A Licensed Practical Nurse (LPN), also known as a Licensed Vocational Nurse (LVN) in some states, is a licensed healthcare provider who delivers routine patient care under the direction of a Registered Nurse (RN) or physician. The practice scope of an LPN focuses on technical skills and direct patient care, but its boundaries are not fixed across the country. The ability of an LPN to remove sutures is a common question that has no single, universal answer, as it depends heavily on the regulatory board and the specific employment setting.
The General Scope of Practice for Suture Removal
Suture and staple removal is generally classified within nursing as a technical skill or a routine procedure, which often places it within the LPN’s potential scope of practice. The fundamental condition for an LPN to perform this task is that the wound must be uncomplicated, meaning it is stable, well-approximated, and shows no signs of delayed healing or infection. These signs include excessive redness, swelling, purulent drainage, or a separation of the wound edges, known as dehiscence.
The LPN’s role typically focuses on the mechanical removal of superficial sutures or staples from a wound that has been previously assessed and determined to be healing normally. This is distinct from advanced wound management, which may involve complex dressing changes, aggressive debridement, or the removal of deep sutures, which generally remain the responsibility of a Registered Nurse or a medical provider. When a wound is stable, the procedure becomes a standardized, low-risk task suitable for the LPN’s education and training.
The procedure requires specific technical knowledge, such as grasping the suture knot with forceps and cutting the thread below the knot line to ensure that only the clean, submerged portion of the suture is pulled through the skin. LPNs are also trained to apply supportive skin closures, like Steri-Strips, immediately after suture removal to provide additional support against tension and prevent the wound from reopening prematurely.
The Critical Role of State and Facility Policy
The legal authorization for an LPN to remove sutures begins with the state’s Nurse Practice Act (NPA), which is administered by the State Board of Nursing (BON). The NPA establishes the maximum legal scope of practice for all licensed nurses within that state. However, the BON often provides only a general framework, classifying the procedure but not mandating its performance.
The practical reality of the LPN’s role is ultimately governed by the policy of the individual facility, clinic, or employer. A hospital policy may be significantly more restrictive than the state law, choosing to limit the task to Registered Nurses only, to maintain a higher standard of uniformity or minimize organizational risk. Therefore, an LPN must always consult both their state’s BON guidelines and their employer’s specific policies before undertaking any procedure.
This two-tiered system means that an LPN who is legally permitted by state law to remove sutures may still be prohibited from doing so by their employer’s internal guidelines. The facility policy serves as the practical floor, specifying the exact conditions, training, and documentation required for the LPN to perform the task within that specific environment.
Necessary Prerequisites and Delegation Requirements
Before an LPN can remove sutures, documented individual competency and proper delegation or assignment must be met. Competency involves formal training, which includes instruction on the proper sterile technique, wound assessment, and the mechanical skill of removal. This training must be followed by a successful skill check-off, where an RN or physician observes the LPN performing the task to verify the technique is safe and effective.
The legal mechanism for the LPN to proceed is delegation, typically from a Registered Nurse or a licensed medical provider. Delegation is the transfer of authority to perform a specific nursing task in a specific situation, but the delegating clinician retains overall accountability for the patient’s outcome. Delegation is only permitted if the delegating clinician has first assessed the patient and determined that the procedure is appropriate and that the LPN has the necessary knowledge and skill.
The pre-removal assessment is a vital step and often falls to the delegating clinician. This assessment checks for contraindications, such as signs of infection or wound separation, that would halt the removal procedure. Following the successful removal, the LPN is responsible for documentation, noting the exact number of sutures removed, the condition of the wound edges, any patient response, and the application of any post-removal dressings.