AlisonRae

Senior Practice

Development Nurse

The Royal Beckham and Victoria Hospitals

NHS

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Wound CareAdults

Removal of suturesEdited by Alison Rae, Senior Lecturer in Adult Nursing, University of Greenwich

©2020 Clinical Skills Limited. All rights reserved

Once a wound has healed, the skin sutures that have held the edges of the wound together may be removed. The type of wound and the site will determine how long the sutures should be left in place. The clinician caring for the patient will decide when the sutures should be removed. The suture material may be absorbable or non-absorbable (Lister et al., 2020; Gurusamy et al., 2014). Only non-absorbable sutures need to be removed, so check which kind the patient has, in the patient’s notes. Sutures are either interrupted, each with its own knot, or continuous, formed from a single length of suture material with a knot placed at the beginning and end of the row of sutures. Continuous sutures are usually inserted underneath the skin’s surface.

Before removing sutures, explain the procedure to the patient, including the rationale for undertaking it. Obtain the patient’s consent and answer any questions they may have (DH, 2009). Assess the patient’s level of comfort and address any problems identified (Perry & Potter, 2015). Help the patient to adopt a comfortable position, with the wound easily visible and accessible. Maintain the patient’s privacy and dignity at all times.

In acute settings, this procedure is normally carried out using an aseptic technique (see clinicalskills.net procedure on “Aseptic technique: key principles”). However, local policy may support a clean non-touch technique if sutures are to be removed in the community, for example in a patient’s own home.

These pages demonstrate the removal of individual (interrupted) sutures, but the principles remain the same for the removal of continuous sutures. You may need to apply sterile adhesive skin-closure strips or a sterile dressing after removing the sutures, if healing is not complete.

Decontaminate your hands

Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

Remove dressing, if present Assess the wound

Decontaminate your hands by washing thoroughly with soap and water, or where appropriate use alcohol-based hand sanitiser (WHO, 2009). (See also the clinicalskills.net procedure, “Routine hand hygiene”.) Ensure your hands are completely dry before continuing.

Visually inspect the wound for a healing ridge; it may be necessary to gently palpate the wound, for which you may need to wear non-sterile gloves depending on your risk assessment and local policy (RCN, 2017; Widgerow, 2013; Vuolo, 2009). Check the wound for any signs of non-union of the wound edges, such as gaping between the sutures. Examine the wound for swelling or clinical signs of infection. If in doubt about whether the sutures should be removed, seek advice from the clinician managing the patient’s care. Count the number of sutures present (Widgerow, 2013; Vuolo, 2009).

If a dressing is present, put on a disposable apron and non-sterile gloves. Remove the dressing and dispose of it according to local policy. Then remove your gloves and apron, and dispose of them. Decontaminate your hands.

Alison Rae

Senior PracticeDevelopment Nurse

The Royal Beckham and Victoria Hospitals NHS

22/2024 Discard surplus

22/2024 Discard surplus

NOT FOR INJECTION20mlSterile Normal Saline

0/9% w/v Sodium Chloride Ph. Eur.

LOT

22/2024 Discard surplus

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WARNING DO NOT FILL ABOVE

DANGER DESTROY BY INCINERATIONCONTAMINATED

SHARPS ONLY 2.5 LITRE /Y1/S/07/GB/3165 SHARPS

SINGLE USE 2 STERILIZED BY GAMMA RADIATION

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STERILITY GUARANTEED

WHILST PACKET REMAINS UNBROKEN

STERILITY GUARANTEED

WHILST PACKET REMAINS UNBROKEN

WOUNDCARE PACK BLUELATEX FREE POWDERED04/2024

STERILE

Wound care packincluding forceps

Sharps bin

Suture cutting blade

Saline podsAdhesive skin-closure strips

NOT FOR INJECTIONLOT Irripod 20 ML STERILE NORMAL SALINE0.9% w/v Sodium Chloride

Discard surplus 2STERILE A

NOT FOR INJECTIONLOT Irripod 20 ML STERILE NORMAL SALINE0.9% w/v Sodium Chloride

Discard surplus 2STERILE A

NOT FOR INJECTIONLOT Irripod 20 ML STERILE NORMAL SALINE0.9% w/v Sodium Chloride

Discard surplus 2STERILE A

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Wound Care

Adults

Removal of sutures Page 2

Gather and check equipment

Prepare the sterile field

Select the equipment you will need. For example, the appropriate sterile wound care pack, sterile forceps, sterile saline and alcohol wipe (if required), new dressing, adhesive skin-closure strips, suture cutter and sharps bin. Before using, ensure that the packaging is intact and dry, and that expiry dates have not passed. Place the wrapped equipment on the lower shelf of the trolley (or in a tray, if used).

Clean the wound, if necessary Lift suture and cut

Use the forceps to grasp the suture knot. Raise the knot slightly to allow room to cut the suture with the suture cutter as close to the skin as possible. Take care not to pierce the patient’s skin.

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Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

Clean the working area

If you are going to clean the wound, clean the lid or spout of the saline container with an alcohol wipe for 30 seconds, then allow to dry for 30 seconds. Decontaminate your hands and put on sterile gloves.

If necessary, irrigate the wound with 0.9 % sodium chloride, i.e. if the wound is dirty or has loose contaminants, or because local policy states that you must. Evidence suggests that tap water is unlikely to be harmful if used for wound cleansing; however, you should take into account the quality of water, the nature of the wound and the patient's general condition (Fernandez & Griffiths, 2012).

Remove your gloves (if worn to assess wound) and dispose of them. Decontaminate your hands and put on an apron. Clean and dry the trolley or other surface (such as a tray) according to local policy. (See also the clinicalskills.net procedure, “Aseptic technique: key principles”.)

Decontaminate your hands. Open the sterile wound care pack onto the top surface of the trolley (or tray, if using). Open the packets of the equipment required and place them on the sterile field; take care not to contaminate any item.

If required, clean the saline pod

AlisonRae

Senior Practice

Development Nurse

The Royal Surrey County Hospitals NHS

Wound Care

Adults

Removal of sutures Page 3

Pull the suture until it is free Remove alternate sutures first

Count the number of sutures If necessary, apply sterile dressing or strips

Count the number of sutures removed and make sure no sutures have been left in place or have broken off under the skin. If necessary, irrigate around the wound with sterile saline. Use sterile gauze to ensure the area is dry. Do not clean the wound itself.

Inspect the wound (Widgerow, 2013; Vuolo, 2009). If necessary, apply a sterile dressing. It may be appropriate to apply sterile adhesive skin-closure strips, but always seek advice from a senior colleague if you are unsure. Make sure the patient is comfortable. Provide the patient with wound-care advice.

Patient Notes ? X

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General Notes

30/11/2020 14.40 A. HargreavesMr Smith had 10 sutures removed.No sutures remain. No complications.Wound appears well healed with no signs of dehiscence or infection. 2 skin-closure strips applied to support wound. Advised patient of aftercare needed.

Allergy Notes

Dispose of equipment and wash hands Documentation

Dispose of sharps and clinical waste according to local policy. Remove gloves and apron and thoroughly wash and dry your hands. Clean the trolley or tray according to local policy.

Document your assessment of the wound, the care given, the procedure undertaken and the plan of care (NMC, 2018; Widgerow, 2013). Record the number of sutures that have been removed and the number left in place, where relevant.

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Do not undertake or attempt any procedure unless you are, or have supervision from, a properly trained, experienced and competent person.Always first explain the procedure to the patient and obtain their consent, in line with the policies of your employer or educational institution.

When removing interrupted sutures, you should remove alternate sutures first, to ensure the wound is closed and to predict any dehiscence (Pudner, 2005). Once you are certain the wound is intact, remove the remaining sutures. Analyse each suture as you remove it, to make sure it is intact. Place the removed suture on a piece of sterile gauze for counting at the end of the procedure.

Use the forceps to pull the suture gently through the skin, towards the side that has been cut (see picture). To prevent infection, you must not pull the exposed/contaminated suture back through the tissue/wound (Pudner, 2005). Gently press the skin with the side of the cutter while removing the suture, to reduce unnecessary pulling on the skin and to reduce pain for the patient. Avoid using excessive force.