Suture removal

[JTT, LPN]

Hi! I just started at a neurosurgeon office and am struggling with removal of carpal tunnel sutures. I believe our surgeon uses the horizontal mattress suturing but when patients come in, the sutures are so extremely tight that the removal process is always painful for the patient. I was told to pull up on the knotted end and cut one side but when I try to pull the knotted end up, the pain is so severe for patient and it's difficult for me to cut only the one side. Does anyone have any experience and can give me any tips?? TIA!

[rzyzzy]

On 3/9/2020 at 12:31 PM, JTT said:

Hi! I just started at a neurosurgeon office and am struggling with removal of carpal tunnel sutures. I believe our surgeon uses the horizontal mattress suturing but when patients come in, the sutures are so extremely tight that the removal process is always painful for the patient. I was told to pull up on the knotted end and cut one side but when I try to pull the knotted end up, the pain is so severe for patient and it's difficult for me to cut only the one side. Does anyone have any experience and can give me any tips?? TIA!

I frequently get the honor of removing sutures after interventions involving the dialysis access in my patients- they’re usually in the arm & often extremely tight as well.

As far as tips, rule #1 for me is controlling the environment- get yourself and the patient in a comfortable, but well-lit position where you can actually see what you’re doing, and you can actually reach the sutures without kneeling or stretching or standing on your head. Many patients expect you to pop a suture out in just a couple of minutes & after you pop fifty or a hundred out you’ll be doing just that, but in the meantime - you’ll need to have a setup of supplies & it might take a minute of looking and strategizing (and some pulling) to figure out the best way to attack your prey.. don’t try to pop one you can’t see.

I have a set of 3x magnifying reading glasses from the dollar store that I use just for pulling sutures. I soak every suture with an alcohol pad & scrub off any dried skin that’s blocking the view of the knot. Then, on especially tight sutures, I’ll often use the beveled edge of a (big) needle to get under the knot & pull the knot away from the skin so I can cut the loop- obviously - explaining to the patient that the needle is just there to expose the suture. If the patient seems sensitive to you pulling the loop up to cut it, you can often use the bevel of the needle like a saw & cut the suture that way as well, without using suture scissors..

like anything else in nursing, patients appreciate you taking the time to focus your attention 100% on them & not acting rushed or inconvenienced (or scared) to help them. When I started pulling sutures at my current job, I definitely felt clumsy & was nervous about making it hurt for the patient, that is, until I saw one of our docs pull a suture.. ouch.. doc was not a bit bashful about pulling and digging and doing whatever it took to get the thing out. I’m a lot more gentle than the doc is, and I’m pretty sure you are too.

Good luck!

[HandsOffMySteth]

Found something on this...

Perhaps going over them with a betadine swab first to clean and loosen them. if they are stubborn.

[Wuzzie]

Also if you are using a cheap disposable suture set you'll find that if you pinch the forceps too firmly it actually makes the tip open some and you'll lose the suture.

[MamaBeaRN]

I used to do these a lot at a previous job. They were always so hard to get out! We had both the disposable s/r kits and the reusable kits that were sent to sterile processing, those worked so much better. Plus I would use the illuminated magnifying goggles which helped me visualize them better.

[JTT, LPN]

Thank you for all of the tips!