CLINICAL DEMONSTRATION SUTURE REMOVAL

SUBMITTED TO: SUMBITTED BY:

MRS.LITTERSHIA BALIN.MSC (N), S. VISHNU PRIYA,
ASSOCIATE PROFESSOR, MSC (N) 1ST YEAR,
TEXCITY COLLEGE OF TEXCITY COLLEGE OF
NURSING. NURSING.

SUMBITTED ON: 12/10/2022

 GENERAL INFORMATION

Name of the student : S. Vishnu Priya

Level of the student : MSc (n) 1st year
Subject : Medical surgical nursing
Topic : Suture removal
Placement of the students : Second year BSc nursing students
Number of the students : 40
Duration : 1 hour
Methods of teaching : Lecture cum discussion &demonstration
Audio visual aids : Chart, pamphlets, leaflets, demonstration with dummy
Venue : ESI hospital
Name of the evaluator : Mrs.littershiabalin MSc (N)
Associate professor, Texcity College of nursing
Date :
Time :
GENERAL OBJECTIVES:
At the end of the class students will gain knowledge on suture removal and develop a positive attitude and apply gained
knowledge and skill in the clinical and teaching methods.

SPECFIC OBJECTIVES:
At the end of the class the students will be able to:
1. define suture removal
2. list down the types of suture removal
3. enlist the equipment of suture removal
4. describe the patient and family education
5. enumerate the patient assessment and preparation
6. explain the procedure
7. state the complication of suture removal
 Suture removal
S TIME SPECIFIC TEACHER’S LEARNER’S AV EVALUATION

No OBJECTIVES CONTENT ACTIVITY ACTIVITY AIDS

5MIN Introducing Teaching Listening Tell me the

the topic topic?
SUTURE REMOVAL
INTRODUCTION:

Sutures are used by your doctor to close wounds to your skin or other
tissues. When your doctor sutures a wound, they’ll use a needle
attached to a length of “thread” to stitch the wound shut. There are a
variety of available materials that can be used for suturing. Your
doctor will choose a material that’s appropriate for the wound or
procedure.

1 The DEFINITION:
5min
student
Define
Explaining Contributing Chart
Will be Suture removal is determined by how well the wound has healed and
Suture
the extent of the surgery. Sutures must be left in place long enough to Teaching
able to
establish wound closure with enough strength to support internal
 define Removal?
suture
tissues and organs.
removal
The health care provider must assess the wound to determine whether
or not to remove the sutures.

The
student Explaining Listening
the types
2 10min Will be able Taking notes OHP What are
to list down Of suture the types of
the types TYPES OF SUTURE REMOVAL suture
of suture Removal
removal Removal?
 The different types of sutures can be classified in many ways.
 First, suture material can be classified as either absorbable or
nonabsorbable.
 Absorbable sutures don’t require your doctor to remove them.
This is because enzymes found in the tissues of your body
 naturally digest them.
 Nonabsorbable sutures will need to be removed by your doctor
at a later date or in some cases left in permanently.
 Second, the suture material can be classified according to the
actual structure of the material. Monofilament sutures consist
of a single thread. This allows the suture to more easily pass
through tissues. Braided sutures consist of several small
threads braided together. This can lead to better security, but at
the cost of increased potential for infection.
 Third, sutures can be classified as either being made from
natural or synthetic material. However, since all suture material
is sterilized, this distinction is not particularly useful.

Types of absorbable sutures

 Gut : This natural monofilament suture is used for repairing

internal soft tissue wounds or lacerations. Gut shouldn’t be
used for cardiovascular or neurological procedures. The body
has the strongest reaction to this suture and will often scar over.
It’s not commonly used outside of gynecological surgery.
 Polydioxanone (PDS): This synthetic monofilament suture can
 be used for many types of soft tissue wound repair (such as
abdominal closures) as well as for pediatric cardiac procedures.
 Poliglecaprone (MONOCRYL): This synthetic monofilament
suture is used for general use in soft tissue repair. This material
shouldn’t be used for cardiovascular or neurological
procedures. This suture is most commonly used to close skin in
an invisible manner.
 Polyglactin (Vicryl): This synthetic braided suture is good for
repairing hand or facial lacerations. It shouldn’t be used for
cardiovascular or neurological procedures.

Types of nonabsorbable sutures

Some examples of nonabsorbable sutures can be found below. These

types of sutures can all be used generally for soft tissue repair,
including for both cardiovascular and neurological procedures.

 Nylon:  A natural monofilament suture.

 Polypropylene (Prolene): A synthetic monofilament suture.
 Silk: A braided natural suture.
  Polyester (Ethibond).:A braided synthetic suture.

Sutures vs. stitches

You’ll often see sutures and stitches referred to interchangeably. It’s

important to note that “suture” is the name for the actual medical
device used to repair the wound. The stitching is the technique used
by your doctor to close the wound.

Suture selection and techniques

 Suture material is graded according to the diameter of the

suture strand. The grading
 system uses the letter “O” preceded by a number to indicate
material diameter. The higher the number, the smaller the
diameter of the suture strand.
 Suture material is also attached to a needle. The needle can
have many different features. It can be of various sizes and also
have a cutting or noncutting edge. Larger needles can close
more tissue with each stitch while smaller needles are more
 likely to reduce scarring.
 Just like there are many different types of sutures, there are
many different suture techniques. Some of them are:

Continuous sutures

This technique involves a series of stitches that use a single strand of

suture material. This type of suture can be placed rapidly and is also
strong, since tension is distributed evenly throughout the continuous
suture strand.
Interrupted sutures

This suture technique uses several strands of suture material to close

the wound. After a stitch is made, the material is cut and tied off. This
technique leads to a securely closed wound. If one of the stitches
breaks, the remainder of the stitches will still hold the wound
together.

Deep sutures

This type of suture is placed under the layers of tissue below (deep) to
the skin. They may either be continuous or interrupted. This stitch is
often used to close fascial layers.

Buried sutures

This type of suture is applied so that the suture knot is found inside
(that is, under or within the area that is to be closed off). This type of
suture is typically not removed and is useful when large sutures are
used deeper in the body.
Purse-string sutures

This is a type of continuous suture that is placed around an area and

tightened much like the drawstring on a bag. For example, this type
of suture would be used in your intestines in order to secure an
intestinal stapling device.

Subcutaneous sutures

These sutures are placed in your dermis, the layer of tissue that lies
below the upper layer of your skin. Short stitches are placed in a line
that is parallel to your wound. The stitches are then anchored at either
end of the wound.

Suture removal

suture are removed will depend on where they are on the body.
According to American family physician. Some general guidelines
are as follow:
  scalp: 7to10 days
 face: 3to5 days
 chest or trunk : 10 to14 days
 arms : 7 to10 days
 legs : 10 to 14 days
 hands or feet : 10 to 14 days
 palms of hands or soles of feet : 14 to 21

To remove your sutures, your doctor will first sterilize the area.
They’ll pick up one end of your suture and cut it, trying to stay as
close to your skin as possible. Then, they’ll gently pull out the suture
strand.
The
student
3 10min Teaching Listening Pamp
Will be hlets
Explaining What are
Able to EQUIPMENT: the
equipment
enlist the
equipment  Nonsterile gloves and mask needs to
of suture  Sterile gloves, towel, or drape suture
removal  Sterile swab with antiseptic cleaning solution according removal ?
 to facility ’ s policy (e.g., chlorhexidine)
 4 × 4 gauze pads
 Suture removal kit with scissors and forceps (if no kit is
 available, obtain sterile scissor and forceps)
 Staple remover
 Skin tape or adhesive skin strips (e.g., Steri-Strips) of
 appropriate width
 Skin adherent (recommended because it helps with
adherence and protects the periwound area)
 The
student
4 10 min
Will be able Taking notes
Explaining Leafle
to PATIENT AND FAMILY EDUCATION t
describe
the patient PATIENT AND FAMILY RATIONALE
and family EDUCATION
education Explain the procedure to the Explanation decreases patient
patient and family. Reassure the anxiety and encourages patient
patient that he or she may feel a and family cooperation and
pulling or stinging sensation as understanding of procedure.
the sutures or staples are
removed. Assure the patient that
the wound is healing properly
and that removal of the sutures
or staples does not weaken the
incision. Explain the use of
adhesive skin strips if needed
Instruct the patient and family Education facilitates patient
on aftercare: pain medication, comfort, decreases risk for
wound care, activity restrictions, infection, and encourages
and observation for signs and prompt follow-up for treatment
symptoms of infection of possible
 The
student Listening
5 10min PATIENT ASSESSMENT AND PREPARATION Teaching Chart
will be able Contributing
What are
to PATIENT ASSESSEMENT RATIONALE Points the
enumerate Obtain the history of the present This knowledge allows a better assessment
the patient
injury and a medical history understanding of the nature of and
assessment
and
the injury and any factors preparation
preparation complicating suture or staple Done for the
removal. suture
Assess patient allergies, Further tissue damage can be removal?
especially to adhesive tape and prevented.
povidone-iodine, chlorhexidine,
or other topical solutions or
medications
After determining Findings may delay
when sutures or suture or staple
staples were placed, removal.
observe the wound
for signs of gaping,
drainage,
inflammation,
infection, or
embedded sutures
PATIENT PREPARATION:
PATIENT PREPARATION
Ensure that the patient and
family understand preprocedural
teachings. Answer questions as
they arise, and reinforce
information as needed
Verify that the patient is the
correct patient using two
identifiers
Administer pain medication as
prescribed
RATIONALE
Understanding of previously
taught information is evaluated
and reinforced.
Before performing a procedure,
the nurse should ensure the
correct identification of the
patient for the intended
intervention.
Pain medication promotes
patient comfort and reduces
activity during suture or staple
removal to provide a stable field.
 Provide privacy and position the Provides patient comfort and
patient for comfort without promotes cooperation during
undue tension on the suture line procedure
or staples

The
Adjust the light to shine directly Light is used to facilitate
student
on the suture line or Staples visibility
Will be

Able to
6 40min Teaching Using
Answering
explain the PROCEDURE: Explaining PPT What are
procedure Contributing
And The steps
INTERMITTENT SUTURE REMOVAL Points

Taking Showi In suture

ng removal ?
Notes
Steps
PROCEDURE RATIONALE
in

1. Confirm physician/nurse
practitioner (NP) orders, and
explain procedure to patient.
Dum
my
Explaining the procedure will
help prevent anxiety and
increase compliance with the
procedure.Inform patient that the
procedure is not painful but the
 patent may feel some pulling of
the skin during suture removal.

2. Gather appropriate supplies. You will need sterile suture

scissors or suture blade, sterile
dressing tray (to clean incision
site prior to suture removal),
non-sterile gloves, normal
saline, Steri-Strips, and sterile
outer dressing.

3. Position patient appropriately Ensure proper body mechanics

and create privacy for procedure. for yourself and create a
comfortable position for the
patient

 4. Perform hand hygiene. Hand hygiene reduces the risk of

infection.
teaching

listening
 what

10min
5. Prepare the sterile field and This allows easy access to
The required supplies for the
student add necessary supplies in an
procedure. Black
Will be able organized manner.
board
To Visually assess the wound for
6. Remove dressing and inspect uniform closure of the wound
the wound using non-sterile edges, absence of drainage,
gloves. redness, and swelling. Pain
should be minimal.

After assessing the wound,

decide if the wound is
sufficiently healed to have the
sutures removed. If there are
concerns, question the order and
seek advice from the appropriate
health care provider.
7

7. Remove non-sterile gloves This prevents the transmission

and perform hand hygiene of microorganisms.

8. Apply clean non-sterile This prevents the transmission

of microorganisms.
gloves.

9. Clean incision site according This step reduces risk of

infection from microorganisms
to agency policy.
on the wound site or surrounding
skin.