NURSING PRACTICE GUIDELINES

Guideline for the Removal Of Sutures, Clips And Staples.

Reference
Date approved
Approving Body
Supporting Policy/ Working in
New Ways (WINW) Package
Implementation date
Supersedes
Consultation undertaken

Target audience

March 2012
Matrons Forum
N/A

2009
Nursing Practice Guidelines Group, Ward
Sisters/Charge Nurses, Practice
Development Matrons (PDMs), Clinical
Leads, Matrons
All Clinical Nursing Staff

Document derivation /
evidence base:
Review Date
Lead Executive
Author/Lead Manager

March 2015
Director of Nursing
Nova Charles (Staff Nurse, MSKN Neurospinal post-operative Unit)
Further Guidance/Information Ellie Dring PDM Nursing Development , Ext
57234
Distribution:
Ward Sisters/Charge Nurses, PDMs, Clinical
Leads, Matrons, Nursing Practice Guidelines
Group (includes University of Nottingham
representative)
This guideline has been registered with the Trust. However, clinical
guidelines are guidelines only. The interpretation and application of
clinical guidelines will remain the responsibility of the individual
clinician. If in doubt contact a senior colleague or expert. Caution is
advised when using the guidelines after the review date.

REMOVAL OF SUTURES, CLIPS AND STAPLES.

INTRODUCTION
The decision to remove sutures, clips or staples from a wound is
taken when the strength of the wound is assessed to be adequate
to support itself.
Factors which might delay wound healing, and should therefore be
considered prior to the removal of sutures or clips, include:
Diseases, disorders and syndromes:o for example, anaemia, autoimmune disorders,
diabetes, cardiopulmonary disease, liver failure,
inflammatory bowel disease, malignancy, thyroid
deficiency, vascular disease and previous surgery
using same suture line, previous surgery in the same
area using the same suture line.
Drugs:o for example, alcohol, cytotoxics, nicotine, steroids, antiinflammatory drugs
Poor nutritional state:o for example, anaemia, malnutrition, mineral deficiency,
protein deficiency, vitamin deficiency
Microenvironment of wound:o for example, blood supply, gas composition, humidity,
infection, allergic reaction to clips
Other factors:-

o for example, the age of the patient, obesity, site of

wound, dehydration.
(Dougherty & Lister, 2008)
The decision to remove sutures, clips and staples from a surgical
wound is usually made by the surgeon, in conjunction with nursing
staff and following a full wound assessment. Any of the above
factors may delay wound healing and a close visual inspection of
the wound is vital. It should be remembered that all wound
closures are foreign bodies and if left in place too long they may
cause excess scarring and/or may become a focus for infection.
Sutures should therefore be removed as soon as the wound is
strong enough to support itself. The earlier the sutures are
removed, the better the cosmetic effect (Bale and Jones 2007).
Although most sutures are removed from wounds, there are
occasions when sutures need to be removed from places other
than wounds, e.g. central venous catheters. In these situations,
the main principles within these guidelines apply.
Although there are different suturing methods (e.g. subcuticular,
interrupted, continuous etc.) and different metal clips used (e.g.
michel, staples) the principles for removal remain the same. Refer
to local guidelines from individual surgeons for the removal of
continuous sutures, as the procedure may vary, according to the
material used, the suturing method etc. Absorbable sutures may
take 3-7 months to be fully absorbed.
Best Practice.
If, during removal, the wound starts to gape, the remaining
sutures, clips or staples should be left in situ, the wound
covered and the surgical team informed (Perry and Potter
2010). To prevent a potential gaping of wound, the alternate
sutures, clips or staples may be removed at first and then
an assessment made whether or not to remove the rest. If
gaping occurs on removal of continuous sutures, the
wound should be reapposed with sterile adhesive sutures
(steristrips) and the surgical team informed (Perry and
Potter 2010).

PROCEDURE FOR THE REMOVAL OF SUTURES FROM A

NON-DISCHARGING WOUND
EQUIPMENT
Basic procedure pack and/or suture removal pack
Sterile stitch cutter
Non-sterile gloves
Sharps container
Apron
Yellow clinical waste bag
Dry dressing if required

Refer to General Principles for All Procedures and Aseptic NonTouch Technique.

PRINCIPLE

RATIONALE

1.

Explain and discuss the

procedure to the patient
and gain verbal consent.

To ensure the patient

understands the procedure and
gives their valid consent (NMC
2006)

2.

Assess the patients

comfort level and address
if necessary.

Get baseline of patients comfort

level. (Perry and Potter 2010)

3.

Pull curtains or close door

To maintain the privacy and

dignity of the patient.

4.

Assist the patient into a

position which is
comfortable and which
allows easy access to the
suture line.

To facilitate the procedure for

both patient and nurse

Wash hands using 5 step

technique.

To reduce the risk of infection

and comply with trust infection
control policy.(NUH Hand
hygiene Policy 2009)

6.

If the wound is covered,

put on the gloves and
remove the dressing.
Dispose of both and clean
hands.

To minimise the risk of crossinfection.

7.

Place a piece of gauze or

gallipot near to wound.

Allows easy disposal of sutures.

8.

Hold the knot of the first

suture with the forceps,
gently lift upwards and cut
one side of the suture, with
the cutter/scissors as close
to the skin as possible.
Gently but firmly pull the
suture out. Place the
sutures on the gauze or in
the gallipot.

To prevent infection caused by

drawing the exposed suture
material through the
subcutaneous tissue (Dougherty
& Lister, 2008).

9.

Continue along the wound

until all the suture material
has been removed check
the wound carefully.

To ensure all sutures are

removed and reduce the risk of
future wound irritation,
breakdown or infection.

5.

10. Record the removal of

sutures and the condition
of the suture line and
surrounding skin in the
appropriate
documentation.

To maintain records and enable

evaluation of the wound
(Dougherty & Lister, 2008).

PROCEDURE FOR THE REMOVAL OF SUTURES

FROM A DISCHARGING WOUND
EQUIPMENT
Sterile stitch cutter/scissors
1 pair non-sterile gloves
1 pair sterile gloves
Sharps container
Trolley/tray
Basic procedure pack or suture removal pack
Sachet of normal saline
Dry adhesive dressing of choice
Steristrips (if necessary)
Wound swab (if required)
Yellow clinical waste bag
Refer to General Principles for All Procedures and Aseptic NonTouch Technique.

BESTPRACTICE
Wound / drain site swabs should be taken if symptomatic of
infection. Signs of infection include pain, inflammation at wound
margins, oedema, pyrexia and purulent exudates. Any wounds
that show signs of infection should be reported to the medical
staff. Swabs should be obtained prior to wound cleansing.
Treatment of infection should be determined from a positive
wound swab. (Doherty and Lister 2008).

PRINCIPLE

RATIONALE

1.

Explain procedure to the

patient and gain verbal
consent.

To ensure the patient understands

the procedure and gives their
consent (Dougherty & Lister,
2008).

2.

Assess the patients

comfort level and
address if necessary.

Get baseline of patients comfort

level. (Perry and Potter 2010)

3.

Pull curtains or close

door

To maintain the privacy and dignity

of the patient.

4.

Assist the patient into a

position which is
comfortable and which
allows easy access to
the suture line.

To facilitate the procedure for both

patient and nurse.

5.

Wash hands using 5

step technique.

To reduce the risk of infection and

comply with trust infection control
policy. (NUH Hand Hygiene Policy
2009)

6.

Apply the non-sterile

gloves and remove the
dressing. Dispose of
both and clean hands
using 5 step technique.

To minimise the risk of cross

infection from the dressing.

7.

Obtain bacteriological
wound swab, if
appropriate, e.g. if signs
of infection.

To determine presence of
pathogenic microorganisms.

PRINCIPLE

RATIONALE

8.

Open the pack, apply

sterile gloves (if used) and
clean the wound using an
aseptic non-touch
technique.

To remove the wound discharge

(Aseptic Non Touch Technique
(ANTT) Policy
NUH, 2011)

9.

Hold the knot of the first

suture (furthest from the
contaminated area), gently
lift upward and cut one side
of the suture as close as
possible to the skin. Gently
but firmly pull the suture
out.

To prevent infection caused by

drawing the exposed suture
material through the
subcutaneous tissue (Dougherty
& Lister, 2008).

10. Continue working towards

the contaminated area:

a)

Removing alternate
sutures

To minimise spread of any

infection.

To prevent sudden dehiscence

of the whole wound if the margin
has not healed.

OR
b)

If a continuous
suture, the first 5cm
of suture material.

To ensure all suture material has

11. If the wound appears
been removed and to reduce the
stable, continue until all the
risk of future wound breakdown or
suture material has been
irritation.
removed. Check the
wound carefully.

12. If any further discharge is

present, clean the wound
with saline using an aseptic
non-touch technique.

13. Cover the wound with the

sterile adhesive dry
dressing.

To minimise spread of any

infection, (Aseptic Non Touch
Technique (ANTT) Policy
NUH, 2011)
To absorb excess wound
discharge.

14. Record the removal of

sutures and the condition To document care and enable
evaluation of the wound (Bale and
of the wound in the
appropriate documentation. Jones 2006).

PROCEDURE FOR THE REMOVAL OF CLIPS OR STAPLES

FROM A NON-DISCHARGING WOUND
EQUIPMENT
Appropriate staple or clip removers
Sharps container
Apron
Non-sterile gloves
Gallipot
Yellow clinical waste bag
Dry adhesive dressing
Refer to General Principles for All Procedures and Aseptic NonTouch Technique.

PRINCIPLE

RATIONALE

1.

Explain procedure to the

patient

To ensure the patient

understands the procedure and
gives their consent (Dougherty
& Lister, 2008).

2.

Assess the patients comfort Get baseline of patients comfort

level and address if
level. (Perry and Potter 2010)
necessary.

3.

Pull curtains or close door.

To maintain the privacy and

dignity of the patient.

10

PRINCIPLE

RATIONALE

To facilitate the procedure for

both patient and nurse.

4.

Assist the patient into a

position which is
comfortable and which
allows easy access to the
suture line.

5.

Wash hands using 5 step

technique.

6.

If the wound is covered,

apply the gloves and
remove the dressing.
Dispose of both and clean
hands.

To minimise the risk of crossinfection.

7.

Place gallipot next to the

patient.

Ensure safe and easy disposal

of clips.

8.

If the suture line is under

To prevent excess pulling of
tension support surrounding wound and minimise patient
skin with forceps or fingers. discomfort on removal of staple
(Dougherty & Lister, 2008).

9.

Open the staple removers

and gently place the lower
two prongs under the
staple. Squeeze the
handles to lift the edges of
the clips/staple.

To reduce the risk of infection

and comply with trust infection
control policy. (Hand Hygiene
Policy, NUH 2009)

To open the clip/staple and

remove atraumatically from the
wound. (Dougherty & Lister,
2008).

11

10. Lift one side of the clip, then To minimise trauma to the
wound edges.
the other (using a rocking
motion) and ease the clip
out of the skin.

11. Continue along the wound

until all the clips/staples
have been removed.
Check the wound carefully
for any remaining
clips/staples.

To ensure all clips/staples are

removed and to reduce the risk
of future wound
irritation/breakdown.

12. Dispose of the clips/staples

in the Sharps container and
the clip/staple removers as
per manufacturers
instructions.

To prevent injury.

13. Record the removal of the

clips/staples and the
condition of the suture line
and surrounding area in the
appropriate documentation.

To maintain records and enable

evaluation of the wound
(Dougherty & Lister, 2008).

12

PROCEDURE FOR THE REMOVAL OF THE CLIPS OR

STAPLES
FROM A DISCHARGING WOUND
EQUIPMENT
Appropriate staple or clip removers
Sharps container
Sterile forceps/sterile gloves
Non-sterile gloves
Sterile dressing pack
Sachet of sterile saline
Dry sterile adhesive dressing
Steristrips
Wound swab (if required)
Yellow clinical waste bag
Refer to General Principles for All Procedures and Aseptic NonTouch Technique.

PRINCIPLE

RATIONALE

1.

Explain procedure to the To ensure the patient

patient
understands the procedure
and gives their consent
(Dougherty & Lister, 2008).

2.

Assess the patients

comfort level and
address if necessary.

Get baseline of patients

comfort level. (Perry and
Potter 2010)

3.

Pull curtains or close

door

To maintain the privacy and

dignity of the patient.

13

4.

5.

Assist the patient into a

position which is
comfortable and which
allows easy access to
the suture line.

To facilitate the procedure

for both patient and nurse.

Wash hands using 5

step technique.

To reduce the risk of

infection and comply with
trust infection control policy.
To minimise the risk of
cross-infection from the
dressing.

6.

Apply the gloves and

remove the dressing.
Dispose of both and
clean hands using the 5
step technique.

7.

Obtain a wound swab

where appropriate.

8.

Open dressing pack and To remove wound

discharge.
clean the wound using
an aseptic non-touch
technique (see latest
guidelines).

9.

Place gallipot next to

patient.

10.

Apply sterile gloves if

appropriate.

11.

If the suture line is

under tension support
surrounding skin with
forceps or fingers.

To determine presence of
pathogenic microorganisms.

Ensures safe and easy

disposal of clips or staples.

To prevent excess pulling

of wound and minimise
patient discomfort on
removal of staple
(Dougherty & Lister, 2004).

14

PRINCIPLE
PRINCIPLE RATIONALE

12.

Open the staple

removers and gently
place the lower two
prongs under the
staple. Squeeze the
handles to lift the
edges of the
clips/staple.

To open the clip/staple and

remove atraumatically from
the wound. (Dougherty &
Lister, 2008).

13.

Lift one side of the clip

then the other (using
a rocking motion) and
ease the clip out of the
skin.

To minimise trauma to the

wound edges.

14.

Continue along the

wound removing
alternate clips/staples,
working towards the
contaminated area.

To minimise spread of any

infection. To reduce the
risk of sudden wound
dehiscence of whole
wound if wound margin not
healed.

15.

Check the wound

carefully:
a) If superficial wound
breakdown, use
adhesive sutures.

b) If major breakdown
is suspected i.e.
dehiscence, cover and
seek immediate
medical advice.

To reduce the risk of

wound breakdown if
healing has not occurred
and to improve the
cosmetic appearance of
the wound.
Further intervention may be
required.

15

PRINCIPLE

16

If the wound appears to be

healing well, continue until
all the clips have been
removed. Check the
wound carefully for any
remaining clips/staples.

RATIONALE

To reduce the risk of future

wound breakdown, irritation, or
infection from a foreign body.

17. If any exudate is still

present, clean the wound
with saline using an aseptic
non-touch technique (see
latest guidelines).

To create optimum local

conditions for wound healing.
(Doherty and Lister 2008)

18. Cover the wound with the

dry dressing.

To absorb any wound

discharge.

19. Dispose of the clips/staples

in the sharps container and
the clip/staple removers as
per manufacturers
instructions.

To reduce the risk of injury.

20. Record the removal of clips

and condition of the wound
in the appropriate
documentation.

To maintain records and enable

evaluation of the wound
(Dougherty & Lister, 2008).

16

REFERENCES
Bale S and Jones V (2007) Wound care nursing: a patientcentred approach London: Baillire Tindall
Dougherty L & Lister S (Eds) (2008) The Royal Marsden NHS
Trust Manual of Clinical Nursing Procedures 7th Edition Oxford:
Blackwell Science
Nottingham University Hospitals NHS Trust Aseptic Non Touch
Technique (ANTT) Policy 2011
http://nuhnet/nuh_documents/Documents/Forms/Staff%20View.as
px
Nottingham University Hospitals NHS Trust Hand Hygiene Policy,
2009
http://nuhnet/nuh_documents/Documents/Forms/Staff%20View.as
px
Perry and Potter (2010) Clinical nursing skills and techniques 7th
Edition Mosby Elsevier
Wilson J (2001) Infection Control in Clinical Practice 2nd Edition
London: Bailliere Tindall

FURTHER READING
Smith L, Baker F and Stead L (1999). Practical Procedures for
Nurses, part 25.1 & 2: Removal of Sutures/Staples. Nursing
Times Vol. 95 Nos. 9 & 10

Author :

NNPDG Link Member:

Nova Charles (MSKN), QMC

(Original Philip Daly, QMC)Based on
the 2003 version by Julie Davies,
Haemostasis Nurse, QMC
Ellie Dring

17

Date:
Review Date:

Jan 2012
2015

18

ELEMENTS FOR ASSESSMENT OF CLINICAL COMPETENCE

Knowledge
Anatomy and Physiology of skin
Wound healing by primary and secondary intention
Factors delaying healing
Signs and symptoms of wound infection
Wound closures as foreign bodies
Types and methods of wound closure
Cosmetic effects
Sharps Policy
Informed consent policy
Infection control

Skills
Wound assessment
Communication
Assembly of appropriate equipment
Use of appropriate equipment
Aseptic non touch technique
Manual dexterity
Accurate recordkeeping
Attitudes
Communication
Privacy & Dignity
Consent
Reflection on practice

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