Training for Healthcare Professionals Module : Specimen Patient Collection Care Blood Culture Suture and Staple Removal Learning Objectives After completing this module, you will be able to: Identify the types of sutures and staples that need to be removed Demonstrate suture and staple removal List the guidelines for care after suture and staple removal Sutures and Staples Sutures and Staples are stitches used to hold the wound and repair it to promote healing. They are used : To close accidental cuts In operations to tie blood vessels To close surgical incisions They should be removed to prevent inflammation of the skin. They should be removed timely (neither too early nor too late) as it can lead to scarring, infection, re-opening, delayed healing and other complications. 1
When are Sutures & Staples Removed? 3 1 2 5 4 7 6 8 The time of removal is based on the stage of healing, the extent of incision and the size and location of the wound. Approx. Removal Time Face - After 3-4 days Neck - After 5 days Scalp - After 6-7 days Arms and back of hands - After 7 days Chest and abdomen - After 7-10 days Legs and top of feet - After 10 days Back - After 10-12 days Palms of hands and soles of feet - After 14 days Types of Sutures & Staples Absorbable Sutures Non-Absorbable Sutures Staples They rapidly break down (get absorbed) in the tissues, lose their strength within 60 days and are made of synthetic material. They do not need to be removed as they get dissolved in the skin. They maintain their strength for longer than 60 days and are made of strong thread. They are used to close skin or external wounds and require removal once the wound has healed They are faster to apply, cause fewer infections than sutures and are made of stainless steel. They are commonly used to close scalp wounds and surgical wounds and require removal once the wound has healed Equipment Required for Removal of Sutures & Staples Antiseptic solution or alcohol Surgical scissors, scalpel, nail clippers, or hobby knife (sterilized) Sterile bandage Forceps or tweezers Magnifying glass, preferably with built-in light Antibiotic ointment 2
Suture Removal Procedure 1. Check doctor s instructions 2. Explain the procedure to the patient; provide analgesic if required 3. Wash your hands and wear gloves to remove dressing 4. Cleanse the wound/incision with antiseptic solution 5. For Suture Removal: Using forceps or tweezers, gently lift the knot and cut the suture just below the knot 6. Pull the thread out through the skin. Continue this process until all sutures have been removed Staple Removal Procedure 1. Staple Remover 2. Count and Remove 3. Dress and Document Place curved edge of the staple remover under midline of staple; squeeze the handles of staple remover together until both ends of staple pull out of skin Count all staples and sutures before and after the removal to ensure that all staples are removed and that none are left in the patient's body or have been lost Cleanse the incision after removal of sutures/staples and apply steri-trips/dressing if required. Always document appearance of the wound following suture/staple removal Suture & Staple - Post Removal Care Apply steri-strips Keep Dry Re-injury & UV Apply lotion 3
Fill in the Gaps Suture Removal Fill in the blanks. 1. Check instructions. 2. Explain the procedure to the patient; provide if required. 3. Wash your hands and wear to remove dressing 4. Cleanse the wound/incision with. 5. Using forceps or tweezers, gently lift the and cut the just below the knot. 6. Pull the thread out through the. Continue this process until all sutures have been removed gloves, doctor s, skin, analgesic, antiseptic, Knot, suture Points to Remember Always seek guidance from a senior practitioner while removing sutures/staples from major surgeries Do not proceed if skin separation is present; apply steri-strips and notify your senior Always notify drainage, if any Always document the wound condition after suture /staple removal and how the patient tolerated the procedure Activity Suture & Staple Removal Time Required (suggested) : 30 Minutes 1. Items Needed: Dummy, clean gloves, dressing set, sterile normal saline, suture cutter or forceps and steri-strips Form Groups Divide yourselves into groups based on the number of item sets available Select Leader to direct activity Initial Demo Each group selects one volunteer to be a nurse and use the dummy as patient Nurse shows how to remove suture/staple from the dummy using shown process Feedback Rest of the group gives feedback to Nurse on what he/she did right or wrong Repeat Demo A second volunteer is selected. Nurse removes sutures/ staples from the dummy Class Demo If time permits, another volunteer does the demo in front of the entire class 4
Check Your Learning 1 Sutures or staples should be removed timely, otherwise it can lead to: 1. scarring 2. infection 3. re-opening 4. delayed healing Select all correct options and click Submit. Check Your Learning 2 While removing sutures and staples, you should count all staples and sutures before and after removal to ensure that: 1. All staples are removed 2. None are left in the patient's body 3. Both of the above Select the correct option and click Submit. Check Your Learning 3 Absorbable sutures get dissolved in the skin and hence are not to be removed. State whether the statement is true or false. 1. True 2. False Select one correct option and click Submit. 5
Check Your Learning 4 Suture and staple post-removal care includes: 1) Applying steri-strips 2) Protecting the wound from UV rays 3) Protect the wound from re-injury 4) All of the above Select the correct option and click Submit. Check Your Learning 5 Which of the following type is made of stainless steel? 1. Absorbable Sutures 2. Non-Absorbable Sutures 3. Staples Select the correct option and click Submit. Now you can Please rank your comfort level for the learning objectives: Identify the types of sutures and staples that need to be removed Yes Need More Practice No Demonstrate suture and staple removal List the guidelines for care after suture and staple removal 2013, Wadhwani Foundation. All rights reserved. 6
Resources For further reference please refer to: http://www.emedicinehealth.com/removing_stitches/article_em.htm http://www.woundcarecenters.org/wound-therapies/suturesstitches-and-staples.html 7