removing sutures and staples Flashcards
time of removal of stples and sutures is based on
stage of incision healing and extent of surgery
generally when are stap/sut removed
7-14 days after Sx
why is timing removal of st/su important
they must ensure proper wound closing but if left in too long sutures can leave suture marks
are sutures/staples always remove all at once?
who decide?
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
sutures
where can they be
can be in deep tissue layers or on surface for closure
choice of type of sutures depends on
type and anatomic location of wound
thickness of the skin
degree of tension
desired cosmetic effect
what det the type of suture used
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
staples are made of
stainless steel wire
when would staples be unable to be used
if there isnt adequate space under the skin d/t vessels, bones etc
wht must you do/assess before starting staple/suture removal
drs order look for factors that impair healing allergies pain healing ridge and skin integrity of suture line the usual eg id pt etc
t or f removing sutures should be painful
what to tell pt abt how it will feel
usually not painful but pt may feel tugging or pulling of skin
how to position pt for suture removl
position pt so that direct light is on suture
materials for suture/staple removal
staple extractor
sterile antiseptic swabs
gloves
garbage
after removing drsg in prep for staple removal what do
PRocedure
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?)
remove intermittent sutures procedure
fx of gauze?
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
which hand should scissors be in vs forceps
scissors in dominant
what not to do when pulling out sutures
cutting them
pull any previously exposed prt through the pt
snip both ends
how to remove blanket stitches
have gauze -snip first suture at end distal to knot -snip second suture on same side -grasp knotted end and pull repeat
next steps after taking out sutures
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
when to apply steri strips OUTCOME
if any separation greater than two stitches or two staples in width is apparent to maint contact between wound edges
how to apply steri strips
what to instruct pt about
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
how to dress area after suture/staple removal
light drsg
or if no clothing will come in contact hen expose to air
general procedure summary of staple removal/sutures
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
what could indicate that pt has suture in skin
pain
what do if retained suture is present
notify
instruct pt to tell doc if suture line infection develops
what to record after taking out sutures or staples
time they were removed number ``cleaning of suture line appearance of wound ``type of drsg applied pt response
what do i evisceration
bleeding
purulent drainage
suture line separation occurs
report to doc
teaching abt suture staple removal
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
how long should pt not lift something heavy for after suture removal
several weeks
who has highest risk of dehiscence
o adults
if cleansing a surgical wound what type of soln to use
if chronic
sterile
clean
how to cleanse a draing !!!!
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
if a pt has a small amount of drainage present is it nec for the to have a drain
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
penrose drain is eg of
where is it in r/t the skin
open drain
tkes drainage from wound and deposits on skin
nursing responsibility for penrose drain includes what
shortening it in stages
protecting the surrounding skin
not accidentally removing it
egs of a closed drain system and how much they should be draining /24hr
jackson pratt 100-200ml/24hr
hemovac 500ml/24hr
2 major principles of wound irrigation (not sure we need to do this)
- Clean-dirty
2. When irrigating ensure that fluid flow is clean-dirty
what should you set suction level on hemovac to if its not specified (i attached to wall suction)
suction level on low
how do closed systems drain
use vacuum to withdraw it into collection device
if the tubing of hemovac or JP isnt patent will it work
no
what part of drain care can HCAs do maybe??
drain and report the drainage?
wound drainage evacuation procedure assessment
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
what can be hooked up to wall suction
hemovac and Jp
what to assess about drain to see if fx properly
insetion site drainage moving through tubing patency of drainage tubing airtight connection sites leaks kinks
where should drain be in r/t pt
attach it to?
below them
clip it to their gown w safety pin in a way that it wont pull
procedure for emptying hemovac or constavac
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
how to empty hemovacc w wall suction
turn off suction disconnect suction tubing from hemovac port empty clean reestablish to wall suction set suction level as presribed
empty JP suction drain
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
where to dispose of vac drainage
toilet
after emptyig wound drainage what next
discard soiled supplies
take off gloves
wash new gloves
drsg change
assess pain
what kind of drsg is often put around drain tubes
split drain sponge drsgs are often taped in place
which part of drain is often prone to cloging
the y site??
what to inspect for in r/t drainage near drain
inspect wound for drainage or collection of fluid under skin causing seroma
where should drainage be reported
what else should be recorded about this procedure
i and o
-emptying reestablishment of vcuum in suction device -amount -color -odor drsg change appearance of drain insertion site
what should be immed reported in r/t drain
suddenc hange in amoutn of drainage absence of output of flow pungent odor new evi of purulence dislodgement of tube
teaching abt drains
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
geri considerations r/t drains
o adult w lots of drainage will need additional fluid intake because theyre likely to become dehydrate
Closed non vacuum drains collect fluid without suction. Examples
can nurses take these out
T-tube drain or pigtail
drain
no. dr takes these and malecot out
other than gloves what must be worn to prtect self when removing rains
faceshield
what to document about drain emptying according to saskatoon thing
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
