How Do You Know if Stitches Are Ready for Removal

Chapter 4. Wound Care

4.4 Suture Removal

Sutures are tiny threads, wire, or other material used to sew together torso tissue and pare together. They may be placed deep in the tissue and/or superficially to close a wound. A variety of suture techniques are used to close a wound, and deciding on a specific technique depends on the location of the wound, thickness of the skin, degree of tensions, and desired corrective effect (Perry et al., 2014).

There are three types of sutures techniques: intermittent, blanket, and continuous (come across Figure four.two). The most commonly seen suture is the intermittent suture.

Effigy 4.ii Types of sutures

Sutures may be absorbent (dissolvable) or non-absorbent (must be removed). Not-absorbent sutures are usually removed within vii to 14 days. Suture removal is determined by how well the wound has healed and the extent of the surgery. Sutures must exist left in place long enough to found wound closure with enough strength to back up internal tissues and organs.

The health intendance provider must assess the wound to determine whether or not to remove the sutures. The wound line must also exist observed for separations during the process of suture removal. Removal of sutures must exist ordered past the primary health intendance provider (doctor or nurse practitioner). An order to remove sutures must be obtained prior to the process, and a comprehensive assessment of the wound site must be performed prior to the removal of the sutures by the wellness care provider.

Alternate sutures (every second suture) are typically removed offset, and the remaining sutures are removed once acceptable approximation of the skin tissue is determined. If the wound is well healed, all the sutures would be removed at the same time. Alternately, the removal of the remaining sutures may be days or weeks later (Perry et al., 2014). Checklist 34 provides the steps for intermittent suture removal.

Checklist 34: Intermittent Suture Removal

Disclaimer: Always review and follow your infirmary policy regarding this specific skill.
Safety considerations: Perform paw hygiene. Cheque room for boosted precautions. Introduce yourself to patient. Confirm patient ID using 2 patient identifiers (e.g., name and date of nascence). Explicate process to patient and offer analgesia, bathroom etc. Heed and attend to patient cues. Ensure patient's privacy and dignity. Assess ABCCS/suction/oxygen/safety.
Steps		Additional Information
1. Ostend medico/nurse practitioner (NP) orders, and explain procedure to patient.		Explaining the procedure will help prevent anxiety and increment compliance with the procedure. Inform patient that the procedure is not painful simply the patent may experience some pulling of the pare during suture removal.
2. Gather advisable supplies.		Y'all volition need sterile suture scissors or suture blade, sterile dressing tray (to clean incision site prior to suture removal), not-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing.
3. Position patient appropriately and create privacy for procedure.		Ensure proper body mechanics for yourself and create a comfortable position for the patient.
4. Perform hand hygiene.		Hand hygiene reduces the risk of infection. Perform hand hygiene
5. Ready the sterile field and add necessary supplies in an organized manner.		This allows piece of cake access to required supplies for the procedure. Prepare sterile field
six. Remove dressing and audit the wound using non-sterile gloves.		Visually assess the wound for uniform closure of the wound edges, absence of drainage, redness, and swelling. Pain should be minimal. Later on assessing the wound, determine if the wound is sufficiently healed to take the sutures removed. If there are concerns, question the order and seek advice from the appropriate wellness care provider. Assess wound
seven. Remove non-sterile gloves and perform hand hygiene.		This prevents the transmission of microorganisms. Hand hygiene with ABHR
8. Apply make clean non-sterile gloves.		This prevents the transmission of microorganisms. Apply not-sterile gloves
ix. Make clean incision site according to agency policy.		This stride reduces risk of infection from microorganisms on the wound site or surrounding skin. Clean incision Cleaning likewise loosens and removes any stale blood or crusted exudate from the sutures and wound bed.
ten. To remove intermittent sutures, hold pair of scissors in ascendant hand and forceps in non-dominant hand.		This allows for dexterity with suture removal. Hold scissors in dominant paw and forceps in non-dominant mitt
11. Identify a sterile ii ten 2 gauze close to the incision site.		The sterile 2 x 2 gauze is a place to collect the removed suture pieces. Place sterile 2 x ii gauze close by
12. Grasp knot of suture with forceps and gently pull up knot while slipping the tip of the scissors under suture almost the peel. Examine the knot.		The knot should have three ends
13. Cut under the knot equally close as possible to the skin at the distal stop of the knot.		Cut nether the knot Never snip both ends of the knot as at that place will be no way to remove the suture from beneath the surface. Do not pull the contaminated suture (suture on elevation of the skin) through tissue. If using a blade to cut the suture, point the blade away from y'all and your patient.
14. Grasp knotted finish with forceps, and in one continuous action pull suture out of the tissue and place cut knot on sterile 2 ten 2 gauze.		Grasp knotted terminate with forceps
fifteen. Remove every second suture until the end of the incision line.		Assess wound healing afterwards removal of each suture to determine if each remaining suture will be removed.
If wound edges open, end removing sutures, apply Steri-Strips (using tensions to pull wound edges together), and notify appropriate health intendance providers.
xvi. Using the principles of sterile technique, place Steri-Strips on location of every removed suture along incision line.		Apply Steri-Strips
17. Cutting Steri-Strips so that they extend 1.5 to 2 inches on each side of incision.		Steri-Strips back up wound tension across wound and help to eliminate scarring. Steri-Strips
18. Remove remaining sutures on incision line if indicated.		Only remove remaining sutures if wound is well approximated. Remove remaining sutures
19. Place Steri-Strips on remaining areas of each removed suture along incision line.		The Steri-Strips volition help keep the skin edges together. Apply Steri-Strips
Information source: BCIT, 2010c; Perry et al., 2014

Video 4.2

Checklist 35 outlines the steps to remove continuous and blanket stitch sutures.

Checklist 35: Continuous and Blanket Stitch Suture Removal

Disclaimer: E'er review and follow your hospital policy regarding this specific skill.
Safety considerations: Perform hand hygiene. Check room for boosted precautions. Introduce yourself to patient. Confirm patient ID using two patient identifiers (e.g., proper name and date of birth). Explain process to patient and offer analgesia, bathroom etc. Listen and attend to patient cues. Ensure patient's privacy and dignity. Assess ABCCS/suction/oxygen/safety.
Steps		Additional Information
ane. Confirm dr./NP orders, and explain process to patient.		Explaining the procedure will help prevent anxiety and increment compliance with the procedure. Inform patient that the process is not painful only the patent may feel some pulling of the pare during suture removal.
2. Gather advisable supplies.		Yous volition demand sterile suture scissors or suture blade, sterile dressing tray (to clean incision site prior to suture removal), non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing.
3. Position patient appropriately and create privacy for procedure.		Ensure proper body mechanics for yourself and create a comfortable position for the patient.
four. Perform hand hygiene.		Hand hygiene reduces the adventure of infection. Perform mitt hygiene
v. Gear up the sterile field and add together necessary supplies in an organized mode.		This step allows for easy admission to required supplies for the process. Prepare sterile field
vi. Remove dressing and audit the wound using non-sterile gloves.		Visually assess the wound for compatible closure of the wound edges, absence of drainage, redness, and swelling. Pain should be minimal. Assess wound Later on assessing the wound, decide if the wound is sufficiently healed to take the sutures removed. If there are concerns, question the order and seek advice from the advisable health intendance provider.
7. Remove non-sterile gloves and perform hand hygiene.		This step prevents the transmission of microorganisms. Remove non-sterile gloves
8. Apply make clean non-sterile gloves.		This prevents the manual of microorganisms. Use non-sterile gloves
9. Clean incision site according to agency policy.		This step reduces the gamble of infection from microorganisms on the wound site or surrounding pare. Cleaning also loosens and removes any dried blood or crusted exudate from the sutures and wound bed. Clean incision site
10. Identify sterile gauze close to suture line; grasp pair of scissors in dominant hand and forceps in non-dominant hand.		This allows for dexterity with suture removal.
11. Snip start suture shut to the peel surface, distal to the knot.		Snip suture distal to the knot Continuous suture removal guide
12. Snip second suture on the same side.		This action prevents the suture from being left under the peel.
thirteen. Grasp knotted end and gently pull out suture; identify suture on sterile gauze.		Never pull contaminated suture underneath the tissue
14. Continue cutting in the same style until the entire suture is removed, inspecting the incision line during the process.		Inspection of incision line reduces the take chances of separation of incision during process.
If separation occurs, finish process, use Steri-Strips, and notify doctor.
fifteen. Apply Steri-Strips to suture line, then apply sterile dressing or leave open up to air.		This step reduces the risk of infection. Apply Steri-Strips
xvi. Position patient and lower bed to condom meridian; ensure patient is comfortable and free from pain.		This ensures patient safety.
17. Complete patient education regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to raise wound healing.		Instruct patient to have showers rather than bathe. Instruct patient to pat dry, and to not scrub or rub the incision. Instruct patient not to pull off Steri-Strips. Permit the Steri-Strips to fall off naturally and gradually (usually  takes i to iii weeks). Instruct patient about the importance of not straining during defecation, and the importance of adequate rest, fluids, diet, and ambulation for optional wound healing.
18. Discard supplies according to agency policies for sharp disposal and biohazard waste.		Scissors and forceps may exist disposed of or sent for sterilization.
19. Perform hand hygiene.		Hand hygiene reduces adventure of infection. Hand hygiene with ABHR
20. Document procedures and findings co-ordinate to bureau policy.		Report any unusual findings or concerns to the advisable wellness care professional.
Information source: BCIT, 2010c; Perry et al., 2014

Video 4.iii

Complications related to suture removal, including wound dehiscence, may occur if wound is not well healed, if the sutures are removed too early on, or if excessive strength (pressure) is applied to the wound. In improver, if the sutures are left in for an extended menstruation of time, the wound may heal effectually the sutures, making extraction of the sutures hard and painful. Table 4.iv. lists additional complications related to wounds closed with sutures.

Table 4.iv Complications of Suture Removal

Complication		Solution
Unable to remove suture from tissue		Contact physician for further instructions.
Wound dehiscence: Incision edges separate during suture removal; wound opens up		Stop removing sutures. Use Steri-Strips across open area. Notify physician.
Patient experiences pain when sutures are removed		Permit small breaks during removal of sutures. Provide opportunity for the patient to deep exhale and relax during the process.
Wound becomes crimson, painful, with increasing pain, fever, drainage from wound		These changes may point the wound is infected. Report findings to the primary health care provider for additional handling and assessments.
Scarring related to sutures		All wounds form a scar and will take months to one yr to completely heal. Scarring may be more prominent if sutures are left in too long.
Keloid germination		A keloidformation is a firm scar-similar mass of tissue that occurs at the wound site. The scarring tends to extend by the wound and is darker in appearance.
Hypertrophic scars		Hypertrophic scars are scars that are bulky merely remain within the boundaries of the wound. These scars can exist minimized by applying firm pressure to the wound during the healing process using sterile Steri-Strips or a dry out sterile bandage.
Data source: BCIT, 2010c; Perry et al., 2014

1. What is the purpose of applying Steri-Strips to the incision afterwards removing sutures?
2. Which health intendance provider is responsible for assessing the wound prior to removing sutures?

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Source: https://opentextbc.ca/clinicalskills/chapter/4-3-suture-care-and-removal/

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