be thoroughly cleaned. It is important that the wound is totally free of debris and harmful bacteria. Sewing up an unclean wound would certainly cause more harm than good as a result of bacteria. Next, the patient needs to receive adequate anesthetic. This is typically administered through injection but can come in the form of a gel that sits on the wound several minutes before the procedure. Numbing the wound not only is for the patient’s comfort, but also for the help of the medical professional performing the procedure. They definitely don't want the patient moving in pain while applying the sutures. Next, the medical professional performing the procedure needs to prepare themselves. He/she needs to wash their hands thoroughly and put on sterile gloves. And finally, the medical professional needs to identify a plan of action. He/she needs to determine what type of suturing technique to use and how many sutures need to be applied.
After those topics were covered, we finally got to start our lab! The first suturing technique discussed was a simple interrupted suture. I actually already was familiar with this technique from a lab we did in Biomed II! I was cool knowing something that the college students didn’t. Next, we practiced a vertical mattress suture. This technique pulls the skin very tightly onto itself and even creates a slight V shaped mountain of skin where the sides of the skin meet. This technique is different from the simple interrupted because instead of sitting on top of the skin, this suture goes below the skin and can only be seen on the sides of the wound. We also discussed the horizontal mattress stitch. These suture techniques are performed the same way but, of course, one is vertical and the other is horizontal. Mr. Edmondson taught us to start our suture in the middle of the wound dividing each section of skin between stitches into two to help ensure the stitches are placed symmetrically. With practice, this step won’t be necessary. Lastly, we learned how to throw a continuous suture. This technique, unlike the others, is as its name suggests, not interrupted. Therefore, the stitches are not placed individually, but rather connected to each other. That day’s lesson was mainly about the skills, so we didn’t learn a lot about when to use each technique, but they did learn it in class the day before.
Overall, I had an amazing experience in this class. I was beyond grateful to have been able to participate in this skills lab nearly six years before I would be required to. I learned a lot, and I was impressed with everything that I already knew from my time in Biomed and from my job shadow in the ER. I would love to show my classmates the skills I learned because right after this class, I bought a suturing kit and have been practicing for fun ever since!
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