Suture care

ARUN S ANGADI M.Sc MSN CRITICAL CARE NURSING.

1. SUTURE AND WOUND
CARE
PREPARED BY
ARUN S. ANGADI
M. Sc Nursing. MSN
CRITICAL CARE NURSING

2. DEFINITION OF SUTURE

Sutures, or stitches, are used
to close cuts and wounds on the
skin.

Absorbable sutures do not
need to be removed. They are
absorbed by your body. Sutures
that are not absorbable need to be
removed after your wound has
healed.

4. Suture care

Keep your sutures covered with a bandage for 24 to
48 hours.
Keep your sutures and bandage clean and dry.
Try not to bump or hit the suture area on anything as
this could open the wound up.
Do not trim or shorten the ends of sutures.
If they rub on your clothing, put a gauze bandage
between the sutures and your clothes.

5. Suture removal

Sterile forceps are used to pick up the knot of
each suture.
A small pair of scissors are used to cut the sutures.
Forceps are again used pull the suture out.
The steps are repeated until all the sutures have been
removed.
Medical strips may be placed across after the sutures
have been removed.
This tape will peel off on its own. Do not pull it off.

6. Clean your wound
Use soap and water and gently clean your
wound as directed to keep it free from germs.
For mouth and lip wounds, rinse your mouth
after meals and at bedtime.
Ask what to use to rinse your mouth.
If you have a scalp wound, you may gently
wash your hair every 2 days with mild
shampoo.
Do not use hair products, such as hair spray

7. Disinfecting the skin:

•An ‘ideal agent’ does not exist – either tissue
toxic or poorly bacteriostatic
•Simple scrub water around wound should be
sufficient
•Avoid mechanical scrubbing unless heavily
contaminated.

8. Solution Antimicrobial
activity
Mechanism
of action
Uses Tissue
toxicit
y
N. Saline - Washing
action
Cleanse surrounding skin
/ irrigation
-
Povidine-iodine
10%, 1%
+ Germicide Cleanse surrounding skin,
? Irrigation contaminated
wounds
+
Chlorhexidine
1%, 0.1%
+ Bacteriostati
c

Cleanse surrounding skin +
Hydrogen
Peroxide
+ Bactericidal Cleanse contaminated
wounds
+
Hexachlorophe
ne
+ Bacteriostati
c
Cleanse surrounding skin +
Nonionic
detergents
- Wound
cleanser
Wound cleanser -

9. Help your wound heal

Limit activity: Limit stretching the areas around your
wound. This will help prevent bleeding and swelling
of the wound area.

Elevate your wound: If your wound is on your arm or
leg, raise the wound higher than the level of your
heart. This will help decrease pain and swelling.
You can use pillows to elevate your arm or leg while
you are sitting or lying down.

10. Minimize your scar: Do not pick at your wound.
Use sun-block if your wound is exposed to the
sun.
Apply it every day after the sutures are removed.
This will help prevent discoloration of scar.

11. Suture Home Care

•First, keep the wound clean and as dry as
possible.
•Do not immerse or soak the wound in water. This
means no swimming, washing dishes (unless
thick rubber gloves are used), baths, or hot tubs
until the stitches are removed or after about two
weeks if absorbable suture material was used.

12. Leave original bandages on the wound
for the first 24 hours. After this time,
showering or rinsing is recommended,
rather than bathing.

13. After the first day, remove old bandages and gently
cleanse the wound with soap and water or half-
strength peroxide (mix equal parts hydrogen
peroxide with water).

Cleansing twice a day prevents buildup of debris,
which may cause a larger scar; debris (for example,
scab formation) makes suture removal slightly
painful, more difficult and may increase the
likelihood of infection

14. 1. Assess:
• Client allergies to wound cleaning agents
•The appearance and size of the wound
• The amount and character of exudates
•Client complaints of discomfort
•The time of the last pain medication
•Signs of systemic infection

15. 2. Determine:
• Any specific orders about the wound or
dressing

16. 3. Assemble equipment and supplies:
•Bath blanket (if necessary)
• Moisture-proof bag
• Mask (optional)
• Acetone or another solution (if necessary to loosen adhesive)
•Disposable gloves
•Sterile gloves
•Sterile dressing set; if none is available, gather the following sterile items:
Drape or towel
o Gauze squares
o Container for the
cleaning solution
o Cleaning solution
o Two pairs of forceps
o Gauze dressings and surgipads
o Applicators or tongue blades, to apply ointments
o Additional supplies required for the particular dressing
o Tape, tie tapes, or binder

17. 4. Prepare the client and assemble the equipment.
•Acquire assistance for changing a dressing on a restless or
confused adult.
•Assist the client to a comfortable position in which the
wound can be readily exposed. Expose only the wound
area.
•Make a cuff on the moisture-proof bag for disposal of the
soiled dressings, and place the bag within reach. It can be
taped to the bedclothes or bedside table.
•Put on a face mask, if required.

18. Procedure

1.Explain to the client what you are going to do, why it is
necessary, and how she can cooperate.
2. Wash hands and observe other appropriate infection
control procedures.
3. Provide for client privacy.
4. Remove binders and tape.
Remove binders, if used, and place them aside. Untie tie
tapes, if used.
•If adhesive tape was used, remove it by holding down the
skin and pulling the tape gently but firmly toward the
wound.
•Use a solvent to loosen tape, if required.

19. 5. Remove and dispose of soiled dressings appropriately.
•Put on clean disposable gloves, and remove the outer
abdominal dressing or surgipad.
•Lift the outer dressing so that the underside is away from the
client’s face.
•Place the soiled dressing in the moisture-proof bag without
touching the outside of the bag.
•Remove the under dressings, taking care not to dislodge any
drains. If the gauze sticks to the drain, support the drain
with one hand and remove the gauze with the other.
•Assess the location, type, and odor of wound drainage, and
the number of gauzes saturated or the diameter of drainage
collected on the dressings.

20. •Discard the soiled dressings in the bag as before.
•Remove gloves, dispose of them in the moisture-
proof bag, and wash hands.

21. 6. Set up the sterile supplies.
•Open the sterile dressing set, using
surgical aseptic technique.
•Place the sterile drape beside the wound.
•Open the sterile cleaning solution, and
pour it over the gauze sponges in the
plastic container.

22. Put on sterile gloves.
7. Clean the wound, if indicated.
•Clean the wound, using your gloved hands or
forceps and gauze swabs moistened with cleaning
solution.
•If using forceps, keep the forceps tips lower than
the handles at all times.
•Use the cleaning methods described, or one
recommended by agency protocol.
•Use a separate swab for each stroke, discard each
swab after use.

23. •If a drain is present, clean it next, taking care to avoid
reaching across the cleaned incision.
•Clean the skin around the drain site by swabbing in half
or full circles from around the drain site outward, using
separate swabs for each wipe.

•Support and hold the drain erect while cleaning around it.
•Clean as many times as necessary to remove the
drainage.
•Dry the surrounding skin with dry gauze swabs, as
required. Do not dry the incision or wound itself.
•Moisture facilitates wound healing.

24. 8. Apply dressings to the drain site and the
incision.
•Place a precut 4” x 4” gauze snugly around the
drain, or open a 4 x 4 gauze to 4” x 8”, fold it
lengthwise to 2” x 8”, and place the 2” x 8” gauze
around the drain so that the ends overlap.

•Apply the sterile dressings one at a time over the
drain and the incision.
•Place the bulk of the dressings over the drain area
and below the drain, depending on the client’s
usual position.

25. Apply the final surgipad, remove gloves,
and dispose of them. Secure the dressing with
tape or ties.

26. 9. Document the procedure and all nursing
assessments.

27. THANK YOU…