Component Task: Removal of Stitches

It is the process of aseptically caring for an injury to body tissues or break in the continuity of the skin or mucous membrane.

Aims

·         Remove exudates

·         Support injured part and hold the skin tissue in place

·         Prevent further injury and infection

·         Obtain wound swab for laboratory investigation

·         Promote healing

Requirements

1.        A trolley containing the following:

a.      Top shelf (a Sterile field with the following sterile items)

·         Two (2) or three (3) gallipots for lotions

·         Two (2) kidney dish

·         Two (2) pairs of dressing forceps

·         Two (2) pairs of dissecting forceps

·         Sinus forceps

·         Probe

2.      Bottom shelf with the following:

·         Dressing lotion

·         Sterile cotton and gauze swab in a drum/pack

·         Mackintosh and dressing towel

·         Adhesive tape/strip

·         Bandage

·         Scissors

·         Apron

·         Disposable gloves

·         Sterile gloves

·         Receiver for used dressings

3.      Sterile stitch scissors

Steps

1.        Establish rapport (Refer to steps)

2.      Explain procedure to patient (Refer to steps)

3.      Ensure privacy

4.      Put on mask and perform hand hygiene

5.      Prepare and send trolley aseptically to the patient’s bedside

6.      Protect the bed with mackintosh and dressing towel

7.       Ask assistant to:

·         Put patient into desired position

·         Protect bed clothes and exposes wound

8.      Ask assistant to:

·         Pour out lotions into gallipots

·         Wear gloves and remove plaster or bandage and discard

9.      Remove soiled dressing using disserting forceps or disposable gloves, assess the soiled dressing and discard

10.    Assess the state of the wound and the type of suturing

11.      Perform hand hygiene

12.    Dab or clean wound with sterile forceps/gloves using antimicrobial solution and swab

13.    Place a sterile gauze swab near the wound to receive the sutures

14.    Count the number of stitches in place if it is an alternate stitch

15.    Explain to the patient that it will be a bit uncomfortable/painful and reassure

16.    Hold the dissecting forceps in the left hand and stitch scissors in the right

17.    Grasp the ends of the stitches with the dissecting forceps, pull it a bit to expose and area between the knot and the skin

18.    Insert one blade of the stitch scissors under the stitches, cut between the knot and the skin

19.    Cut it in such a way that no piece of stitch is left in the tissue and remove the stitch without dragging the exposed area through the tissue

20.  Place all removed stitches on the swab, count and examine

21.    Clean or dab wound with series of swabs until wound is clean

22.  Clean the surrounding skin

23.  Apply sterile dressing using prescribed dressing lotion

24.  Add enough sterile dressing and secures into position or leaves exposed where necessary

25.  Ask assistant to help apply the adhesive tape or bandage to the site where necessary

26.  Remove mackintosh and dressing towel

27.  Reposition patient in bed with the help of the assistants

28.  Inform patient about the state of the wound

29.  Dispose off used items, decontaminate used instruments and trolley

30.  Perform hand hygiene

31.    Document and report state of the wound in the nurse notes (manually or electronically)

32.  Report findings to the appropriate officer


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