Suture Removal: Demonstration (Nursing)

00:04 Hey guys, let's take a look at suture removal.

00:07 So, I have my equipment here and I just want you to look at what we have today.

00:12 So, of course, typically what you're going to see, is a post-op incision and we're going to remove the sutures out of that.

00:18 But, for our demonstration today, I’ve got this really neat practice pad and a great friend of mine a great neurosurgeon in the area, that made these beautiful sutures for us for demonstration.

00:29 So, before we get started, we would perform our hand hygiene and put on gloves.

00:34 Now, typically if we're talking about a post-op incision, we would have a wound dressing covering that.

00:40 So, if that was the case, this would be the time we would remove that, and of course, we want to assess that incision site, that's the whole point about post-op incisions, does it have signs and symptoms of infection? If it does, we need to report that promptly.

00:55 Now, once we've removed our dressing, if I touched it with my gloves, I of course would remove these soiled gloves, perform my hand hygiene, and put on some new clean gloves and I’ll do that now.

01:09 Now, once I’ve done this I can go ahead and open up my suture removal kit.

01:13 So, if you see this image, typically, what it's going to contain, are your suture removal scissors, some tweezers and usually a gauze pad for example, so, I’m going to go ahead and open this now.

01:28 So, I’m going to go ahead and open this and get this ready.

01:32 And next step is, we're going to clean the incision site, with some saline, from the inner to outer aspect of the wound.

01:38 So, what I have here are just some gauze, in a little bit of a package for me, easiest way to do this, is, I’ve got my saline as well and I’m going to pour this in here.

02:04 So, when I go ahead and cleanse my incision site, I’m going to just take a gauze pad, kind of squeeze out the excess and then I’m going to take this, and I’m going to go from the inner to the outer aspect of the wound, and then once I’ve cleansed this, I’m going to go ahead and get rid of all these supplies.

02:28 Now, once I’ve done this, I can go ahead and proceed and remove the stitch.

02:32 So, I want to take my tweezers here and I’ve also got my suture removal scissors.

02:39 Now, just note, when we're talking about the suture removal scissors, these are special scissors, not just any scissors that you can grab, so, these, have a great little dip, that helps you get underneath the stitch, so, just know, not any scissors will do.

02:55 So, what I’m going to do, is I’m going to grab this stitch for example.

02:59 So just remember, you want to grasp your little tail and the knot if you will, then I’m going to hold on one side, cut on the other.

03:09 So, before we go too far, let me talk about something.

03:13 There are knots, in these particular sutures, these are called, “Simple interrupted sutures,” there's lots of different kinds out there.

03:20 But, these particular sutures and most sutures, you will see a knot, that holds the suture together.

03:28 That is what you do not want to cut.

03:30 The reason being, if you cut the knot, the suture fall apart and maybe you don't get all the suture out.

03:36 So, make sure you do not cut the knot.

03:39 So, I’m going to hold on one side and cut on the other.

03:43 Now, here's why I’m going to do this.

03:46 Do you see this black part that's running through on the outside of the skin? That's what you don't want to pull back through, in the patient's skin.

03:56 So, let me show you what I’m talking about.

03:59 If I pull my knot and I cut on the opposite side, see how this outside piece when I pull it out, it's not going to run underneath the skin.

04:12 The reason why I’m saying that, this is the stuff that's been exposed to air, so, we don't want to thread that through the patient's skin, that'll help reduce bacteria in the incision.

04:22 So, it's a great idea and what I like to do, is to take my sutures and put them back into the little gauze here and it makes for easier visualization and I can count them and I don't lose them.

04:33 So again, I’m going to remove the suture, by gently lifting and pulling this stitch, you don't want the outside or the knot to pass through, and I’m going to repeat this process until all the stitches are removed, if applicable.

04:47 So, let me show you one more time up close, on how I would do this, I’ll show you a few more.

04:53 So again, I’m going to grasp the knot or the little knot side, I’m not cutting the knot remember, hold on one side, we're going to get our scissors underneath there and cut the opposite side, so again, this piece doesn't pass underneath through the skin and I pull out my knot.

05:11 And I’m going to repeat, so, pulling this, hold one side, cut on the other, and then pulling it out.

05:23 So, one thing I want you to note, is a lot of the times when we're removing sutures, it's a great idea to actually go, one, take it out, skip one, and then do the next.

05:36 The reason if the incision starts to separate, we still have some things to hold it together, so, keep that in mind.

05:44 Now, once we're done, we would go ahead and gently cleanse the incision site again if needed, then sometimes that incision just to make sure it stays together, we're going to apply adhesive strips, for any gaps in the incision or just to stabilize to make sure that incision grows over, so, let me show you those.

06:04 So, let's take a moment and talk about the adhesive strips themselves.

06:09 So, I’m going to take one of these strips and demonstrate for you.

06:13 Now, the whole point of the adhesive strip, is this is going to help adhere and close the wound, and many times, we're going to have a adhesive agent, that's going to help attach the adhesive bandage to the wound itself, and to the skin.

06:28 So, when we're using these, one thing to note, is you want to take one side of the adhesive strip, and pull the wound taut.

06:37 So, you see when I do this, this is going to help close the wound and it's also going to help approximate the edges to facilitate wound healing.

06:46 So, then if necessary and we need to recover this site, we would apply addressing.