Welcome back. Today we are talking about suture removal when we're working with
interrupted sutures and then how to apply steri-strips afterwards. We'll talk
about wound assessment and equipment you need all right after this. Welcome back
my name is Tammy and this is NurseMinder and on this channel we do
everything nursing so if you're new here consider subscribing below so that you
get the next video when it's released. Suture removal is a fairly common skill
you may be doing if you work in a med-surg unit especially a surgery unit,
and it's not a complicated skill but there are some very critical elements to
remember to make sure we're putting our patients at the least risk for harm. Some
patients will ask if suture removal is painful, and most often it's not, but
there can be some tugging and some discomfort and depending on how long
those sutures have had to stay and there may be some scar tissue built up and
definitely you're likely to see some drainage on the exterior surface of the
skin that may be making it a little bit more challenging to get that suture out.
So if your patient is expressing concern about pain you may want to look at maybe
providing some non pharmacological methods of pain relief - perhaps offering
them a warm blanket. If they do request an analgesic then I would certainly
support that for them and make sure I administer it in time for it to take
effect before we remove those sutures. Let's go over some of the supplies you
may need to remove your sutures. We do have to clean our hands so our hand
sanitizer or soap and water is required along with a clean set of gloves. This is
not a sterile procedure. The next thing I want to gather is my suture removal kit.
You'll see that it comes with scissors, tweezers, and a gauze. Now the gauze can be
used to gather your sutures on to - I see a lot of nurses use it that way, or you can
keep that sterile and use it to cover the wound after you've removed those
sutures in case there's drainage. You can see kit has been opened a few times (practice set). We
would keep that wrapped up until we need it (unopened).
The second thing I'm going to grab are some steri-strips so that I can put
those on to the wound after I have removed the sutures and cleansed it, and
this will help add some tensile strength to it as it continues to heal. Those
steri-strips will stick better if I use a skin protectant pad so I've got one of
those, and then I have a couple of different cleaning aseptic tools so I've
got my Solu-Prep pad or my alcohol swab in case I need to clean that wound,
the wound edges, not the wound itself, prior to. And in case there's extra, extra
dried secretions I may just find myself requiring some saline and some gauze. So
you would determine what you need prior to going in. Now we're at the bedside. If
there's a dressing you want to remove it, and inspect it for any drainage. This
appears to be dry and intact. The second thing we are going to look at is the wound itself
before we remove any sutures. We're still responsible to make sure that that order
fits our patient's current situation. Now as we're inspecting the wound bed itself
we need to be looking for that nice pink healed tissue - we're looking at the wound
edges and that just means that the two sides of the initial insult, whether that
was a cut or um a tear have come together, and we call that well
approximated when those two edges join up nicely. And so what it looks like here
is I do have that pink healthy tissue all the way down the middle of the scar.
This means that we have some tensile strength. Next I want to count how many
sutures I have so I see one, two, three, four, five. So these stitches have been in
for a long time and all of that exterior exposed stitch is considered
contaminated so I'm going to clean it up with my Solu Prep pad here and that's
to help prevent the spread of any microorganisms and contamination as I
remove those stitches from accidentally going into the patient's body under the skin.
So after it's clean I'm just gonna get my supplies ready. I'm gonna open up my
suture removal kit and set it aside here so I've got a little bit of a sterile
field, um you notice that there's the gauze, the tweezers, and the scissors inside. Get
my Solu Prep pad and my steri-strips ready to go. We're gonna start by working
with our tweezers and our scissors in order to remove our first suture. So
you'll notice that these scissors in particular, they've got a little bit of
an edge, or a little bit of a curved end and that is to put underneath the suture
so that we can grasp that suture and cut it at skin level. So by grabbing onto the
knot, and I need to turn my scissors around here to grab that inside, you can
see I'm going to cut closest to the skin on this side and my suture that I'm
going to pull through there's no contaminated area. So now I can just
simply pull up and I have my entire suture and I'm gonna just put that over
into my plastic. So I started with number one so I'm gonna go now to number three.
Again grab that suture underneath, clip, stabilizing it and I'm just gonna pull
straight up. Now I've brought the gauze into this particular part of it because
some people use the gauze in their sterile package to put their sutures on.
And so just again I'm going to grab that knot, I've got my sutures - my
scissors open, you can see I'm going under and cutting right close to the
skin. Stabilize and lift up, and I can set that over here. Now that I've removed
every second one I'm going to re-inspect that tension. I see that the wound bed
has not pulled apart so it looks like it's safe to continue on. So we're just
going to remove the others.
Now after removal I want to make sure I have all of my sutures so I'm going to
come and just take a quick check 1, 2, 3, 4, 5. I do have 5 sutures and I have a
healthy wound bed. So now I'm going to clean it up and put on my steri-strips.
Cleaning this wound can involve simple gauze and saline if we need to get off
gunk or I can use another alcohol prep pad, cleaning up both of those sides. I'm
just going to go ahead and grab my steri-strips while that's drying and you
see that this comes with a perforation - we're just going to pull that
perforation off, and these are now ready to simply lay down and spread across my
wound. Now before I do that I also want to use my skin protect pad. Open this
up and now I can all the way around my wound - I don't need to cover my wound but
the skin around it. Now the skin protective does get a little tacky and you
can see that my gloves are starting to stick to each other, that's going to help
the steri-strips stay on the skin longer. So now I'm simply going to just - I want
to make sure that I have about a half an inch on either side of my wound. I've got
that label out, I'm gonna put down my three, flip it over and as I pull out I'm just
going to lay those down. And I see one came off so I can certainly grab by
find my gloves - this is a clean technique - and put that across my wound, When it
comes to teaching your patients about steri-strips we certainly want to keep
those on for as long as they will stay. They can wash and shower but they don't
but you don't want them to emerge in water and then these will just fall off
on their own over time. You're prepared to care for your patients suture removal
show at the time arise and if you've watched a lot of my videos you know
what's coming next. Until next time, make it a
day!! :)