PROCEDURE
130
Suture and Staple Removal
Brian D. Schaad
PURPO SE: Sutures and staples are placed to approximate tissues that have been
separated. When wound healing is sufficient to maintain closure, sutures and
staples are removed.
PREREQUISITE NURSING
KNOWLEDGE
❖
• Wound healing is a nonspecific response to injury. It
involves the biologic processes of inflammation, collagen
metabolism, and contraction in an overlapping, integrated
continuum. Wound healing is divided into three phases:
inflammatory, fibroblastic, and remodeling. The condition
of the tissues and the mechanism of wound closure determine the relative duration of these phases and the end
result of the healing process.
• Factors influencing the choice of wound closure method
are determined by risk for infection, wound location, need
for tension, cosmetic considerations, age and condition of
the patient, and cost.
• There are three types of sutures: nonabsorbable, absorbable (which dissolve in as little as 10 days), and slowly
absorbable (which take up to 6 months to completely
dissolve).4
• In addition to conventional metal staples, absorbable
staples are available that are placed under the skin by the
stapling device and absorb within a few months. The use
of the absorbable staple has been found to save both time
and cost, with comparable cosmetic outcomes to conventional metal staples.1
• Nonabsorbable sutures and staples must be completely
removed to avoid further tissue inflammation, possible
infection, and unnecessary discomfort to the patient.
• Retention sutures are a special type of suture made of very
strong material, with each stitch passing through a larger
amount of tissue than conventional sutures. They may be
used to reinforce a primarily closed and sutured incision
or to aid in the management of the open abdomen. Retention sutures reduce the risk of evisceration, allowing
ongoing dressing changes and gradual closure of the
abdominal incision.3
• Timing of suture and staple removal depends on the following (Table 130-1):
❖ Shape, size, and location of the incision
❖ Absence of inflammation, drainage, and infection
❖ The patient’s general condition
❖ Type of suture used
• Timing of suture removal may be prolonged in patients
with the following risk factors:
❖ Steroid use
❖ Irradiation treatment
❖
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❖
❖
❖
Cytotoxic agent use
Diabetes
Rheumatoid arthritis
Trace element imbalance
Advanced age
EQUIPMENT
• Nonsterile gloves and mask
• Sterile gloves, towel, or drape
• Sterile swab with antiseptic cleaning solution according
to facility’s policy (e.g., chlorhexidine)
• 4 × 4 gauze pads
• Suture removal kit with scissors and forceps (if no kit is
available, obtain sterile scissor and forceps)
or
• Staple remover
• Skin tape or adhesive skin strips (e.g., Steri-Strips) of
appropriate width
• Skin adherent (recommended because it helps with adherence and protects the periwound area)
PATIENT AND FAMILY EDUCATION
• Explain the procedure to the patient and family. Reassure
the patient that he or she may feel a pulling or stinging
sensation as the sutures or staples are removed. Assure the
patient that the wound is healing properly and that removal
of the sutures or staples does not weaken the incision.
Explain the use of adhesive skin strips if needed. Rationale: Explanation decreases patient anxiety and encourages patient and family cooperation and understanding of
procedure.
• Instruct the patient and family on aftercare: pain medication, wound care, activity restrictions, and observation for
signs and symptoms of infection. Rationale: Education
facilitates patient comfort, decreases risk for infection,
and encourages prompt follow-up for treatment of possible infection.
PATIENT ASSESSMENT AND
PREPARATION
Patient Assessment
• Obtain the history of the present injury and a medical
history. Rationale: This knowledge allows a better
130 Suture and Staple Removal
TABLE 130-1
Timing of Suture Removal
Location of Sutures
Extremities, scalp, and trunk
Face
Palms, soles, back, and skin over
mobile joints
Retention sutures
Days Before Removal
7–14
3–5
10–14
14–21
understanding of the nature of the injury and any factors
complicating suture or staple removal.
• Assess patient allergies, especially to adhesive tape and
povidone-iodine, chlorhexidine, or other topical solutions
or medications. Rationale: Further tissue damage can be
prevented.
• After determining when sutures or staples were placed,
observe the wound for signs of gaping, drainage, inflammation, infection, or embedded sutures. Rationale: Findings may delay suture or staple removal.
Procedure
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Patient Preparation
• Ensure that the patient and family understand preprocedural teachings. Answer questions as they arise, and
reinforce information as needed. Rationale: Understanding of previously taught information is evaluated and
reinforced.
• Verify that the patient is the correct patient using two
identifiers. Rationale: Before performing a procedure, the
nurse should ensure the correct identification of the patient
for the intended intervention.
• Administer pain medication as prescribed. Rationale:
Pain medication promotes patient comfort and reduces
activity during suture or staple removal to provide a stable
field.
• Provide privacy and position the patient for comfort
without undue tension on the suture line or staples. Rationale: Provides patient comfort and promotes cooperation
during procedure.
• Adjust the light to shine directly on the suture line or
staples. Rationale: Light is used to facilitate visibility.
for Suture Removal
Steps
1. Check order to confirm exact timing and
other relevant information.
2. HH
3. PE
4. Apply sterile drapes or towels over or
under the area as needed.
5. Gently tug on the sutures to test the
wound line before removal, to be sure the
wound does not separate. If any doubt
exists to the integrity of the suture line,
apply a skin adherent and adhesive skin
strips between sutures before removing
them. Remove alternate sutures initially,
until integrity of the incision is ensured;
then remove the remaining sutures.5
(Level E*)
6. Clean the suture line with antiseptic skin
cleanser. The wound is considered clean,
so when cleaning it, wipe from clean to
dirty, moving from the inner aspect to the
outer margins of the wound.
Rationale
Special Considerations
Ensures appropriate treatment.
Prescribing physician, advanced
practice nurse, or other
healthcare professional may
want to leave some sutures in
place for an additional day or
two to support the suture line.
Provides protective barrier.
Ensures that the wound is healed
sufficiently before removal of
all sutures.
If the patient has both retention
and regular sutures in place,
retention sutures may remain
in place for 14–21 days.
Decreases the number of
microorganisms and reduces
the risk for infection.
Be particularly careful to clean
the suture line before removing
mattress sutures, especially if
the visible, contaminated part
of the stitch is too small to cut
twice for sterile removal.
Carefully remove encrusted
drainage to allow visualization
of all sutures to be removed.
*Level E: Multiple case reports, theory-based evidence from expert opinions, or peer-reviewed professional organizational standards without clinical studies to
support recommendations.
Procedure continues on following page
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Unit VII
Procedure
Integumentary System
for Suture Removal—Continued
Steps
Rationale
Special Considerations
7. Use sterile techniques to remove running
sutures (Fig. 130-1)2:
A. Use sterile forceps to grasp the knot
and gently raise it off of the skin.
B. Use the rounded tip of the sterile
suture scissors to cut the suture at the
skin edge on one side of the visible
part of the suture.
C. Remove the suture by lifting the
visible end of the skin to avoid
drawing the contaminated portion
through subcutaneous tissue.
8. To remove mattress sutures (Fig. 130-2)6:
A. Remove the small visible portion of
the suture opposite the knot by cutting
it at each visible end and lifting the
small piece away from the skin.
B. Remove the rest of the suture by
pulling it out in the direction of the
knot.
C. If the visible portion is too small to
cut twice, cut once and pull the entire
suture out in the opposite direction.
9. If the wound dehisces, apply butterfly
adhesive strips or paper tape to support
and approximate the edges and call the
physician or physician extender.
10. Wipe the incision line gently with gauze
soaked in antiseptic skin cleanser or
prepackaged swab.2 (Level E*)
11. Apply adhesive skin strips or paper tape
and a light, sterile gauze dressing, if
desired. Leave strips in place for 3–5
days or as ordered.
12. Dispose of gloves and equipment in
appropriate receptacles.
13. HH
Visible part of suture is exposed
to skin bacteria and is
considered contaminated.
For running sutures, each
individual section needs to be
cut to prevent the contaminated
suture material from being
pulled through the
subcutaneous tissue.
Prevents pulling it through and
contaminating subcutaneous
tissue.6
Adhesive strips may be used to
reapproximate the wound
edges until complete wound
closure occurs.
Removes serous or bloody
drainage from the suture line.
Wound dehiscence is the
premature opening of a wound
along a suture line.6
Holds incision edges together,
decreases transmission of
microorganisms, and decreases
irritation from clothing.
*Level E: Multiple case reports, theory-based evidence from expert opinions, or peer-reviewed professional organizational standards without clinical studies to
support recommendations.
Figure 130-1 Removal of plain interrupted sutures with sterile
forceps and scissors.
Figure 130-2 Removal of interrupted mattress sutures with
sterile forceps and scissors.
130
Procedure
Suture and Staple Removal
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for Staple Removal
Steps
1. Check order to confirm exact timing and
other relevant information.
2. HH
3. PE
4. Apply sterile drapes or towels over or
under the area as needed.
5. Gently test the wound line before
removal of the staple to be sure the
wound does not separate. If any doubt
exists, apply a skin adherent and
adhesive skin strips between staples
before removing them. Remove alternate
staples initially, until integrity of the
incision is ensured, then remove the
remaining staples.5 (Level E*)
6. Clean the staple line with antiseptic skin
cleanser. The wound is considered clean,
so when cleaning it, wipe from clean to
dirty, moving from the inner aspect to
the outer margins of the wound.
7. Use sterile techniques to remove staples
(Fig. 130-3).
A. Gently place the tip of the staple
remover under the staple at its center.
B. If the incision line is under tension,
gently squeeze the opposite sides
together with your free hand as each
staple is removed.
C. Compress the staple remover until
the staple bends in the center and the
edges lift out of the skin.
D. Discard the staple and proceed to the
next staple.
8. If the wound dehisces, apply butterfly
adhesive strips or paper tape to support
and approximate the edges and call the
prescribing physician, advanced practice
nurse, or other healthcare professional.
Rationale
Special Considerations
Ensures appropriate treatment.
Prescribing physician, advanced
practice nurse, or other
healthcare professional may
want to leave some staples in
place for an additional day or
two to support the staple line.
Provides protective barrier.
Ensures that wound is healed
sufficiently before removal of
all staples.
Decreases the number of
microorganisms and reduces
the risk for infection.
Carefully remove encrusted
drainage to allow
visualization of all staples to
be removed.
Provides approximation of wound
edges until the physician,
advanced practice nurse, or
other healthcare professional
reassesses the wound.
Monitor wound dehiscence for
sign of infection.
**Level E: Multiple case reports, theory-based evidence from expert opinions, or peer-reviewed professional organizational standards without clinical studies to
support recommendations.
Procedure continues on following page
Figure 130-3
Staple removal.
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Unit VII
Procedure
Integumentary System
for Staple Removal—Continued
Steps
Rationale
Special Considerations
9. Wipe the incision line gently with the
gauze soaked in antiseptic skin cleanser
or prepackaged swab.
10. Apply adhesive skin strips or paper tape
and a light, sterile gauze dressing, if
desired. Leave strips in place for 3–5
days or as ordered.
11. Dispose of gloves and equipment in
appropriate receptacle.
12. HH
Removes serous or bloody
drainage from the staple line.
Holds incision edges together,
decreases transmission of
microorganisms, and decreases
irritation from clothing.
Expected Outcomes
Unexpected Outcomes
• Wound remains infection free
• Function is preserved
• Appearance is restored
•
•
•
•
Wound infection and possible sepsis
Loss of function
Abnormal appearance
Wound dehiscence
Patient Monitoring and Care
Steps
Rationale
Reportable Conditions
1. Retest range of motion and
sensory perception after suture
or staple removal.
2. Observe for wound discharge or
other abnormal changes.
Ensures no further damage
was imposed.
3. Provide detailed patient and
family education, including
wound care, medications, signs
and symptoms of infection, when
the patient can get the incision
wet, and follow-up instructions.
4. Follow institutional standards for
assessing pain. Administer
analgesia as prescribed.
Facilitates patient and family
cooperation.
Allows for early treatment and
prevents systemic infection.
Identifies need for pain
interventions.
These conditions should be reported if they
persist despite nursing interventions.
• Altered range of motion
• Change in sensation, paresthesia,
tingling
• Wound that is red, swollen, tender, or
warm
• Wound that begins to drain or fester
• Red streaks around the wound
• Tender lumps in the groin or under the
arm
• Chills or fever
• Redness that surrounds the incision and
does not gradually disappear or shows
only a thin line after a few weeks2
• Continued pain despite pain
interventions
Documentation
Documentation should include the following:
• Patient and family education and aftercare instructions
• Date and time sutures were placed, and date and time
sutures were removed
• Care of the wound after suture removal
• Location and appearance of wound
• Range of motion and sensory perception
• Pain assessment, interventions, and effectiveness
130 Suture and Staple Removal
References and Additional Readings
For a complete list of references and additional readings for
this procedure, scan this QR code with any freely available
smartphone code reader app, or visit
http://booksite.elsevier.com/9780323376624.
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