Removal of sutures in pediatric patients requires a gentle, reassuring approach and strict attention to infection control.
Indications
| Indication | Rationale |
|---|---|
| Wound edges are well approximated | Indicates proper healing and reduced risk of dehiscence. |
| No signs of infection | Redness, swelling, or discharge must be absent before removal. |
| Time-based removal | Sutures are removed based on anatomical site (e.g., face: 3–5 days, scalp: 7–10 days, extremities: 10–14 days). |
| Absorbable sutures not used | Non-absorbable sutures require manual removal once healing is adequate. |
| Patient comfort and cosmetic outcome | Early removal (when safe) minimizes scarring and discomfort. |
| Provider assessment confirms readiness | Clinical judgment based on wound inspection and healing timeline. |
Equipment Needed for Removal of Sutures
- A sterile tray containing:
- Suture cutting scissors-one
- Toothed dissecting forceps-one
- Gauze pieces
- Gloves
- A clean tray containing:
- Mackintosh and towel
- Kidney tray
Preparation of Child
- Explain the child that he/she may feel little discomfort such as pulling sensation or stinging.
- Position the child
- Wash hands and wear clean gloves
- Inspect the wound for edge approximation and signs of infection
- Remove the gloves
Procedure
- Hand hygiene and don sterile gloves.
- Clean the suture line with antiseptic or saline to soften crusts and reduce infection risk.
- Grasp the knot with forceps and gently lift it.
- Cut the suture close to the skin to avoid dragging contaminated material through the tissue.
- Remove alternate sutures first to assess wound integrity. If edges remain approximated, remove the rest.
- For staples: Use a staple remover, squeeze handles to bend and lift the staple, then remove gently
Plain, Interrupted Suture
- Gently grasp the knot with forceps and raise it slightly.
- Place the curved tip of the suture scissors directly under the knot or on the side, close to the skin.
- Gently cut the suture and pull it out with the forceps.
- Make sure that you remove all suture materials and place the suture on clean gauze.
- Remove alternate sutures. Assess the wound for dehiscence; if none occurs, remove the remaining sutures.
Removal of Staples
- Place the lower jaw of the remover under a staple.
- Squeeze the handles completely to close the device.
- This bends the staple in the middle and pulls the edges out of the skin.
- Clean the suture line with normal saline.
- Cover the wound with sterile wound strips.
Aftercare
- Clean and replace the articles.
- Discard the wastes.
- Wash hands.
- Document the date and time of suture or staple removal, the number removed, dressings or adhesive wound strips applied, child’s response, and the appearance of the incision.
Nursing Considerations
- If dehiscence occurs, cover the wound with sterile gauze saturated with sterile 0.9% sodium chloride solution and immediately notify the healthcare provider.
- Do not lift the staple remover while squeezing the handle.
- Do not remove remaining sutures or staples if dehiscence occurs.
Special Considerations
- If dehiscence occurs, stop immediately, cover with sterile saline-soaked gauze, and notify the provider.
- Use distraction techniques or comfort positioning to reduce distress.
- Never remove sutures if the wound appears infected or not fully healed.
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 Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- 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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