Removing Sutures

Skill 8-9

Removing Sutures

Skin sutures are used to hold the tissue and skin together. Sutures may be made from several natural or synthetic materials, such as silk, cotton, linen, or fine wire. Surgical sutures are removed when enough tensile strength has developed to hold the wound edges together during healing. Sutures should be removed within 1 to 2 weeks of placement, depending on the anatomic location, to reduce the risk of suture marks, infection, and tissue reaction (Ratner, 2020a). The removal of sutures may be done by the primary health care provider and an advanced practice professional, or by the nurse, as indicated in facility policy. Adhesive wound closure strips may be applied across the wound after suture removal to provide continued wound support as it continues to heal. Some sutures are buried sutures, placed with absorbable material, which are not removed but left in place because they dissolve (Ratner, 2020a).

Delegation Considerations

The removal of surgical sutures is not delegated to assistive personnel (AP). Depending on the state's nurse practice act and the organization's policies and procedures, the removal of surgical sutures may be delegated to licensed practical/vocational nurses (LPN/LVNs). The decision to delegate must be based on careful analysis of the patient's needs and circumstances as well as the qualifications of the person to whom the task is being delegated. Refer to the Delegation Guidelines in Appendix A.

Equipment

Suture removal kit or forceps and scissors
Gauze
Wound cleansing agent, according to facility policy
Disposable gloves
Additional PPE, as indicated
Adhesive wound closure strips, as indicated
Skin protectant/barrier wipes

Assessment

Inspect the surgical incision and the surrounding tissue. Assess the appearance of the wound for the approximation of wound edges, the color of the wound and surrounding area, presence of wound drainage noting color, volume, and odor, and for signs of dehiscence. Note the stage of the healing process and characteristics of any drainage. Assess the surrounding skin for color, temperature, and the presence of edema, maceration, or ecchymosis.

Actual or Potential Health Problems and Needs

Many actual or potential health problems or issues may require the use of this skill as part of related interventions. An appropriate health problem or issue may include:

Altered skin integrity
Infection risk
Knowledge deficiency

Outcome Identification and Planning

The expected outcome to achieve when removing surgical sutures is that the sutures are removed without causing trauma to the wound or causing the patient to experience pain or discomfort.

Implementation

Action	Rationale
1. Review the patient's health record for prescribed intervention for suture removal. Gather necessary supplies.	Reviewing the health record and care plan validates the correct patient and correct procedure. Preparation promotes efficient time management and an organized approach to the task.
2. Perform hand hygiene and put on PPE, if indicated.	Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions.
3. Identify the patient.	Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
4. Assemble equipment on the overbed table or other surface within reach.	Organization facilitates performance of task.
5. Close the curtains around the bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Describe the sensation of suture removal as a pulling or slightly uncomfortable experience.	This ensures the patient's privacy. Explanation relieves anxiety and facilitates engagement.
6. Assess the patient for possible need for nonpharmacologic pain-reducing interventions or analgesic medication before beginning the procedure. Administer appropriate prescribed analgesic. Allow enough time for the analgesic to achieve its effectiveness before beginning the procedure.	Pain is a subjective experience influenced by past experience. Wound care and dressing changes may cause pain for some patients.
7. Place a waste receptacle at a convenient location for use during the procedure.	Having a waste container handy means that the soiled dressing may be discarded easily, without the spread of microorganisms.
8. Adjust the bed to a comfortable working height (VHACEOSH, 2016).	Having the bed at the proper height prevents back and muscle strain.
9. Assist the patient to a comfortable position that provides easy access to the incision area. Use a bath blanket to cover any exposed area other than the incision. Place a waterproof pad under the incision site.	Patient positioning and the use of a bath blanket provide for comfort and warmth. Waterproof pad protects underlying surfaces.
10. Put on clean gloves. Carefully and gently remove any dressings that may be in place. Refer to Skill 8-2.	Gloves protect the nurse from handling contaminated dressings. Appropriate removal of the dressing is more comfortable for the patient and prevents medical adhesive-related skin injury (MARSI) (Fumarola et al., 2020).
11. Clean the incision, according to prescribed wound care or facility policy and procedure. Refer to Skill 8-2. Assess the wound (Refer to Assessment section of skill and Fundamentals Review 8-1) (Figure 1).	Incision cleaning prevents the spread of microorganisms and contamination of the wound. Assessment provides validation of healing related to timing of suture removal.
12. Perform hand hygiene. Open the suture removal kit. Put on gloves.	Hand hygiene prevents the transmission of microorganisms. Gloves prevent contact with blood and body fluids.
13. Using the forceps, grasp the first suture and gently lift the suture up off the skin.	Raising the suture knot prevents accidental injury to the wound or skin when cutting.
14. Using the scissors, cut one side of the suture below the knot, close to the skin (Figure 2). Grasp the knot with the forceps and gently pull the suture toward the wound or suture line until the suture material is completely removed. Avoid pulling the suture away from the suture line.	Cutting close to the skin results in minimal exposed suture to pull through skin, reducing the risk for contamination of the incision area. Pulling the cut suture toward the wound or suture line reduces the risk the wound edges will separate; pulling the suture away from the suture line increases the risk the wound edges may separate (Ratner, 2020a).
15. Remove every other suture to be sure the wound edges are healed. If the wound edges remain approximated, remove the remaining sutures, as prescribed. Dispose of sutures according to facility policy.	Removing every other suture allows for inspection of the wound, while leaving adequate suture in place to promote continued healing if the edges are not totally approximated. Follow Standard Precautions in disposing of sutures.
16. If wound closure strips are to be used, apply skin protectant/barrier to skin around incision. Do not apply to incision. Apply adhesive closure strips (Figure 3). Take care to handle the strips by the paper backing.	Skin protectant helps adherence of closure strips and prevents skin irritation and excoriation from tape, adhesives, and wound drainage (Fumarola et al., 2020). Adhesive wound closure strips provide additional support to the wound as it continues to heal. Handling by the paper backing avoids contamination.
17. Reapply the dressing, based on the prescribed interventions and facility policy. Refer to Skill 8-2.	A new dressing protects the wound. Some policies advise leaving the area uncovered.
18. Remove and discard gloves. Perform hand hygiene.	Proper removal of gloves prevents the spread of microorganisms. Hand hygiene prevents the transmission of microorganisms.
19. Remove all remaining equipment; place the patient in a comfortable position, with side rails up as indicated and bed in the lowest position.	Proper patient and bed positioning promotes safety and comfort.
20. Remove additional PPE, if used. Perform hand hygiene.	Proper removal of PPE reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms.
21. Assess all wounds every shift. More frequent checks may be needed if the wound is more complex.	Checking wound and dressings ensures the assessment of changes in patient condition and timely intervention to prevent complications.

Evaluation

The expected outcomes have been met when the sutures were removed without causing trauma to the wound or causing the patient to experience pain or discomfort.

Documentation

Guidelines

Document the location of the incision and the assessment of the site. Include the appearance of the surrounding skin. Document cleansing of the site and suture removal. Record any skin care, application of wound closure strips, and the dressing applied, if appropriate. Note pertinent patient and family/caregiver education and any patient reaction to this procedure, including the patient's pain level and effectiveness of nonpharmacologic interventions or analgesia if administered.

Sample Documentation

3/4/25

1800 Right lower lateral leg surgical wound appears healed. Incision edges are approximated, without erythema, edema, ecchymosis, or drainage. Skin warm with consistent tone. Sutures removed without difficulty; skin protectant/barrier applied to skin surrounding incision and adhesive wound closure strips applied. Patient instructed on how to care for wound and expectations regarding wound closure strips; patient and wife verbalized an understanding of information and asked appropriate questions.

—L. Downs, RN

Developing Clinical Reasoning and Clinical Judgment

Unexpected Situations and Associated Interventions

Sutures are crusted with dried blood or secretions, making them difficult to remove: Moisten sterile gauze with sterile saline and gently loosen crusts before removing sutures.
Resistance is met when attempting to pull suture through the tissue: Use a gentle, continuous pulling motion to remove the suture. If the suture still does not come out, do not use excessive force. Report findings to the health care team and document the event in the patient's record.

Special Considerations

After suture removal, continue to encourage the patient to splint chest and abdominal wounds during activity, such as changing position, ambulating, coughing, and sneezing. This provides increased support for the skin and underlying tissues and can decrease discomfort.

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Skill 8-9