Suture to laceration

[Lacie]

My son had his finger accidentally slammed in car door and suffered about 3" gash to his finger. He presented to ER within a 3 hour time due to noone to take him at the incident time. They stated they could not suture as he didnt present within a 1 hour window of the initial injury. It's been awhile since I worked ER but we always had a 12 hour window? It's a nasty/deep gash and now not approximated at all. They didnt even use surgical glue, only had him soak and dressed it and placed him on Keflex. What is the window for your organizations or was this possibly just a lazy situation as they were busy?

[mwboswell]

NO - don't wait.

If they said "follow up" in 'x' days - DO IT!

The provider's liability becomes minimal when the patient doesn't follow instructions.

If you had a claim against the original provider and you do "wait" to see your regular MD; some lawyer would ask you - "so you have a medical license and you know when to break a doctor's orders?".....

Just go do the follow up. Then it is documented that YOU are doing everything YOU are supposed to be doing. As well, probably the ER crew is MUCH MORE familiar in assessing for EARLY signs of potential wound complications than your "regular" MD is.

I say go do the follow up as instructed!

Good luck.

[back2bRN]

Do the follow up as directed. Be your sons' advocate and remember if it doesn't make sense, find out why. Ask questions, use your common sense and experience on your sons' behalf. Good Luck

And anywhere I have worked, 12 hours was the general rule.

[hypocaffeinemia, BSN, RN]

Anyone know what the evidence says regarding time to suture?

[mwboswell]

I wouldn't really call it "evidence" but more general guidelines.

But I would say there is no "hard" rule that is arbitrarily applied.

It should be on a case-by-case basis and individualized based on the following:

-type of wound

-depth

-body location

-wound care prior to eval.

-hx of diabetes, vascular, immune compromised

-ability of pt to care for wound/monitor

-ability of pt to make follow up arrangements

-compliance

-consider will abx be Rx'd.

These are some of the factors I would consider.

[TraumaNurseRN]

My son had his finger accidentally slammed in car door and suffered about 3" gash to his finger. He presented to ER within a 3 hour time due to noone to take him at the incident time. They stated they could not suture as he didnt present within a 1 hour window of the initial injury. It's been awhile since I worked ER but we always had a 12 hour window? It's a nasty/deep gash and now not approximated at all. They didnt even use surgical glue, only had him soak and dressed it and placed him on Keflex. What is the window for your organizations or was this possibly just a lazy situation as they were busy?

Ours has been always a 12 hour window as you mentioned in your post. What did they say as far as closure?....No need?...What were the discharge instructions?