REMOVAL OF STITCHES

REQUIREMENTS #

A trolley containing the following:

1. 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