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01 Introduction 2 min  Introduction:- Give some hint Black
to students board
 Suture means to ‘sew’ or ‘seam’. related topic
 Sutures are tiny threads, wire, or other material and ask them to
used to sew body tissue and skin together. They guess the topic
may be placed deep in the tissue and/or
superficially to close a wound
 a stitch or row of stitches holding together the
edges of a wound or surgical incision.
Define the 3 min
 Definition:-
02) term of suture  In surgery suture is the act of sewing or bringing Ask students to OHP
tissue together and holding them in apposition own perception
until healing has taken place. about what is a
suture?
 Suture material is an artificial fiber used to keep
wound together until they hold sufficiently well
by themselves by natural fiber (collagen) which is
synthesized and woven into a stronger scar OHP
SR.N SPECIFIC DURATION CONTENT TEACHING A.V AIDS
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3) Discuss the 5 min PURPOSES:-
purpose of OHP
suture
 It is to hold severed tissues in close
approximation until the healing process provides Discuss with
the wound with sufficient strength to withstand students
stress without the need for mechanical support.
 Since wounds do not gain strength until 4-6 days
after injury, the tissues are approximated till then
by sutures.

 TYPES :-
o Sutures can be divided into two types :
 Absorbable sutures Teacher
4) Enumerate explain the
the types of 5 min  Non-absorbable sutures
 Absorbable which are absorbable and will break types of Black
suture suture to board
down harmlessly in the body over time without
intervention, students
 sutures as the name suggests will eventually be
absorbed in the body and after some time there
will be no trace of them.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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7 min  which are non-absorbable and must be manually
removed if they are not left indefinitely
 These are sutures that are not degraded by the
body. Although the body can try to do this, the
process is so slow that the suture if left in place
can remain there permanently. When used
externally, these sutures have to be removed in
about 7-10 days of surgery
 SCIENTIFIC PRINCIPLES:-
Described
5) scientific
 Principles of microbiology:- students
o Maintain the hygiene and prevent the
principles “which chart
bacteria’s and germs
principles are
o Follow strict aseptic techniques as for caring
there in the
of wounds. suture ?
o Clean the wounds thoroughly if
contaminated with dust particles or when
blood clots are present.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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 Principles of legal ethical aspects
o Do the procedure step by step and
o followed the ethics of the procedures

 Principles of safety:-
o Doing procedure care fully to no any harm
to the patients and maintain the safety of
the patients

 Principles of psychology:-
o given psychological support to the patient
o given comfortable position to the patient

 Principles of anatomy and physiology:-

o the skin edges should be approximated to
help in the healing of the wound and to
prevent to prevent gapping of the wound
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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6) Enlist the 7 min  ARTICLES:- Teacher articles
articles of Explain
suture Articles Rational articles
A sterile tray:  to hold the cotton purposes and
1. Sponge holding forceps balls or gauze pieces uses
–1 for cleaning the
wound and the
surrounding tissues.
 to create a sterile
2. Slit or dressing towels
field around the
with towel clips
wound.
3. B.P. handle with blades  to debride the wound
edges or to cut the
4. Scissors – 2, one devitalized tissues.
pointed and one round  to debride the wound
tipped. edges, to cut the
sutures,dressing
materials etc.
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5. Dissecting forceps – 2,
one plain and one
toothed.
6. Artery forceps
(hemostats) – 4: straight
-2, curved -2.
7. Tissue forceps -2.
8. Skin retractors – 2.
9. Suture needles, non
cutting, curved.
10. Suture needles, cutting
-2, one straight and one
curved.
TEACHING A.V AIDS
LEARNING
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 to hold the sutures,
wound edges and
dressings.
 to check hemorrhage
by catching the
bleeding points.
 to hold the wound
edges.
 to keep the wound
edges apart, in order
to visualize the
wound.
 to suture the tissues
beneath the skin.
 : to suture the skin.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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11. Needle holder -1.  to hold the suture
needles.
12. Probe -1, sinus  to explore the wound
forceps -1. and to find any
cavities leading to
13. Suture materials, the wound.
Catgut and non-  to suture different
absorbable materials. layers of the wound.
14. Syringes – 20ml, and  to take the cleaning
small bowl. solution for the
cleaning of the
wound.
15. Syringes -5ml with 2  to administer local
needles. anesthesia

 to ensure asepsis.
16. Gown, gloves and
masks.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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An unsterile tray :  to clean the wound
1. Cleaning lotions-spirit, and the surrounding
iodine, normal saline etc. areas. Tr. Benzoin is
and Tr. Benzoin. used for the sealing
of small wound
edges.

2.Local anaesthetics e.g.,
Lignocaine 1 to 2 percent.
3. Transfer forceps in a
sterile container.
 to anaesthetize the
wound edges.
 to handle sterile
supplies

 to clean and dress

4. Dressing materials in the wound.
sterile containers-cotton
balls, gauze cotton pads
etc.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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5. Bandages,  to secure the
elastoplasts, scissors. dressings in place.

6. Kidney tray and  : to receive the

paper bag. wastes.

7. Mackintosh and  to protect the bed

towel. and garments.
Purpose:
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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7) Perform the 12 min  PROCEDURE:-
procedure
with rational  Nursing responsibility before the
procedure:-
1. Explain the procedure to win the confidence and
co-operation of the patient. Explain the sequence of
the procedure and tell the patient how he can co-
operate with you. Reassure the patient and his
relatives.
2. Get the signature of the patient or his guardian in
case anesthesia is to be given.
3. Prepare the wound area as for a surgical procedure.
Shave the hairy regions. Clean the surrounding skin
thoroughly with an antiseptic. While shaving and
cleaning the area, place a sterile cotton pad or gauze
piece over the wound to prevent future
contamination of the wound.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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 Nursing responsibility during the
procedure:-

 Give analgesics if the patient is in pain.

 Provide privacy with curtains and drapes, if

necessary.

 Protect the bed with mackintosh and towel.

 Call for assistance if necessary e.g., to hand over

the sterile supplies, to restrain the patient etc.

 Place the patient in a comfortable position. See

that the doctors or the nurse is also in a
comfortable position to do the
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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STEPS OF PROCEDURE:-
STEPS RATIONAL
1. Wear mask and wash  to prevent cross
hands. infection.
2. Open the sterile tray  to create a sterile
and spread the sterile field around the
towel around the wound and to
wound. minimize the wound
of contamination.
 checking hemorrhage
3. Control the is necessary to
hemorrhage either by prevent shock and
exerting pressure on the also to prevent
wound or by applying complications later
hemostats on the (e.g. hematoma)
bleeding vessels.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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4. Prepare to  accidental injection
anaesthetize the wound of anesthetics into
edges. Take the local the blood vessel can
anesthetic in a small cause arrhythmias in
syringe. Insert a small the patient.
gauge needle gently into
the margin of the
wound. Aspirate to
prevent accidental
injection of the
anesthetic agent into the
blood vessels. Inject the
anesthetic slowly into
the wound margins.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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5. Clean the wound  thorough cleaning of
thoroughly with normal the wound helps to
saline using a 20 ml keep the wound
syringe. Irrigate the clean and thus aids in
wound with large the healing process.
amounts of normal saline
solution to remove all
foreign bodies lodged in
the wound. (cleaning
may be done by using a
bulb syringe or a septo
syringe).
6. Cleaning of the wound
also facilitates thorough
inspection of the wound
for damage to the bones
and tendons.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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7. Put on fresh sterile  to minimize wound
gloves and sterile drapes, contamination
if necessary.  too tight knots will
8. The wound margins cause necrosis by
are carefully brought cutting the blood
together and the wound supply. The knots will
is closed layer by become tighter on
layer.Round body the next day due to
needles and catgut are the formation of
used for suturing the edema and the
subcutaneous tissue. patient will complain
Cutting needles and non of much pain.
absorbable materials are
used for the skin.
Use interrupted sutures
tied with a square knot.
Sutures should be firm
but not tied with excess
tension.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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 NURSING RESPONSIBILITY AFTER THE
PROCEDURE:-
After Care of the Patient and the Articles:-

1. Following wound closure, clean the wound again

and apply a multilayered dressing to absorb drainage
and to arrest bleeding by exerting pressure.

2. Secure the dressings with a roller bandage or

adhesive tapes. As far possible, avoid covering the
wound area with adhesive straps, completely,
because it may foster accumulation of moisture and
subsequent maceration of the wound edges.

3. Keep the wound as dry as possible.

SR.N SPECIFIC DURATION TEACHING A.V AIDS
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4. Remove the mackintosh and towel. Replace the

bed linen. Change the garments if necessary. Make
the patient comfortable by adjustable his position in
bed.

5. Ask the patient to rest in bed to prevent fainting

attacks.

6. Elevate the injured part above the heart level to

minimize the oedema and pain. Mild analgesics may
be given to reduce pain.
7. Take all the articles to the utility room. Discard the
soiled dressing and send for incineration. Wash and
clean the articles first in the cold water and then with
warm water and soap. Wash them thoroughly and dry
them. Reset the suturing tray and send for
autoclaving. Replace all articles to their proper places.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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8. Wash hands. Record on the nurses record with date
and time the type of the wound, the number of
sutures applied, type of drainage tube applied, if any
etc.

9. Return to the bedside to assess the comfort of the

patient and to observe the condition of wound. Watch
for any bleeding from the wound area. Change the
dressing if there is an excessive bleeding. Report to
the doctor.

10. Watch for the vital signs regularly to detect early

signs of shock and collapse on the first day and signs
of infection on subsequent days.
11. On discharge of the patient, the patient should be
given the instructions about the care of the wound,
and the time when he has return for the removal of
sutures.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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8) Enlist the 2 min  SUTURE REMOVAL Teacher articles
articles of demonstrate
suture  ARTICLES:- the steps of
removal procedure
Articles Rational
A tray containing:-  For remove the suture
 Suture removal kit  For remove the
(sterile) staples
 sterile
scissors/staples
remover as
indicated.  Catch the suture or
 Sterile forceps stples
 Anti septic swab  For wipe wound
packets.  For dressing or wipe
 Gauze pieces wound
 Clean gloves  Protect
microorganism
 Sterile gloves
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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 Disinfectant-  For clean and
surgical spirit and dressing wound
povidone iodine.
 Kidney tray  For waste material

 STEPS OF THE PROCEDURE

STEPS RATIONAL
  Explain procedure  helps in obtaining
9) Explain the to patient and cooperation of
procedure of describe the patient
suture sensations that will Teacher articles
removal be experienced demonstrate
such as pulling or the steps of
10 min slightly procedure
uncomfortable
experience

SR.N SPECIFIC DURATION TEACHING A.V AIDS

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  Use sterile  prevent spread of
technique infection
 Check physician  act as a guideline for
order. suture removal
 Arrange all needed  save time, energy
equipments at bed and effort.
side.
 Provide privacy  Prevent
embarrassment

 Wash hand  Prevent risk of

transmission of
microorganisms.
 Position the patients
so that the dressing
or incision is
exposed

SR.N SPECIFIC DURATION TEACHING A.V AIDS

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  Open sterile suture  Ensure aseptic
removal kit. Prepare a technique
sterile field and place
supplies on it
 Don clean gloves  Removes
 Remove and discard potentially
any dressing covering contaminated
the wound material.
 Inspect the wound for
sign of dehiscence
and infection.
 Wash hand, done
sterile gloves  Prevent infection
 Clean sutures with  Cleaning and
spirit swabs moving antiseptic action of
from proximal to alcohol removes,
distal end. Discard surface
swabs after wiping microorganism
each surface once. from the wound
site.
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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  Removal of plan
interrupted suture.
 Place dry sterile
gauze near the  Suture material that
wound is visible to the eye
 Grasp the suture at in contact with
the knot a pair of resident bacterial of
forceps skin and must not
 Place the curved tip be pulled beneath
of the suture scissor the skin during
under the suture as removal. Suture
close to the skin as material that is
possible , either on beneath the skin is
the side opposite considered free
the knot or directly from bacteria
under the knot and
cut the suture.

SR.N SPECIFIC DURATION TEACHING A.V AIDS

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  Suture are cut as
close to the skin as
possible on one side
the visible part.
 with the forceps ,
pull the suture out in
one piece . inspect
the suture carefully
to make sure that all
suture material are
removed.  Steri-strips hold the
 Apply steri-strips on incision edges
the wound or clean together and
with betadin after promote support in
removing suture as healing of the
ordered by physician. wound.
 Provides a
protective covering

SR.N SPECIFIC DURATION TEACHING A.V AIDS

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  Instruct the client  Give neat appearance
about follow- up if of the work area.
wound discharge  Prevent spread
appears. infection
 Place dressing over
the incision if
ordered.
 Reposition the
client, wash and
replace articles
 Wash hand  Acts as a
 Document the communication
number of suture between staff
removed, the members.
condition of the
incision, evidence
of dehiscence
infection if noticed.
and time of the
procedure
SR.N SPECIFIC DURATION TEACHING A.V AIDS
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  SPECIFIC INSTRUCTION FOR STAPLE REMOVAL:-
As directed on the package , gently position the sterile
staple remover under the staple to be removed
Firmly close the staple remover to straighten the
staple ends.9do not lift upward while disengaging
staple ends)
Carefully lift the clips upward with the closes staple
remove them from the incision line, it may be
necessary to remove one end of the staple and then
the other if it does nit easily lift-out

 COMPLICATION OF SUTURE:-
Given all chit
 Wound infection
to the
 Wound reopening students and Rotary
 Excessive scarring say read one method
 Keloid formation by one
10) Enlist the
complication  Hypertrophic scars
of suture

SR.N SPECIFIC DURATION TEACHING A.V AIDS

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 2 min  SUMMARY:-
In the class of students are able to understand
definition, purpose, indication, contra indication, step
of procedure, and nursing responsibility of suturing
and suture removal.

RECAPITULIZATION:-
o What is the definition of suture?
o Which are the purposed of the suture?
1 min o What is complication of suture?

 CONCLUSION:-
suturing and suture removal will always used in
health care especially in hospitalization patients
it is important for the staff providing care for the
to be educate on suturing and suture removal
how important it is to prevent infection from
occurring

SR.N SPECIFIC DURATION TEACHING A.V AIDS

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 BIBLIOGRAPHY:-
 Potter and perry, “CLINICAL NURSING SKILLS
TECHNIQUE. Mosby 5th edition,
 TNAI, “FUNDAMENTAL OF NURSING” secretary
general on behalf on TNAI,2005
 Annama Jacob, rekha R, jodhav sohali tarchand
clinical nursing procedure the art of nursing
practice 3rd edition, jaypee: the health science
publishers new delhi/London/Philadelphia
panama 2015 page no:- 342-343
 https://opentextbc.ca/clinicalskills/chapter/4-3-
suture-care-and-removal/