Removing skin sutures and staples

Removing skin sutures and staples

Definition sutures and staples:
Sutures and staples are a surgical means of closing wound by sewing, wiring, or stapling
the edges of the wound together. Most wounds are sutured in layers to maintain alignment
of the tissues and reduce scaring.
Indications:

1. Promote healing by holding the tissue and skin edges together until healing occur.
2. Aid in process of homeostasis. But if applied too tightly, they can cause necrosis of
surrounding tissue.

Types of suture materials:

1. Absorbable suture: Material that can be completely removed by body’s phagocytes.

e.g. natural gut.
2. Non absorbable suture: Are either natural fibers (silk, cotton, linen) or synthetic (nylon
and Dacron), therefore need removal when applied to the skin.
Suturing techniques:

1. Interrupted: Each stitch is tied and knotted individually along the incision
2. Continuous: Are made with one thread, tied at the beginning and at the end of the
suture line.
3. Retention (deep tension suture): By passing the suture through all layers of the wound
and by approximating the skin edges with large, Non absorbable suture, a polyster or
plastic sleeve is placed over the retention sutures so as to prevent the suture from cutting
into the skin.
4. Staples: Are used for large incision areas where the risk of dehiscence is greater.
Uses of retention sutures:
1. If there is a risk of gross contamination of the wound.
2. Excessive tissue damage.
3. Recurrent suturing of the wound.
4. If the patient is very obese.

Suggested time for suture removal:

Generally done 7-10 days post surgery depending on wound healing.

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Types of sutures:

1. Mattress suture: Interrupted, continuous and retention.

2. Plain suture: Interrupted, continuous and retention.
3. Blanket suture: Interrupted and continuous.

Assessment:

1. Assess the wound to determine whether the edges approximate and healing. Palpate
around the suture site for edema or any evidence of failure of tissue to adhere below the
skin's surface.
2. Assess for any signs of infection, such as increased warmth, redness, exudates or
drainage, and pain.
3. Assess any conditions that impede the healing process, such as age, immunosuppressant,
diabetes, obesity, smoking, radiation, poor nutrition, infection, and deep wounds.

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Equipment needed:
1. Suture removal kit or sterile forceps with sterile suture removal scissors.
2. Gauze size as appropriate for wound area to be covered.
3. Biohazard bag or appropriate water proof disposable bag.
4. Sterile saline, prepackaged antiseptic swabs, or gauze for cleaning if appropriate.
5. Examination gloves.
6. Sterile gloves if dressings are to be applied.
7. Adhesive strips or butterfly adhesive tap as needed.
8. Sterile gauze to wipe stitches or sutures from forceps and scissors.
9. Tincture of benzoin as indicated
Patient education needed:
1. Teach the patient for signs of infection, such as increased warmth, redness, and pain.
2. Teach the patient to assess body temperature daily at home for appropriate period of
time depending on wound.
3. Teach the patient if deep wound with internal sutures, to observe for swelling or
increased pain over the incision area.
4. If staples have been used, instruct the patient to protect area with a pillow when
coughing.
5. If suture or staples were used in abdominal wounds, instruct the patient to avoid any
lifting for up to 6 weeks.
6. If the patient is sent home with sutures, teach how to assess for infection and set up
appointment for suture removal. Let the patient know that timing is important.
Nursing implementation:
1. Action: Wash hands.
Rationale: Reduces the transmission of microorganisms.
2. Action: Assess the wound to determine whether the edges approximate and healing.
Rationale: If the wound not healed suture should be left.
3. Action: Explain procedure to the patient.
Rationale: Provides information about the procedure to reduce anxiety.
4. Action: Close the door and curtains around the patient bed.
Rationale: Provides for privacy.
5. Action: Raise the bed to comfortable level.
Rationale: To provides for proper body mechanics.
6. Action: Position the patient for comfort with easy access and visibility of the suture line.
Rationale: To facilitate removal of the sutures.
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7. Action: Drape the patient so that only the suture area is exposed.
Rationale: Provides for privacy.
8. Action: Open the suture kit, and assemble any supplies needed within easy access on a
clean surface.
Rationale: To facilitate removal of the sutures.
9. Action: Apply clean gloves to remove the old dressing and place it in a disposal bag.
Rationale: Protects patient from transmission of microorganisms.
10. Action: Remove gloves and wash hands.
Rationale: Reduces the transmission of microorganisms.
11. Action: If dressing is to be used, assemble equipment and supplies on sterile field.
Rationale: Protects patient from transmission of microorganisms.
12. Action: Apply sterile gloves according to institutional policy.
Rationale: Protects incision from microorganisms on the nurse's hand.
13. Action: Applying a cleaning solution to sterile gauze. Clean the incision with normal
saline soaked gauze pads, antiseptic swabs, or per institutional policy (Fig. 132 ).
14. Action: When removing interrupted suture, hold forceps in your domoninant hand and
grasp the suture near the knot.
Rationale: Pulls the suture up and away from the skin. (Fig. 133 ).
15. Action: Place the curved edge of the scissors under the suture near the knot.
Rationale: To facilitate clipping of the suture.
16. Action: Cut the suture close to the skin where the suture emerges from the skin (not in
the middle). Pull the long end and remove it in one piece.
Rationale: To facilitate suture removing.
17. Action: If the patient has a continuous suture, cut both the first and second suture before
removing them.
Rationale: To facilitate suture removing.
18. Action: Assess the suture line to ensure that the edges remain approximated.
Rationale: Any dehiscence should be detected early.
19. Action: Discard the suture onto gauze squares as they are removed and then place gauze
squares in the disposable bag when all the sutured has been removed.
Rationale: Decreases the transmission of microorganisms.
20. Action: Assess the suture line to ensure that the edges remain approximate and that all
sutures have been removed
Rationale: Detects early signs of dehiscence.
21. Action: Apply adhesive strips or butterfly tape adhesive strips across the suture line to
secure the edges.
Rationale: Adhesive skin closures can be used to reinforce the suture line.
22. Action: Remove gloves and wash hands.
Rationale: Reduces the transmission of microorganisms.
23. Action: If removing staples: Repeat actions 2 to 12.
Rationale: Prepares for staple removal.
- Use a staple extractor to remove every other staple. Place the lower tip of staple and
squeeze the handles together.
- To remove every staple and assess wound adherence before removing all staples.
- Repeat actions 20 to 22.

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