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18.2 Suture removal

Essential equipment

  • Personal protective equipment
  • Sterile dressing pack containing gallipots or an indented plastic tray, low‐linting swabs and/or medical foam, disposable metal forceps, sterile field and disposable bag
  • Fluids for cleaning and/or irrigation
  • Appropriate dressing
  • Any other materials as determined by the nature of the dressing; special features of a dressing should be referred to in the patient's nursing care plan
  • Detergent wipe for cleaning trolley
  • Total traceability system for surgical instruments and patient record form
  • Any extra equipment that may be needed during the procedure, for example sterile scissors, stitch cutter or sterile adhesive sutures

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [82], C).
  2. 2.
    Perform the procedure using aseptic technique (i.e. use of a trolley, clean hands, and apply apron and gloves).
    To prevent infection (Fraise and Bradley [33], E).

Procedure

  1. 3.
    Clean the wound with an appropriate sterile solution, such as 0.9% sodium chloride, if required.
    To remove crusts/dry skin to increase the visibility of the sutures to be removed (Perry et al. [85], E).
  2. 4.
    Lift knot of suture with metal forceps.
    Plastic forceps tend to slip against nylon sutures. E
  3. 5.
    Using a stitch cutter or scissors, snip the first stitch close to the skin. Pull the suture out gently. For intermittent sutures, alternate sutures should be removed first before the remaining sutures are removed.
    To avoid previously exposed (potentially contaminated) aspects of the suture being pulled through underlying tissues (Trott [107], E).
    To ensure wound closure and predict dehiscence (Cooper and Gosnell [15], E).
  4. 6.
    Use the tips of the scissors slightly open or the side of the stitch cutter to gently press the skin when the suture is being drawn out. Continue until all appropriate sutures are removed as required.
    To minimize pain by counteracting the adhesion between the suture and surrounding tissue. E
  5. 7.
    Apply a suitable dressing.
    To protect the wound from further trauma or contamination and ensure optimum healing (Fraise and Bradley [33], E).

Post‐procedure

  1. 8.
    Dispose of waste in orange plastic clinical waste bags and sharps in a sharps bin. Remove gloves and wash hands.
    To prevent environmental contamination and sharps injury. Orange is the recognized colour for clinical waste (DH [23], C).
  2. 9.
    Record the condition of the suture line and surrounding skin (amount of exudate, pus, inflammation, pain, etc.).
    To document care and enable evaluation of the wound (Hess [48], E; NMC [82], C).
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