Advanced Skills Training: suturing dry lighting ends of two cigarettes.

This skills training module allows medical officers (non-specialist physicians) and general surgeons to become confident and competent in the gentle handling of delicate infant tissues as part of neonatal colostomy procedures performed in low to middle income countries (LMICs).

Learning Objectives[edit | edit source]

The learner should already have basic suturing skills for this skills training module.

By the end of this module, learners will be able to perform the following skills during a neonatal colostomy procedureː

  • Gentle and delicate tissue handling
  • Avoiding crushing tissue
  • Avoiding tight sutures
  • Avoiding undue tension and pull

Simulator Materials[edit | edit source]

The Neonatal Enterocutaneous Anastomosis Simulator requires the following componentsː

  • 1 reusable cup with clean water
  • Cigarettes (minimum of 10 for this skills training module)
  • 4-0 or 5-0 silk sutures with a round bodied (tapered) needle (NOTEː 4-0 or 5-0 Vicryl or PDS sutures with a round bodied needle should be used during the actual procedure on live patients. Inexpensive silk sutures are recommended for use in this module's simulation training to maximize affordability and accessibility for learners.)
  • Smooth (non-toothed) dissecting forceps
  • Standard needle driver
  • Mayo scissors (used to cut sutures and stabilize the proximal end of the cigarette closest to you)

Training Logbook[edit | edit source]

Please print out the Training Logbook below and write your name at the bottom of the Training Logbook page.

Training Logbook - Colostomy in Newborns
Basic Skills Training Intermediate Skills Training Advanced Skills Training* (Optional) Expert Skills Training
Training Goal Place 4 interrupted sutures equally spaced apart circumferentially on the dry filter ends of 2 cigarettes Place 4 interrupted sutures equally spaced apart circumferentially on the wet filter ends of 2 cigarettes Place 12 consecutive sutures on the dry lighting ends on a total of 3 pairs of cigarettes* Place 12 consecutive sutures on the wet lighting ends on a total of 3 pairs of cigarettes
Cigarettes ends are successfully sutured
No spilling of the contents of the cigarettes
No tears on the cigarette wrap
Ends not rumpled or squashed
Photograph taken on cellphone
Task Completion Date

*When the learner has successfully completed a minimum of 12 consecutive sutures on the dry lighting ends on a total of 3 pairs of cigarettes, then they will have practiced to a sufficient level of mastery to perform a colostomy procedure in a neonatal patient.

Learner's Name:

Other Equipment[edit | edit source]

  • Cellphone Camera

Gentle Tissue Handling Skills Training Using the Neonatal Enterocutaneous Anastomosis Simulator[edit | edit source]

1
Basic Skills Training
Basic Skills Training: suturing dry filter ends of two cigarettes.
  1. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
  2. Suture the dry filter ends of two cigarettes together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
  3. Each stitch should have 4 throws for a secure bowel anastomosis
  4. Place 4 interrupted sutures equally spaced apart circumferentially
  5. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
  6. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone
  7. Once successful with the dry filter ends of the cigarette, move to the next stage
2
Intermediate Skills Training
Intermediate Skills Training: suturing wet filter ends of two cigarettes.
  1. Briefly dip the filter end of two cigarettes in water for 1 second to make them wet
  2. Allow the filter ends to dry slightly so they are moist but not soggy
  3. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
  4. Suture the two wet ends together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
  5. Each stitch should have 4 throws for a secure bowel anastomosis
  6. Place 4 interrupted sutures equally spaced apart circumferentially
  7. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
  8. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone
  9. Once successful with the wet filter ends of the cigarette, move to the next stage
3
Advanced Skills Training
Advanced Skills Training: suturing dry lighting ends of two cigarettes.
  1. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
  2. Suture the dry lighting ends of two cigarettes together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
  3. Each stitch should have 4 throws for a secure bowel anastomosis
  4. Place 4 interrupted sutures equally spaced apart circumferentially
  5. Repeat Steps 1-4 on two additional pairs of cigarettes for a total of 12 consecutive sutures on the lighting ends for a total of 3 pairs of dry cigarettes
  6. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
  7. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone.

When the learner has successfully completed a minimum of 12 consecutive sutures on the dry lighting ends on a total of 3 pairs of cigarettes, then they will have practiced to a sufficient level of mastery to perform a colostomy procedure in a neonatal patient.

4
Expert Skills Training
OPTIONAL

Once successful with the dry lighting ends of the cigarette, the learner can choose to further develop their gentle tissue handling skills in this optional expert skills training activity.

Expert Skills Training: suturing wet lighting ends of two cigarettes.
  1. Briefly dip the lighting ends of two cigarettes in water for 1 second to make them wet
  2. Allow the lighting ends to dry slightly so they are moist but not soggy
  3. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
  4. Suture the two wet ends together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
  5. Each stitch should have 4 throws for a secure bowel anastomosis
  6. Place 4 interrupted sutures equally spaced apart circumferentially
  7. Repeat Steps 1-6 on two additional pairs of cigarettes for a total of 12 consecutive sutures on the wet lighting ends for a total of 3 pairs of cigarettes
  8. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
  9. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone
Page data
Part of Colostomy in Newborns
Type Medical skill
Keywords pediatric surgery, surgical training, frugal innovation, anorectal malformation, neonatal colostomy, gentle tissue handling skills, enterocutaneous anastamosis
SDG Sustainable Development Goals SDG03 Good health and well-being
Authors Medical Makers
Published 2021
License CC-BY-SA-4.0
Language English (en)
Impact Number of views to this page and its redirects. Updated once a month. Views by admins and bots are not counted. Multiple views during the same session are counted as one. 227
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