Sutures, commonly known as stitches, are medical devices used to hold the edges of a wound or surgical incision together. They approximate tissue, which significantly reduces the space the body needs to bridge during tissue regeneration. This approximation accelerates healing, minimizes scarring, and lowers the risk of infection. Removing these non-absorbable threads requires a sterile approach and mechanical accuracy to prevent wound trauma. This guide provides a step-by-step process for the safe and effective removal of sutures.
Pre-Procedure Assessment and Equipment Gathering
Before removal, the nurse must confirm the provider’s order, specifying the timing and number of sutures to be removed. The wound site requires careful visual inspection for uniform closure of the skin edges and a lack of separation, indicating sufficient tensile strength. Signs of proper healing include minimal redness, no swelling, and no purulent drainage. Infection or dehiscence requires halting the procedure and notifying the provider.
The nurse explains the process to the patient, confirming their pain level and reassuring them they may only feel a slight tugging sensation. Hand hygiene is performed, and a sterile field is prepared to maintain an aseptic environment. Supplies are typically contained within a sterile suture removal kit, which includes specialized suture scissors and forceps.
In addition to the kit, the nurse must have the following items readily available:
- Sterile gloves
- Antiseptic solution
- Gauze for cleansing and disposal
- Adhesive strips (Steri-Strips)
Steri-Strips are used to support the incision line after removal, especially if there are concerns about wound stability. A biohazard container must also be positioned nearby for the disposal of the removed suture material.
Step-by-Step Guide for Suture Removal
After preparing the sterile field, gently clean the incision site using antiseptic solution and gauze to remove surface debris or crusting that could pull into the wound. For the common intermittent suture pattern, use forceps to grasp the knot of the first suture and lift it gently away from the skin. This exposes the small, clean segment of the suture that was beneath the epidermis.
The sterile suture scissors are then carefully slipped under the exposed, lifted thread, and a cut is made close to the skin at the point where the suture emerges, distal to the knot. Cutting this specific, clean segment ensures that the contaminated portion of the suture thread is not pulled through the underlying tissue layers. Once cut, use the forceps to grasp the knot and remove the entire suture in one smooth, continuous action, pulling toward the incision line.
If the incision is long or its healing is questionable, the nurse often begins by removing every second suture, or “alternate sutures,” to assess the wound’s integrity before removing the rest. For a continuous suture, the technique differs because the thread runs the length of the incision; cut the suture near the knot and every subsequent loop, pulling each removed segment out. Staple removal requires a specialized staple remover, which works by placing the lower jaw beneath the staple and pressing the handles to lift the prongs out of the skin simultaneously.
Post-Removal Wound Care and Documentation
After the final suture is removed, inspect the incision line for separation or gapping. If the edges are stable, cleanse the site again with antiseptic to remove any remaining debris. Adhesive strips (Steri-Strips) are then applied perpendicular to the incision line, spaced approximately 1/8 inch apart, to provide continued support to the newly closed wound.
The strips are applied by securing one end to the skin, then gently bringing the opposite side of the incision together before securing the other end, taking care not to create tension that could lead to blistering or skin tearing. A sterile dressing may be applied over the strips if ordered, particularly for wounds in areas prone to friction or contamination. All used equipment and removed sutures are discarded.
Patient education is a primary responsibility at this stage, focusing on signs of potential infection, such as increasing redness, swelling, or foul-smelling discharge. Patients are instructed to allow the applied Steri-Strips to fall off naturally, which typically occurs within 7 to 10 days, and not to pull them off prematurely. They are also advised on when they can safely wet the area, often permitting a shower after a day or two, but cautioning against soaking the wound in a bath or pool until fully healed.
The nurse must document the procedure meticulously. Documentation includes the exact number and type of sutures removed, the condition of the wound edges before and after removal, the type of dressing or strips applied, and the patient’s tolerance and teaching provided.