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old 242 > removing sutures and staples > Flashcards

removing sutures and staples Flashcards

1
Q

time of removal of stples and sutures is based on

A

stage of incision healing and extent of surgery

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2
Q

generally when are stap/sut removed

A

7-14 days after Sx

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3
Q

why is timing removal of st/su important

A

they must ensure proper wound closing but if left in too long sutures can leave suture marks

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4
Q

are sutures/staples always remove all at once?

who decide?

A

no, they can be removed eg every other then later the rest

doctor and nurse judge whether to not remove ll at once. if the suture line is separating then maybe remove every other suture initially

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5
Q

sutures

where can they be

A

can be in deep tissue layers or on surface for closure

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6
Q

choice of type of sutures depends on

A

type and anatomic location of wound
thickness of the skin
degree of tension
desired cosmetic effect

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7
Q

what det the type of suture used

A

hx of wound healing
site of wound
tissues involved
purpose of the sutures

eg if pt having repeate abd Ssx he might need wire sutures

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8
Q

staples are made of

A

stainless steel wire

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9
Q

when would staples be unable to be used

A

if there isnt adequate space under the skin d/t vessels, bones etc

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10
Q

wht must you do/assess before starting staple/suture removal

A 
drs order
look for factors that impair healing
allergies
pain
healing ridge and skin integrity of suture line
the usual eg id pt etc
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11
Q

t or f removing sutures should be painful

what to tell pt abt how it will feel

A

usually not painful but pt may feel tugging or pulling of skin

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12
Q

how to position pt for suture removl

A

position pt so that direct light is on suture

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13
Q

materials for suture/staple removal

A

staple extractor
sterile antiseptic swabs
gloves
garbage

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14
Q

after removing drsg in prep for staple removal what do

PRocedure

A

inspect incision and suture line
hand hygiene-gloves
clean sutures or staples and healed incision w antiseptic swab
place lower tips of staple extractor under first staple and pul out and dispose. (may need to count?)

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15
Q

remove intermittent sutures procedure

fx of gauze?

A

gauze next to suture line is receptacle for removed sutures

  • hold scissors and forceps
  • grasp knot of suture as close to skin as possible at end distal to knot and slip scissors uder suture near skin
  • snip suture as close to skin as possible at end DISTAL to knot
  • grasp knot end w forceps and pull out smoothly
  • remove every other suture
  • observe heling level to see if you can take out the rest of the sutures
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16
Q

which hand should scissors be in vs forceps

A

scissors in dominant

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17
Q

what not to do when pulling out sutures

cutting them

A

pull any previously exposed prt through the pt

snip both ends

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18
Q

how to remove blanket stitches

A 
have gauze
-snip first suture at end distal to knot
-snip second suture on same side
-grasp knotted end and pull
repeat
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19
Q

next steps after taking out sutures

A

inspect incision to make sure you got all sutures and just look at wound

wipe suture line w antiseptic swab to remove debris and clean incision

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20
Q

when to apply steri strips OUTCOME

A

if any separation greater than two stitches or two staples in width is apparent to maint contact between wound edges

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21
Q

how to apply steri strips

what to instruct pt about

A

cut them to extend 4-5cm on each side of incision
remove from backing and apply
tell pt to take showers not soak in tub

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22
Q

how to dress area after suture/staple removal

A

light drsg

or if no clothing will come in contact hen expose to air

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23
Q

general procedure summary of staple removal/sutures

A 
order/assess
remove drsg w gloves
inspect
wash hands
take out sutures/staples. maybe w gloves?
inspect
antiseptic wipe
apply steri strips if space bigger tha two staples or sutures
apply light drsg or expose to air
clean uo
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24
Q

what could indicate that pt has suture in skin

A

pain

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25
Q

what do if retained suture is present

A

notify

instruct pt to tell doc if suture line infection develops

26
Q

what to record after taking out sutures or staples

A 
time they were removed
number
``cleaning of suture line
appearance of wound
``type of drsg applied
pt response
27
Q

what do i evisceration
bleeding
purulent drainage
suture line separation occurs

A

report to doc

28
Q

teaching abt suture staple removal

A

teach to observe for signs of separation of wound edges before taking out stuaples sutures
inspect owund
prevent abd straing during defecation
adeuqate nutrition and ambulation
bathing and showering
dont put stress on sturue line from activities like lifting or bending
that small amount of drainage from wound immed after suture removal

29
Q

how long should pt not lift something heavy for after suture removal

A

several weeks

30
Q

who has highest risk of dehiscence

A

o adults

31
Q

if cleansing a surgical wound what type of soln to use

if chronic

A

sterile

clean

32
Q

how to cleanse a draing !!!!

A

use a circular stroke starting w area immed next to drain

using a new swab, cleanse immed next to the drain and attempt to clean a little further out from the drain

continue this process until the skin surrounding the drain is cleaned

33
Q

if a pt has a small amount of drainage present is it nec for the to have a drain

A

if drainage accum in the wound bed healing is delayed so drainage will be

remove w open or closed drain system even if small amount of drainage

34
Q

penrose drain is eg of

where is it in r/t the skin

A

open drain

tkes drainage from wound and deposits on skin

35
Q

nursing responsibility for penrose drain includes what

A

shortening it in stages
protecting the surrounding skin
not accidentally removing it

36
Q

egs of a closed drain system and how much they should be draining /24hr

A

jackson pratt 100-200ml/24hr

hemovac 500ml/24hr

37
Q

2 major principles of wound irrigation (not sure we need to do this)

A
  1. Clean-dirty

2. When irrigating ensure that fluid flow is clean-dirty

38
Q

what should you set suction level on hemovac to if its not specified (i attached to wall suction)

A

suction level on low

39
Q

how do closed systems drain

A

use vacuum to withdraw it into collection device

40
Q

if the tubing of hemovac or JP isnt patent will it work

A

no

41
Q

what part of drain care can HCAs do maybe??

A

drain and report the drainage?

42
Q

wound drainage evacuation procedure assessment

A

id loc, purpose of wound drains as pt returns from sx

  • ass drainage present on pts drsg
  • id number of wound drain tubes and what each will be draining. label them
  • is system intact and good
  • if penrose drain does it have sterile safety pin in place
  • type of drainage
43
Q

what can be hooked up to wall suction

A

hemovac and Jp

44
Q

what to assess about drain to see if fx properly

A 
insetion site
drainage moving through tubing
patency of drainage tubing
airtight connection sites
leaks
kinks
45
Q

where should drain be in r/t pt

attach it to?

A

below them

clip it to their gown w safety pin in a way that it wont pull

46
Q

procedure for emptying hemovac or constavac

A

you dont need order to empty drainage
gloves
have meas container
empty
-tilt suction ontainer in direction of plug
-slowly sueeze two flat surfaces together while pouring
-hold uncovered alcohol swab in dominant hand
-press drain down until top and bottom are in contact while on flat surface. quickly clean opening and plug w other hand and immed replace plug
-secure to bed
check that suction is reestablished

47
Q

how to empty hemovacc w wall suction

A 
turn off suction
disconnect suction tubing from hemovac port
empty
clean
reestablish to wall suction
set suction level as presribed
48
Q

empty JP suction drain

A

open port on bulb shaped top
tilt to port and drain
clean end of port and PLUG W ALCOHOL WIPE
compress bulb over drainage container and replace plug immed

49
Q

where to dispose of vac drainage

A

toilet

50
Q

after emptyig wound drainage what next

A

discard soiled supplies
take off gloves
wash new gloves
drsg change

assess pain

51
Q

what kind of drsg is often put around drain tubes

A

split drain sponge drsgs are often taped in place

52
Q

which part of drain is often prone to cloging

A

the y site??

53
Q

what to inspect for in r/t drainage near drain

A

inspect wound for drainage or collection of fluid under skin causing seroma

54
Q

where should drainage be reported

what else should be recorded about this procedure

A

i and o

-emptying
reestablishment of vcuum in suction device
-amount
-color
-odor
drsg change
appearance of drain insertion site
55
Q

what should be immed reported in r/t drain

A 
suddenc hange in amoutn of drainage
absence of output of flow
pungent odor
new evi of purulence
dislodgement of tube
56
Q

teaching abt drains

A

abt the anticipated drainage
expected progress of wound healing and drainage volume
estimated date of removal of drain as volume establishes

if pt is going home w it teach how to empty and record amount of drainage. ask to bring recording to next visit

57
Q

geri considerations r/t drains

A

o adult w lots of drainage will need additional fluid intake because theyre likely to become dehydrate

58
Q

Closed non vacuum drains collect fluid without suction. Examples
can nurses take these out

A

T-tube drain or pigtail
drain

no. dr takes these and malecot out

59
Q

other than gloves what must be worn to prtect self when removing rains

A

faceshield

60
Q

what to document about drain emptying according to saskatoon thing

A

Document
• Amount of drainage, color, consistency and if any odor present from each
drain on appropriate record.
• Number drains if more than one and record amount of drainage from
each separately.
• Report excessive drainage or lack of drainage to physician

old 242 (8 decks)

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