Sunday, 31 October 2010

SUTURE REMOVAL

Read more : http://careville.blogspot.com/2011/12/suture-removal-procedure.html

Suture Removal Procedure



The goal of this procedure is to remove skin sutures from a healed wound without damaging newly formed tissue. The timing of suture removal depends on the shape, size, and location of the sutured incision; the absence of inflammation, drainage, and infection; and the patient's general condition. Usually, for a sufficiently healed wound, sutures are removed 7 to 10 days after insertion. Techniques for removal depend on the method of suturing, but all require sterile procedure to prevent contamination. Although sutures usually are removed by a physician, in many facilities, a nurse may remove them on the physician's order.
Equipment
Waterproof trash bag • adjustable light • clean gloves, if the wound is dressed • sterile gloves • sterile forceps or sterile hemostat • normal saline solution • sterile gauze pads • antiseptic cleaning agent • sterile curve-tipped suture scissors • povidone-iodine pads • optional: adhesive butterfly strips or Steri-Strips and compound benzoin tincture or other skin protectant.
Prepackaged, sterile suture-removal trays are available.
Preparation of equipment
Assemble all equipment in the patient's room. Check the expiration date on each sterile package and inspect for tears. Open the waterproof trash bag, and place it near the patient's bed. Position the bag properly to avoid reaching across the sterile field or the suture line when disposing of soiled articles. Form a cuff by turning down the top of the trash bag to provide a wide opening and prevent contamination of instruments or gloves by touching the bag's edge.


Implementation
  • If your facility allows you to remove sutures, check the physician's order to confirm the details for this procedure.
  • Check for patient allergies, especially to adhesive tape and povidone-iodine or other topical solutions or medications.
  • Tell the patient that you're going to remove the stitches from his wound. Assure him that this procedure typically is painless, but that he may feel a tickling sensation as the stitches come out. Reassure him that because his wound is healing properly, removing the stitches won't weaken the incision.
  • Provide privacy, and position the patient so he's comfortable without placing undue tension on the suture line. Because some patients experience nausea or dizziness during the procedure, have the patient recline if possible. Adjust the light to have it shine directly on the suture line.
  • Wash your hands thoroughly. If the patient's wound has a dressing, put on clean gloves and carefully remove the dressing. Discard the dressing and the gloves in the waterproof trash bag.
  • Observe the patient's wound for possible gaping, drainage, inflammation, signs of infection, and embedded sutures. Notify the physician if the wound has failed to heal properly. The absence of a healing ridge under the suture line 5 to 7 days after insertion indicates that the line needs continued support and protection during the healing process.
  • Establish a sterile work area with all the equipment and supplies you'll need for suture removal and wound care. Open the sterile suture-removal tray, maintaining sterility of the contents, and put on sterile gloves.
  • Using sterile technique, clean the suture line to decrease the number of microorganisms present and reduce the risk of infection. The cleaning process should also moisten the sutures sufficiently to ease removal. Soften them further, if needed, with normal saline solution.
  • Proceed according to the type of suture you're removing. (See Methods for removing sutures.) Because the visible part of a suture is exposed to skin bacteria and considered contaminated, be sure to cut sutures at the skin surface on one side of the visible part of the suture. Remove the suture by lifting and pulling the visible end off the skin to avoid drawing this contaminated portion back through subcutaneous tissue.
  • If ordered, remove every other suture to maintain some support for the incision. Then go back and remove the remaining sutures.
  • After removing sutures, wipe the incision gently with gauze pads soaked in an antiseptic cleaning agent or with a povidone-iodine pad. Apply a light sterile gauze dressing, if needed, to prevent infection and irritation from clothing. Then discard your gloves.
  • Make sure the patient is comfortable. According to the physician's preference, inform the patient that he may shower in 1 or 2 days if the incision is dry and heals well.
  • Properly dispose of the solutions and trash bag, and clean or dispose of soiled equipment and supplies according to your facility's policy.
Special considerations
  • Be sure to check the physician's order for the time of suture removal. Usually, you'll remove sutures on the head and neck 3 to 5 days after insertion; on the chest and abdomen, 5 to 7 days after insertion; and on the lower extremities, 7 to 10 days after insertion.
  • If the patient has interrupted sutures or an incompletely healed suture line, remove only those sutures specified by the physician. He may want to leave some sutures in place for an additional day or two to support the suture line.
  • If the patient has both retention and regular sutures in place, check the physician's order for the sequence in which they are to be removed. Because retention sutures link underlying fat and muscle tissue and give added support to the obese or slow-healing patient, they usually remain in place for 14 to 21 days.
  • Be particularly careful to clean the suture line before attempting to remove mattress sutures. This decreases the risk of infection when the visible, contaminated part of the stitch is too small to cut twice for sterile removal and must be pulled through tissue. After you have removed mattress sutures this way, monitor the suture line carefully for subsequent infection.
  • If the wound dehisces during suture removal, apply butterfly adhesive strips or Steri-Strips to support and approximate the edges and call the physician immediately to repair the wound.
  • Apply butterfly adhesive strips or Steri-Strips after any suture removal, if desired, to give added support to the incision line and prevent lateral tension on the wound from forming a wide scar. Use a small amount of compound benzoin tincture or other skin protectant to ensure adherence. Leave the strips in place for 3 to 5 days, as ordered.
Home care
If the patient is being discharged, teach him how to remove the dressing and care for the wound. Instruct him to call the physician immediately if he observes wound discharge or any other abnormal change. Tell him that the redness surrounding the incision should gradually disappear and only a thin line should show after a few weeks.
Documentation
Record the date and time of suture removal, type and number of sutures, appearance of the suture line, signs of wound complications, dressings or butterfly strips applied, and the patient's tolerance of the procedure.