Suture And Staple Removal.docx

PROCEDURE ON STAPLE AND SUTURE REMOVAL

SUBMITTED TO: Mr. EKE Lama Tamang HOD Med Surg Nursing SUBMITTED BY: Sneha Sehrawat MSc Nursing Rufaida College of Nursing

DEFINITION:Removal of suture and staple is to remove the suture and staple from a sutured and stapled wound with the following of aseptic technique. The decision to remove sutures, clips or staples from a wound istaken when the strength of the wound is assessed to be adequate to support itself.

SUTURES AND ITS TYPES Sutures are the materials used in operation theatre for joining the two edges of the incised surgical or other wounds. Sutures need to be of large caliber so as not to cut through the tissue. These need to be strong and non irritant to skin and body tissue.

TYPES Sutures are commonly of two types: 1. Absorbable sutures 2. Non absorbable sutures

Absorbable sutures – also known as catgut. This type of sutures are commonly used to suture the inner structure of the body such as walls of the organs, rectus sheath, muscles, subcutaneous tissue, peritoneum and for intestinal anastomosis etc. these sutures are completely digested and absorbed by the tissues. Size of the absorbable catgut suture vary from 5/0 which is the finest to 2 which is the thickest. e.g. plain, chromic, atraumatic catgut.

Non absorbable sutures – these types of sutures are not absorbed. These sutures are used for closing or suturing outer surface of the body such as skin. These sutures are cheaper, easy to handle, easy to sterilize, have smooth surface. These kind of sutures are liable to cause stitch infection and stich sinus. e.g. silk sutures, linen suture, nylon suture (ethilon).

Factors to be kept in mind:Factors which might delay wound healing, and should therefore be considered prior to the removal of sutures or clips, include: Diseases, disorders and syndromes:for example, anaemia, autoimmune disorders, diabetes, cardiopulmonary disease, liver failure, Drugs:for example, alcohol, cytotoxics, nicotine, steroids, antiinflammatory drugs Poor nutritional state:o for example, anaemia, malnutrition, mineral deficiency, protein deficiency, vitamindeficiency Microenvironment of wound:o for example, blood supply, gas composition, humidity, infection, allergic reaction to clips

PROCEDURE 1.Patient Preparation It is mandatory to ensure that the patient has received appropriate information to provide informed consent and, that patient identification, correct procedure and correct site process is completed prior to any procedure. Explain procedure to the patient/parent/carer. Alert them that they may feel a slight pulling or stinging sensation with removal of wound closures. Offer analgesia and administer if required to the patient 1 hour prior to removing sutures, staples or clips. 2.Staff Preparation It is mandatory for staff to follow relevant: “Five moments of hand hygiene”, infection control, moving safely/safe manual handling and documentation practices. Assess level of PPE required based on risk of infection for the patient/clinician, and the type of procedure being undertaken. Ensure there is a written order for removal of alternate and/or all wound closure device/s, including the site of the wound closures, by an Authorised Clinician prior to removal.

PROCEDURE FOR THE REMOVAL OF SUTURES FROM A NON-DISCHARGING WOUND

ARTICLES REQUIRED: Basic procedure pack and/or suture removal pack  Sterile stitch cutter  Non-sterile gloves  Sharps container  Apron  Yellow clinical waste bag  Dry dressing if required Refer to General Principles for All Procedures and Aseptic Non-Touch Technique.

STEP AND RATIONALE:-

1. Explain and discuss the procedure to the patient and gain verbal consent. R- To ensure the patient understands the procedure and gives their valid consent .

2. Assess the patients comfort level and address if necessary. R- Get baseline of patients comfort level.

3.Pull curtains or close door. R- To maintain the privacy and dignity of the patient.

4. Assist the patient into a position which is comfortable and which allows easy access to the suture line. R- To facilitate the procedure for both patient and nurse

5.Wash hands using 5 step technique. R- To reduce the risk of infection and comply with trust infection control policy.

6. If the wound is covered, put on the gloves and remove the dressing. Dispose of both and cleanhands. R- To minimise the risk of crossinfection.

7. Place a piece of gauze near to wound. R- Allows easy disposal of sutures.

8. Hold the knot of the first suture with the forceps, gently lift upwards and cut one side of the suture, with the cutter/scissors as close to the skin as possible.Gently but firmly pull the suture out. Place the sutures on the gauze. R- To prevent infection caused by drawing the exposed suture material through the subcutaneous tissue .

9. Continue along the wound until all the suture material has been removed – check the wound carefully. R- To ensure all sutures are removed and reduce the risk of future wound irritation, breakdown or infection.

10. Record the removal of sutures and the condition of the suture line and surrounding skin in the appropriate documentation. R- To maintain records and enable evaluation of the wound.

PROCEDURE FOR THE REMOVAL OF SUTURES FROM A DISCHARGING WOUND

EQUIPMENT:-

 Sterile stitch cutter/scissors  1 pair non-sterile gloves  1 pair sterile gloves  Sharps container  Trolley/tray  Basic procedure pack or suture removal pack  Sachet of normal saline  Dry adhesive dressing of choice  Steristrips (if necessary)  Wound swab (if required)  Yellow clinical waste bag Refer to General Principles for All Procedures and Aseptic NonTouch Technique.

STEP AND RATIONALE

1. Explain procedure to the patient and gain verbal consent. R- To ensure the patient understands the procedure and gives their consent.

2. Assess the patients comfort level and address if necessary. R- Get baseline of patients comfort level.

3. Pull curtains or close door. R- To maintain the privacy and dignity of the patient.

4. Assist the patient into a position which is comfortable and which allows easy access to the suture line. R- To facilitate the procedure for both patient and nurse. 5. Wash hands using 5 step technique. R- To reduce the risk of infection and comply with trust infection control policy.

6. Apply the non-sterile gloves and remove the dressing. Dispose of both and clean hands

using 5 step technique. R- To minimise the risk of cross infection from the dressing.

7. Obtain bacteriological wound swab, if appropriate, e.g. if signs of infection. R- To determine presence of pathogenic microorganisms.

8. Open the pack, apply sterile gloves (if used) and clean the wound using an aseptic non-touch technique. R- To remove the wound discharge.

9. Hold the knot of the first suture (furthest from the contaminated area), gently lift upward and cut one side of the suture as close as possible to the skin. Gently but firmly pull the suture out. R- To prevent infection caused by drawing the exposed suture material through the subcutaneous tissue . 10. Continue working towards the contaminated area: R- To minimise spread of any infection.

11. If the wound appears stable, continue until all the suture material has been removed. Check the wound carefully. R- To ensure all suture material has been removed and to reduce the risk of future wound breakdown or irritation.

12. If any further discharge is present, clean the wound with saline using an aseptic non-touch technique. R- To minimise spread of any infection,

13. Cover the wound with the sterile adhesive dry dressing. R- To absorb excess wound discharge.

14. Record the removal of sutures and the condition of the wound in the appropriate documentation. R- To document care and enable evaluation of the wound.

PROCEDURE FOR THE REMOVAL OF CLIPS OR STAPLES FROM WOUND

ARTICLES REQUIRED

 Appropriate staple or clip removers  Sharps container  Apron  Non-sterile gloves  Gallipot  Yellow clinical waste bag  Dry adhesive dressing

Refer to General Principles for All Procedures and Aseptic Non-Touch Technique.

STEP AND RATIONALE 1. Explain procedure to the patient R- To ensure the patient understands the procedure and gives their consent.

2. Assess the patients comfort level and address if necessary. R- Get baseline of patients comfort level.

3.Pull curtains or close door. R- To maintain the privacy and dignity of the patient.

4. Assist the patient into a position which is comfortable and which allows easy access to the suture line. R- To facilitate the procedure for both patient and nurse

5. Wash hands using technique. R- To reduce the risk of infection and comply with trust infection control policy.

6. If the wound is covered, apply the gloves and remove the dressing. Dispose of both and clean hands. R- To minimise the risk of crossinfection.

7. Place gauze next to the patient. R- Ensure safe and easy disposal of clips.

8. If the suture line is under tension support surrounding skin with forceps or fingers. R- To prevent excess pulling of wound and minimise patient discomfort on removal of staple.

9. Open the staple removers and gently place the lower two prongs under the staple. Squeeze the handles to lift the edges of the clips/staple. R- To open the clip/staple and remove atraumatically from the wound.

10. Lift one side of the clip, then the other and ease the clip out of the skin. R- To minimise trauma to the wound edges.

11. Continue along the wound until all the clips/staples have been removed. Check the wound carefully for any remaining clips/staples. R- To ensure all clips/staples are removed and to reduce the risk of future wound irritation/breakdown. 12. Dispose of the clips/staples in the Sharps container and the clip/staple removers as per manufacturer’s instructions. R- To prevent injury.

13. Record the removal of the clips/staples and the condition of the suture line and surrounding area in the appropriate documentation. R- To maintain records and enable evaluation of the wound.

AFTER CARE OF PROCEDURE

For all suture lines, if the wound gapes slightly use adhesive sutures (steri-strips) to oppose the wound edges. • Observe site for signs of infection or inflammation e.g. redness and drainage and report to doctor. • Sort and dispose of equipment in contaminated waste bin. Remove non-sterile gloves and perform Hand Hygiene as per ‘Five moments of hand hygiene” • Wipe trolley down with large alcohol based wipe or neutral detergent. • Remove remaining PPE eg. apron and perform hand hygiene as per ‘Five moments of hand hygiene” • Provide instruction to patient on care of wound site, including any showering / hygiene restrictions and to report any discomfort, pain, inflammation to the nurse or midwife caring for them • Document procedure in patient’s health record, recording the condition of the suture line and surrounding skin i.e. any exudate, inflammation or pain • Record vital sign observations at least once each shift and report abnormalities.