Specialty instruments, needles, and wound closure

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Ophthalmologic and otolaryngologic instruments

Instrument	Description
Krause nasal snare	Wire loop at the tip that can be tightened Used to remove polyps from the nares
Metal tongue depressor	Used to depress the tongue for oral examinations
Hartmann “alligator” ear forceps	3-inch shaft; made in a variety of styles Action of the jaw similar to that of an alligator’s jaws Used to remove foreign bodies or polyps
Laryngeal mirror	May have a nonfogging surface Used for examination of the larynx and postnasal area
Ivan laryngeal metal applicator	6 to 9 inches long with curved end for use in throat or postnasal areas Holds cotton in place with its roughened end; used to swab or sponge throat or postnasal tissue Used to remove foreign bodies embedded in the pharynx
“Buck” ear curette	Available as disposable curettes in many different sizes Has a stainless steel loop at the end Made with sharp or blunt scraper ends Used to remove foreign matter from the ear canals
Sharp ear dissector	Used to remove debris from the ear canal
Wilde ear forceps	Angled, with serrated tips Provides easier access to the ear canal and nasal cavities Used for packing after ear or nasal procedures Can be used to remove foreign bodies

Biopsy instruments

Instrument	Description
Cervical biopsy forceps	Available with or without teeth Used to obtain cervical specimens for diagnostic examination
Rectal biopsy punch	Manufactured with interchangeable stems Used through a proctoscope or sigmoidoscope
Silverman biopsy needle	Manufactured with a split cannula Stylus is removed, and cannula is inserted to retrieve the specimen Needle biopsy can eliminate the need for surgical incision

Needles

Surgical needles are chosen according to the area in which they are to be used and the depth and width of the desired suture. They are classified according to shape, which may be straight or curved. Most sutures are applied with curved needles because they allow the provider to penetrate the surface and then come up on the other side. The sharper the curve of the needle, the deeper the provider can pass it into the tissue. The point of a needle can be a taper or a cutting edge. A taper is used on delicate tissues. The cutting-edge needle is used on the skin. It lacerates the skin as the needle is passed through. This is advantageous for tougher tissues, such as connective tissue.

Needles are manufactured with the suture material attached, or swaged, to the needle. These atraumatic needles do not have an eyelet and cause the least amount of trauma as they are passed through the tissue. Manufacturers package suture strands with the suture needle attached in peel-apart sterile, disposable packages. These may be obtained as single, individually packed, or multipack sutures in a variety of needle types and sizes with a wide range of suture materials and lengths. The most common needle type for minor skin repair is the curved, cutting-edge, swaged needle.

Genitourinary instruments

Instrument	Description
Foley catheter with inflated balloon	Manufactured in sizes 8 to 32 French with a double rubber lining toward the tip (each French unit is equal to about 0.33 mm, so the diameter in millimeters is the French size divided by 3; the higher the number, the larger the lumen) After insertion, sterile solution is injected into the inner lining (inflating the balloon) to hold it in the bladder Used as an indwelling catheter
Robinson (red rubber) catheter	Soft rubber urethral catheter in sizes 8 to 32 French Inserted temporarily into the bladder for drainage or to obtain a specimen
Coudé-tip catheter	Slightly curved catheter tip Designed to allow it to navigate past obstructions in the urinary tract, such as a swollen prostate in men
12-mL Luer-Lok syringe	Typically used to inject sterile saline into a catheter to inflate the balloon at the tip of an indwelling catheter Used for injecting amounts greater than 5 mL

Foley catheter with drainage bag displayed — Foley bag

The clinical need drives which catheter is used: a Robinson catheter is chosen for brief, one-time drainage or to collect a specimen; a Foley catheter is chosen when the catheter must stay in place (indwelling) because its inflated balloon holds it in the bladder; and a Coudé-tip catheter is chosen when an obstruction, such as an enlarged prostate, blocks the path of a straight-tipped catheter.

Wound care with sutures

Nonabsorbable sutures that are on the face should be removed in 5 to 7 days, on the neck, 7 days; on the scalp, 10 days; on the trunk and upper extremities, 10 to 14 days; and on the lower extremities, 14 to 21 days. Sources vary on these intervals, so the provider’s order sets the removal date for each patient. The patient will need to have instructions on how to care for the site while the sutures are still in place. Those instructions should include the following guidelines:

Keep the area clean and dry for the first 24 to 48 hours after the sutures have been placed.
After 24 to 48 hours, gently wash around the site one to two times daily with cool water and soap. Do not wash or rub the sutures directly.
Dab the site dry. Do not rub the area, and avoid using the towel directly on the stitches.
If there was a bandage, replace it with a new clean bandage and antibiotic ointment if instructed to do so.
Return for suture removal as directed by the provider.

Other closure materials

Surgical staples can also be used for skin closure. They are made of stainless steel or titanium and are available in different sizes. Surgical staples usually remain in place for 7 to 14 days. They are applied and removed with specific staple instruments. Care for a surgical site closed with surgical staples is the same as the care for a site closed with sutures.

Suture packet and needle used for wound closure — Suture packet and needle

Another technique for wound closure is the use of adhesive skin closure strips, which are self-adhesive tapes that are placed over the wound, pulling the wound edges together. Using a tincture of benzoin prior to the application of adhesive skin closure strips can help them remain in place longer. A tincture of benzoin is applied parallel to the edges of the wound. Care should be taken so that it does not go into the wound because it can cause burning pain. The compound becomes tacky, and the adhesive skin strips stay on longer. Adhesive skin strips can be used to support a wound if there is potential tension at the site or for superficial wounds.

Frequently, small, clean lacerations may be closed with adhesive skin strips. These strips reduce the chance of infection and do not leave suture scars. Adhesive skin strips are used on areas of the body that are protected from movement and stress. They often are used on the face. A medical assistant can place adhesive skin strips as ordered by the provider. They are placed on the wound in the same sequence and at the same intervals as interrupted sutures and are left in place until they fall off or the wound heals. The patient can wash or shower with them in place but should take care to pat dry with a clean towel instead of rubbing.

Scope of practice: What a medical assistant may perform is set by state law and board rule and delegated by the supervising provider - there is no single national list. Whether a medical assistant may place adhesive skin strips, handle a given instrument, or assist with a closure is decided by the state’s rules and the provider’s order, so confirm both before beginning. See Standards of care for the full scope-of-practice framework.

Tissue adhesives, similar to glue, can also be used for superficial wounds. Examples of tissue adhesives are Histoacryl, Dermabond, and SurgiSeal. Tissue adhesives form a strong bond across wound edges, allowing normal healing to occur below. Skin adhesives are also an alternative to sutures. They are frequently used for the closure of facial lacerations, especially in pediatric patients, because they are effective for wound closure without requiring the use of needles and sutures.

Advantages of tissue adhesive

Saves time during wound repair and eliminates the need for suture removal
Creates a flexible, water-resistant coating that results in better cosmetic outcomes, since there’s no suture-entry scarring
May be used on larger wounds only after subcutaneous (deep) sutures relieve tension, so the adhesive closes just the skin surface

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Specialty instruments, needles, and wound closure

Ophthalmologic and otolaryngologic instruments

Instrument	Description
Krause nasal snare	Wire loop at the tip that can be tightened Used to remove polyps from the nares
Metal tongue depressor	Used to depress the tongue for oral examinations
Hartmann “alligator” ear forceps	3-inch shaft; made in a variety of styles Action of the jaw similar to that of an alligator’s jaws Used to remove foreign bodies or polyps
Laryngeal mirror	May have a nonfogging surface Used for examination of the larynx and postnasal area
Ivan laryngeal metal applicator	6 to 9 inches long with curved end for use in throat or postnasal areas Holds cotton in place with its roughened end; used to swab or sponge throat or postnasal tissue Used to remove foreign bodies embedded in the pharynx
“Buck” ear curette	Available as disposable curettes in many different sizes Has a stainless steel loop at the end Made with sharp or blunt scraper ends Used to remove foreign matter from the ear canals
Sharp ear dissector	Used to remove debris from the ear canal
Wilde ear forceps	Angled, with serrated tips Provides easier access to the ear canal and nasal cavities Used for packing after ear or nasal procedures Can be used to remove foreign bodies

Biopsy instruments

Instrument	Description
Cervical biopsy forceps	Available with or without teeth Used to obtain cervical specimens for diagnostic examination
Rectal biopsy punch	Manufactured with interchangeable stems Used through a proctoscope or sigmoidoscope
Silverman biopsy needle	Manufactured with a split cannula Stylus is removed, and cannula is inserted to retrieve the specimen Needle biopsy can eliminate the need for surgical incision

Needles

Genitourinary instruments

Instrument	Description
Foley catheter with inflated balloon	Manufactured in sizes 8 to 32 French with a double rubber lining toward the tip (each French unit is equal to about 0.33 mm, so the diameter in millimeters is the French size divided by 3; the higher the number, the larger the lumen) After insertion, sterile solution is injected into the inner lining (inflating the balloon) to hold it in the bladder Used as an indwelling catheter
Robinson (red rubber) catheter	Soft rubber urethral catheter in sizes 8 to 32 French Inserted temporarily into the bladder for drainage or to obtain a specimen
Coudé-tip catheter	Slightly curved catheter tip Designed to allow it to navigate past obstructions in the urinary tract, such as a swollen prostate in men
12-mL Luer-Lok syringe	Typically used to inject sterile saline into a catheter to inflate the balloon at the tip of an indwelling catheter Used for injecting amounts greater than 5 mL

Wound care with sutures

Keep the area clean and dry for the first 24 to 48 hours after the sutures have been placed.
After 24 to 48 hours, gently wash around the site one to two times daily with cool water and soap. Do not wash or rub the sutures directly.
Dab the site dry. Do not rub the area, and avoid using the towel directly on the stitches.
If there was a bandage, replace it with a new clean bandage and antibiotic ointment if instructed to do so.
Return for suture removal as directed by the provider.

Other closure materials

Advantages of tissue adhesive

Saves time during wound repair and eliminates the need for suture removal
Creates a flexible, water-resistant coating that results in better cosmetic outcomes, since there’s no suture-entry scarring
May be used on larger wounds only after subcutaneous (deep) sutures relieve tension, so the adhesive closes just the skin surface

Ophthalmologic and otolaryngologic instruments

Instrument	Description
Krause nasal snare	Wire loop at the tip that can be tightened Used to remove polyps from the nares
Metal tongue depressor	Used to depress the tongue for oral examinations
Hartmann “alligator” ear forceps	3-inch shaft; made in a variety of styles Action of the jaw similar to that of an alligator’s jaws Used to remove foreign bodies or polyps
Laryngeal mirror	May have a nonfogging surface Used for examination of the larynx and postnasal area
Ivan laryngeal metal applicator	6 to 9 inches long with curved end for use in throat or postnasal areas Holds cotton in place with its roughened end; used to swab or sponge throat or postnasal tissue Used to remove foreign bodies embedded in the pharynx
“Buck” ear curette	Available as disposable curettes in many different sizes Has a stainless steel loop at the end Made with sharp or blunt scraper ends Used to remove foreign matter from the ear canals
Sharp ear dissector	Used to remove debris from the ear canal
Wilde ear forceps	Angled, with serrated tips Provides easier access to the ear canal and nasal cavities Used for packing after ear or nasal procedures Can be used to remove foreign bodies

Biopsy instruments

Instrument	Description
Cervical biopsy forceps	Available with or without teeth Used to obtain cervical specimens for diagnostic examination
Rectal biopsy punch	Manufactured with interchangeable stems Used through a proctoscope or sigmoidoscope
Silverman biopsy needle	Manufactured with a split cannula Stylus is removed, and cannula is inserted to retrieve the specimen Needle biopsy can eliminate the need for surgical incision

Needles

Genitourinary instruments

Instrument	Description
Foley catheter with inflated balloon	Manufactured in sizes 8 to 32 French with a double rubber lining toward the tip (each French unit is equal to about 0.33 mm, so the diameter in millimeters is the French size divided by 3; the higher the number, the larger the lumen) After insertion, sterile solution is injected into the inner lining (inflating the balloon) to hold it in the bladder Used as an indwelling catheter
Robinson (red rubber) catheter	Soft rubber urethral catheter in sizes 8 to 32 French Inserted temporarily into the bladder for drainage or to obtain a specimen
Coudé-tip catheter	Slightly curved catheter tip Designed to allow it to navigate past obstructions in the urinary tract, such as a swollen prostate in men
12-mL Luer-Lok syringe	Typically used to inject sterile saline into a catheter to inflate the balloon at the tip of an indwelling catheter Used for injecting amounts greater than 5 mL

Wound care with sutures

Keep the area clean and dry for the first 24 to 48 hours after the sutures have been placed.
After 24 to 48 hours, gently wash around the site one to two times daily with cool water and soap. Do not wash or rub the sutures directly.
Dab the site dry. Do not rub the area, and avoid using the towel directly on the stitches.
If there was a bandage, replace it with a new clean bandage and antibiotic ointment if instructed to do so.
Return for suture removal as directed by the provider.

Other closure materials

Advantages of tissue adhesive

Saves time during wound repair and eliminates the need for suture removal
Creates a flexible, water-resistant coating that results in better cosmetic outcomes, since there’s no suture-entry scarring
May be used on larger wounds only after subcutaneous (deep) sutures relieve tension, so the adhesive closes just the skin surface