Definition
Removing sutures and staples is a delicate nursing procedure that must be done with sterile technique to prevent infection and ensure proper wound healing.
Articles
A tray containing:
- Suture removal kit (sterile)
a. Sterile scissors/staple remover as indicated.
b. Sterile forceps.
c. Antiseptic swab packets.
- Gauze pieces.
- Clean gloves (1 pair).
- Sterile gloves (1 pair).
- Disinfectant: Surgical spirit and povidone-iodine.
- Kidney tray.
| Nursing Action | Rationale | |
| 1 | Before procedure Explain procedure to patient and describe the sensations that will be experienced such as a pulling or slightly uncomfortable experience | Helps in obtaining cooperation of patients. |
| 2 | Use sterile techniques | Prevents spread of infection. |
| 3 | Check for physician’s order. | Acts as a guideline for suture removal. |
| 4 | Arrange all needed equipment at bedside. | Saves time, energy and effort |
| 5 | Provide privacy. | Prevents embarrassment. |
| 6 | During procedure Wash hands | Prevents risk of transmission of microorganisms. |
| 7 | Position the patient so that the dressing or incision is exposed. | |
| 8 | Open sterile suture removal kit. Prepare a sterile field and supplies on it. | Ensures aseptic technique. |
| 9 | Don clean gloves. | |
| 10 | Remove and discard any dressing covering the wound, | Removes potentially contaminated materials. |
| 11 | Inspect the wound for signs of dehiscence and infection. | |
| 12 | Wash hands, don sterile gloves. | Prevents infection. |
| 13 | Clean sutures with spirit swabs moving from proximal to distal end. Discard swabs after wiping each surface once | Cleaning and antiseptic action of alcohol removes surface microorganisms from the wound site. |
| 14 | Removal of plain interrupted sutures: Place dry sterile gauze near the wound. Grasp the suture at the knot with a pair of forceps. Place the curved tip of the suture scissors under the suture as close to the skin as possible, either on the side opposite the knot or directly under the knot and cut the suture. With the forceps, pull the suture out in one piece. Inspect the suture carefully to make sure that all suture materials are removed. | Suture material that is visible to the eye is in contact with resident bacteria of skin and must not be pulled beneath the skin during removal. Suture material that is beneath the skin is considered free from bacteria. |
| 15 | Apply steri-strips on the wound or clean with betadine after removing sutures as ordered by physician | steri-strips hold the incision edges together and promote support in healing of the wound. |
| 16 | Instruct the client about follow-up if wound discharge appears. | |
| 17 | Place dressing over the incision if ordered. | Provides a protective covering. |
| 18 | After procedure Reposition the client, wash and replace articles. | Gives neat appearance of the work area. |
| 19 | Wash hands. | Prevents spread of infection. |
| 20 | Document the number of sutures removed, the condition of the incision, evidence of dehiscence or infection if noticed, and time of the procedure. | Acts as a communication between staff members. |
Specific instruction for staple removal
- As directed on the package, gently position the sterile staple remover under the staple to be removed
- Firmly close the staple remover to straighten the staple ends (do not lift upward while disengaging staple ends).
- Carefully lift the clips upward with the closed staple remover to remove them from the incision line. It may be necessary to remove one end of the staple and then the other if it does not easily lift-out.
Special considerations
1. Abdominal belts or many tailed bandages may be applied on the abdomen after removal of abdominal sutures in obese patients to prevent wound dehiscence and evisceration.
2. Patient should be instructed not to strain the part, e.g., not to cough or lift heavy weights in case of abdominal sutures.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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