clinical patient care
Suture Removal
Suture removal means taking out non-absorbable stitches once the provider has judged the wound healed enough and ordered removal.
16 steps4 criticalLimit 5 min
Steps
- 1Confirm the provider's order to remove the sutures
- 2Perform hand hygiene, confirm the patient's identity with two identifiers, and explain the procedure, including that they may feel some pulling of the skin
- 3Gather supplies: sterile suture scissors, forceps, sterile gauze, normal saline or wound cleanser, nonsterile gloves, Steri-Strips and a sterile outer dressing
- 4Position the patient, adjust the bed height, turn on good lighting, and keep the patient private
- 5Critical stepPerform hand hygiene, put on nonsterile gloves, and set out supplies on a clean, dry barrier or a sterile field as your policy says
- 6Remove the dressing and inspect the wound for even closure and for drainage, redness and swelling; if you have concerns, check with the provider before removing sutures
- 7Remove gloves, perform hand hygiene, and put on new gloves (nonsterile or sterile, depending on the wound and your policy)
- 8Clean the incision with sterile normal saline or a wound cleanser (per agency policy) to remove debris and dried drainage
- 9Critical stepHold the scissors in your dominant hand and the forceps in your other hand, and place sterile gauze next to the incision to collect the removed sutures
- 10Grasp the knot with the forceps, gently lift it, and cut under the knot as close to the skin as possible; never cut both ends of the knot
- 11Critical stepGrasp the knotted end with the forceps and pull the suture out in one continuous motion, without pulling the part that was on the skin through the tissue, then place it on the gauze
- 12Remove every second suture first and check the wound after each one; if the edges open, stop, apply Steri-Strips and notify the provider
- 13Remove the remaining sutures only if the wound is well approximated, and apply Steri-Strips where indicated
- 14Remove gloves, dispose of sharps and supplies per policy, and perform hand hygiene
- 15Help the patient into a comfortable position, and before leaving make sure the call light and table are in reach, the bed is low and locked, and the room is free of fall risks
- 16Document the procedure and the wound findings, and report any concerns per policy
What graders are watching for
Tips
- Never cut both ends of the knot: then there is no way to remove the suture from below the surface.
- The part of the suture that sat on top of the skin is considered contaminated, so do not pull it through the tissue.
- The provider decides when sutures come out and orders it; removing them too early can cause the wound to open (dehiscence), so look at the wound first and ask if it does not look ready.
Common mistakes
- Removing sutures without an order or without looking at the wound first.
- Cutting both sides of the knot.
- Removing all the sutures without rechecking, so a wound that is opening goes unnoticed.
- Dragging the thread that was on the skin through the tissue.
Practice this skill
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