REMOVAL OF

SUTURES

 CHRISTOPHER M. BENTRES BSN_RN

 1650 BC – 2000’s  The origins of surgery can
be traced back many centuries
AD
 Through the ages,
Practitioners have used a wide
range of materials and
techniques for closing tissue…
 In the 10th century BC, ANTS was held over the wound until it
seized the wound edges in its jaws. It was then decapitated.
 The thorn, used by African
tribes to close tissue,
was passed through the skin
on either side of the wound.
 A strip of vegetable fibre
was then tied
around the edge in a figure
eight.
The tough membrane of sheep intestine was provided
to the surgeon pre-sterilised and required threading
through the eye of the needle before use.
 Sutures

Absorbable Non-absorbable

Natural Synthetic Natural Synthetic

Mono-filament Mono-filament Mono-filament Mono-filament

Multi-filament Multi-filament Multi-filament Multi-filament

Monofilament Multifilament (braided)
 Tensile
Tensile
strength
strength

knot
knot
Sterility
Sterility security
security
QUALITIES
QUALITIES

Low
Low Easy
Easy
tissue
tissuereactivity
reactivity handling
handling
 ABSORBABLE!
Usually lose their tensile strength within
60 days.
ABSORBED by
Hydrolysis or enzymatic degradation
 P
L
A
Derived from the small intestine I
of healthy sheep.
Loses 50% of tensile strength by N
5-7 days.
Used on mucosal surfaces.
G
U
T
 C
H
R
O
M
I
C
Treated with chromic acid to
delay tissue absorption time.
50% tensile strength by 10-14 G
days. U
Used in episiotomy repairs.
T
 ®)
D S
(P
N E
N O
X A
IO
Y D
L
PO Monofilament
50% tensile strength = 30+ days
Sites = need for prolonged
strength,
 Po
lyg
ly
ca
ne
91
0
(v
ic
yle
®
)
Braided, synthetic polymer
50% tensile strength for 30 days
Used: subcutaneous
 NON-ABSORBABLE!
Permanent, used for long term strength
 Po
ly
pr
op
yl
en
e
(P
ro
le
ne
®
)

Appears to be stronger then

nylon and has better overall
wound security.
 S
Braided
Before the advent of synthetic fibers,
I
silk was the mainstay of wound closure.
Easy handling, excellent knot security. L
High reactivity and infection due
to the absorption of body fluids
by the braided fibers. K
 Suture size
USP (United States Pharmacopoeia)

5..4..3..2..1..0..2/0..3/0..4/0..5/0..6/0..7/0..8/0..9/0..10/0..11/0

General

Thick Thin
 SUTURE SELECTION
Bowel: 2/0 - 3/0
Fascia: 1 - 0
Ligatures: 0 - 3/0
Pedicles: 2 - 0
Skin: 2/0 - 5/0
Arteries: 2/0 - 8/0
Micro surgery 9/0 - 10/0
Corneal closure: 9/0 - 10/0
 The Suture Packaging

PROD
STRAND UCT
SIZE
CODE
NEEDLE
CODE
MATERIAL WITH LIFE
SIZE
PICTURE
OF
STRAND NEEDLE
LENGTH

NEEDLE POINT NEEDLE

COLOUR CIRCLE TYPE LENGTH
BASIC SURGICAL KNOTS
& SUTURING
Suture techniques

Common suture stitching techniques include:

• Simple Interrupted Stitch
• Running Stitch
• Mattress
• Horizontal mattress
• Vertical mattress
• Continuous locking
• Subcuticular
Surgical techniques
• Continuous

• Running stitch
Surgical techniques
• Simple interrupted

• Subcuticular
Surgical techniques
• Mattress
Surgical needles
• Traumatic needles are needles with holes
or eyes which are separate from their
suture thread.

• Atraumatic needles with sutures

comprise an eyeless needle attached to a
specific length of suture thread.
Surgical needles

There are several shapes of surgical needles,

including:
• straight
• half curved or ski
• 1/4 circle
• 3/8 circle
• 1/2 circle
• 5/8 circle
• compound curve
Needles
Other methods
• Tissue adhesives
Topical cyanoacrylate adhesives ("liquid stitches")
have been used in combination with, or as an
alternative to, sutures in wound closure.

• Surgical staples
Specialized surgery staples, which prove to be
faster, consistent & accurate. Staple lines are
less likely to leak blood, air or bowel contents.
Staples
 REMOVING OF SUTURES
 SKIN SUTURES
• Are used to hold tissue and skin together.
Sutures may be black silk, synthetic material, or
fine wire. Sutures are removed when enough
tensile strength has developed to hold the wound
edges together during healing.
• The time frame varies depending on the patient’s
age, nutritional status and wound location.
Frequently, after the skin sutures are removed,
Steri- strips (small wound- closure strips of
adhesive) are applied across the wound to give
additional support as it continous to heal.
• The removal of sutures may be done by the
physician or by the nurse with a physician’s order
EQUIPMENT

 Sterile suture removal kit or sterile forceps and

scissors
 Gauze
 Wound cleansing agent, according to facility
policy
 Clean disposable gloves
 Sterile gloves
 Steri- strips
 Tincture of Benzoin, if indicated
ASSESSMENT
 Inspect the surgical incision and the surrounding
tissue.
 Assess the appearance of the wound for the
approximation of wound edges, the color of the
wound and surrounding area, presence of wound
drainage, noting color, volume and odor, and for
signs of dehiscene.
 Note the stage of the healing process and
characteristic of any drainage.
 Assess the surrounding skin for color, temperature,
and the presence of edema, maceration or
ecchymosis.
NURSING DIAGNOSIS
 Determine the related factors for the nursing diagnosis
based on the patient’s current status.
 An appropriate nursing diagnosis is Risk for Infection.
Other nursing diagnoses that maybe appropriate include:
 Anxiety
 Pain
 Acute pain
 Impaired skin integrity
 Delayed surgical recovery
 Risk for Situational Low Self- Esteem
OUTCOME IDENTIFICATION AND
PLANNING
The expected outcome to achieve when removing
surgical sutures is that the sutures are removed
without contaminating the incisional by
maintaining sterile technique, without causing
trauma to the wound, and without causing the
patient to experience pain or discomfort. In
addition, other outcomes that are appropriate
include: the patient remains free form exposure
to infectious microorganisms; the patient
remains free of complications that would delay
recovery; and the patient verbalizes positive
aspects about self.
IMPLEMENTATION
ACTION
1.Review the physician’s
order for suture removal.
RATIONALE
- Reviewing the order
validates the correct
patient and correct
procedure
IMPLEMENTATION
 ACTION
2. Gather the necessary
supplies.
RATIONALE
- Adequate preparation
ensures efficient time
management.
IMPLEMENTATION
ACTION
3. Identify the patient.
RATIONALE
- This ensures the right
patient receives the right
intervention
IMPLEMENTATION
ACTION
4. Explain the procedure to the
patient. Describe the sensation
as a pulling or slightly
uncomfortable experience.
RATIONALE
- Discussion and explanation help
allay the anxiety and prepare the
patient for what to expect
IMPLEMENTATION
ACTION
5. Perform hand
hygiene.

RATIONALE
- Hand hygiene
prevents the spread of
microorganisms
IMPLEMENTATION
ACTION
6. Close the room door or curtain.
Place the bed at an appropriate
and comfortable working height.
RATIONALE
- Closing the door or curtains
provide privacy. Placing the bed
at an appropriate height helps
reduce back strain when
performing the procedure
IMPLEMENTATION
ACTION
7. Assist the patient to a comfortable
position that provides easy access
to the wound area. Use the bath
blanket to cover any exposed area
other than the wound.
RATIONALE
- A comfortable patient position helps
reduce anxiety. Bath blanket
provides for comfort and warmth.
IMPLEMENTATION
ACTION
8. Put on clean gloves. Remove and
dispose of any dressings on the
surgical incision. Remove gloves
and put on sterile gloves. Inspect
the incision area.
RATIONALE
- Use of gloves and proper removal of
dressings help prevent spread of
microorganisms. Removal of
dressings allows access to the
incision
IMPLEMENTATION
ACTION
9. Clean the incision using the
wound cleanser and gauze,
according to facility policies
and procedures.
RATIONALE
- Incision cleaning prevents the
spread of microorganisms and
contamination of the wound
 IMPLEMENTATION
 ACTION
11. Using the sterile scissors, cut one
side of the suture below the knot,
close to the skin. Grasp the knot with
the forceps and pull the cut suture
through the skin. Avoid pulling the
visible portion of the suture through
the underlying tissue.
 RATIONALE
- Pulling the cut suture through the skin
helps reduce the risk for contamination
of the incision area and resulting
infection.
 IMPLEMENTATION
ACTION
12. Remove every other suture to be sure the
wound edges are healed. If they are,
remove the remaining sutures as ordered .
Dispose of sutures in a biohazard bag.
RATIONALE
- Removing every other suture allows for
inspection of the wound, while leaving
adequate suture in palce to promote
continued healing if the edges are not totally
approximated. Follow standard precautions
in disposing of sutures.
IMPLEMENTATION
ACTION
13. Apply steri- strips if
ordered. If necessary,
prepare the skin with
tincture of bezoin before
applying steri- strips
RATIONALE
- Steri- strips provide
additional support to the
wound as it conitnues to
heal. Applying benzoin aids
in adherene of steri- strpis.
IMPLEMENTATION
ACTION
14. Reapply the dressing,
depending on the
physician’s orders and
facility policy.
RATIONALE
- A new dressing protects the
wound. Some policiess
advise leaving the area
uncovered.
IMPLEMENTATION
ACTION
15. Remove gloves and
perform hand hygiene
RATIONALE
- Removing gloves and
performing hand
hygiene prevent the
spread of
microorganism.
EVALUATION
The expected outcome is
met when the patient
exhibits an incision area
that is clean, dry, and
intact without sutures.
The incision area is free of
trauma and infection, and
the patient verbalizes
minimal to no complaints
of pain or discomfort and
positive aspects about self