Definition
The removal of sutures in neonates refers to the careful extraction of surgical stitches used to close wounds or incisions in newborns. This procedure is performed once adequate healing has occurred to prevent complications such as infection or wound dehiscence.
Key Aspects of Neonatal Suture Removal
- Gentle Handling: Neonatal skin is delicate, requiring careful technique.
- Sterile Technique: Prevents infections and ensures a safe removal process.
- Assessment Before Removal: Ensures the wound has healed properly.
- Post-Removal Care: Includes wound cleaning and monitoring for complications.
Equipment Needed
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
- Position the baby.
- Wash hands and wear clean gloves.
- Inspect the wound for edge approximation and signs of infection.
- Remove the gloves.
Procedure
| Step | Nursing Action | Rationale |
|---|---|---|
| Preparation | Wash hands, wear sterile gloves, and explain the procedure to caregivers. | Prevents infection and reassures caregivers about the process. |
| Assessment of Healing | Inspect the wound for signs of infection, dehiscence, or incomplete healing. | Ensures the wound is ready for suture removal and prevents complications. |
| Cleaning the Area | Use sterile saline or antiseptic solution to clean around the sutures. | Reduces bacterial load and prevents contamination. |
| Suture Removal | Hold the knot with forceps, cut close to the skin, and gently pull the suture out. | Minimizes trauma and ensures smooth removal without damaging tissue. |
| Post-Removal Care | Apply sterile dressing or adhesive strips if needed. Educate caregivers on wound care. | Supports continued healing and prevents reopening of the wound. |
| Documentation | Record the date, number of sutures removed, wound condition, and any complications. | Ensures accurate medical records and follow-up care. |
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.
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
- Naveen Bajaj, Rajesh Kumar, Manual of Newborn Nursing, 2nd Edition, 2023, Jaypee Publishers, ISBN:978-9354659294
- 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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