PNC 1 SKILLS - Removing Sutures

A nurse is removing a client's surgical sutures. Place the following steps in the correct order. Use all options.

1)Clean the incision using the wound cleanser and gauze. 2)Using the forceps, grasp the knot of the first suture and gently lift the knot up off the skin. 3)Using the scissors, cut one side of the suture below the knot, close to the skin. 4)Grasp the knot with the forceps and pull the cut suture through the skin. 5)Remove every other suture to be sure the wound edges are healed. 6)Apply adhesive closure strips. Rationale: Incision cleaning prevents the spread of microorganisms and contamination of the wound. Raising the suture knot prevents accidental injury to the wound or skin when cutting. Pulling the cut suture through the skin helps reduce the risk for contamination of the incision area and resulting infection. 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. Adhesive wound closure strips provide additional support to the wound as it continues to heal.

What action will the nurse take to ensure a wound is ready for the sutures to be removed?

Remove every other suture and assess the wound edges. Rationale: To ensure the wound is ready for the sutures to be removed, the nurse should only remove every other suture and then assess the wound to ensure the wound edges are healed and the wound remains approximated. This leaves an adequate number of sutures in place if the wound is not healed enough for suture removal. The number of days the sutures have been in place will not provide adequate information to determine if they are ready to be removed. Applying sterile saline or pressure to the site is not an appropriate action for this type of wound closure.

Which action by the nurse is most appropriate when the sutures are difficult to remove because of crusted dried blood?

Use a sterile gauze and sterile saline to gently remove the crusted dried blood. Rationale: When sutures have crusted dried blood on them, the nurse should use sterile gauze and sterile saline to gently remove the crusted dried blood before attempting to remove the sutures. Cutting the dried blood off is likely to also cut the suture and make it more difficult to remove. The nurse should not notify the health care provider until after trying to remove the dried crusted blood. Alcohol should not be used to soak the sutures.

Which client is most likely to require that the sutures be left in place for an extended period of time? A client who:

has a current history of alcoholism. Rationale: The client which is most likely to require longer for the wound to heal and therefore the sutures be left in place for an extended period of time is the client with a current history of alcoholism. Excessive alcohol intake alters the absorption of nutrients by the body and, as a result, alcoholics often are malnourished and deficient in protein and vitamins, both important factors for wound healing. Factors that help to determine how quickly a wound will heal and, therefore, how soon sutures can be removed include the client's nutritional status, the location of the wound, and the client's age. The client's hourly urine output and use of a PCA pump have not been shown to influence how soon sutures can be removed. It is expected that clients with wounds will need assistance to get out of bed and ambulate, especially in the early stage of wound healing.

The nurse has removed the sutures and is now planning to apply wound closure strips. What should the nurse do before applying the strips?

Apply a skin protectant to the skin around the incision. Rationale: Before applying the wound closure strips, the nurse should apply a skin protectant to the skin surrounding the incision site. The skin barrier will help the closure strips to adhere to the skin and helps prevent skin irritation and excoriation from tape, adhesives, and wound drainage. The skin protectant should not be place on the incision itself. Nothing should be place over the incision site itself before the closure strips are applied.