SELF/Perioperative Nursing/Suturing and Suture Removal/Psychomotor Skills Practice Instructions
Skin Suturing and Suture Removal – Perioperative Nursing (ECSACONM)
[edit | edit source]Overview
[edit | edit source]This page provides a psychomotor skills practice guide for skin suturing and suture removal, developed for perioperative nursing training under ECSACONM (East, Central and Southern Africa College of Nursing). It is intended as a self-directed developer worksheet, outlining the sequential steps, associated learning objectives ("good skills"), common errors, and practical guidance for wound closure by suturing and for subsequent suture removal.
During practice, non-sterile instruments, equipment, and supplies may be used. For the purposes of this simulation, treat every instrument, supply, and surface as though it were sterile. Maintain aseptic technique throughout the exercise and respond to any simulated contamination exactly as you would during an actual suturing or suture removal procedure.
Perform every action as though patient safety depends on it: assess the wound before beginning, handle tissues gently using atraumatic technique, align wound edges accurately, place sutures with consistent spacing and tension, tie secure knots without strangulating tissue, and remove sutures carefully without disrupting wound healing. Throughout the exercise, maintain aseptic technique, recognize when simulated findings require modification of the procedure or escalation for further evaluation, and continuously reassess the wound during both suturing and suture removal. Consistent practice under realistic conditions will develop the technical skills, clinical judgment, and disciplined aseptic technique required to perform skin suturing and suture removal safely and effectively.
NB: This practice requires the low-cost silicone suturing simulator and one assistant. The assistant should support the exercise by performing the assistant actions described in the procedure, such as handling supplies, maintaining visibility of the wound, and assisting with patient positioning where indicated.
Purpose
[edit | edit source]To guide nursing students and practitioners through a systematic, step-by-step process for skin suturing and suture removal, ensuring patient safety, aseptic technique, atraumatic tissue handling, accurate wound edge alignment, secure knot placement, and careful suture removal that preserves wound healing.
Psychomotor Skills Practice Instructions
[edit | edit source]| # | Step | Assistant | Instructions | Good Skills (Learning Objectives) | Common Errors | Guidance |
|---|---|---|---|---|---|---|
| 1 | Gather supplies | Say aloud: "I would gather all supplies and equipment needed for suturing and suture removal and check that they are complete, intact, and within their expiry dates before starting." | ||||
| Wound suturing | ||||||
| 2 | Provide analgesia if indicated | Hands syringe/needle, monitors patient comfort | Say aloud: "Pain control is administered." | |||
| 3 | Clean and prepare the wound site | Pours saline/antiseptic, manages waste, and holds light | Assess the wound. Clean the wound and surrounding skin using aseptic technique, working from the cleanest area toward the less clean area. Remove debris as needed and allow antiseptic to dry completely before closure. | Assesses the wound, cleans it appropriately, removes debris, and allows antiseptic to dry before closure. | Inadequate cleaning; recontamination; aggressive scrubbing; antiseptic not allowed to dry. | Practise systematic wound cleansing while protecting healthy tissue and maintaining aseptic technique. |
| 4 | Load needle onto needle holder | - | Hold the needle with forceps or the non-dominant hand. Grasp the needle at the junction of the proximal two-thirds and distal one-third using the needle holder. Align the needle with its natural curvature and secure it firmly within the jaws of the needle holder before beginning suturing. | Holds the needle at the correct grasp point, aligns it with its natural curvature, secures it firmly within the needle holder, and confirms that it is stable without wobble or rotation. | Needle grasped too close to the tip or swage; loose or rotating needle; incorrect orientation; unsafe handling. | Repeat until the needle can be loaded consistently without wobble or rotation. Focus on grasp location, alignment with the needle curvature, and ergonomic positioning before every stitch. |
| 5 | Align wound edges | - | Using forceps, gently grasp the dermis or subcutaneous tissue rather than crushing the epidermis. Align the wound edges anatomically with even tension and slight edge eversion before placing the first suture. Correct any step-off deformity before proceeding. | Uses atraumatic tissue handling, achieves correct anatomical alignment, maintains equal tension, and creates appropriate wound edge eversion before suturing. | Tissue crushing; poor alignment; excessive tension; inverted wound edges; persistent step-off deformity. | Practise gentle tissue handling while repeatedly checking wound symmetry, edge eversion, and tension before every suture placement. |
| 6 | Place sutures | Blots blood gently, maintains visibility, and helps keep patient still | Using forceps, gently grasp the dermis or subcutaneous tissue rather than crushing the epidermis. Align the wound edges anatomically with even tension and slight edge eversion before placing the first suture. Correct any step-off deformity before proceeding. | Uses atraumatic tissue handling, achieves correct anatomical alignment, maintains equal tension, and creates appropriate wound edge eversion before suturing. | Tissue crushing; poor alignment; excessive tension; inverted wound edges; persistent step-off deformity. | Practise gentle tissue handling while repeatedly checking wound symmetry, edge eversion, and tension before every suture placement. |
| 7 | Tie sutures | - | Using forceps, gently grasp the dermis or subcutaneous tissue rather than crushing the epidermis. Align the wound edges anatomically with even tension and slight edge eversion before placing the first suture. Correct any step-off deformity before proceeding. | Uses atraumatic tissue handling, achieves correct anatomical alignment, maintains equal tension, and creates appropriate wound edge eversion before suturing. | Tissue crushing; poor alignment; excessive tension; inverted wound edges; persistent step-off deformity. | Practise gentle tissue handling while repeatedly checking wound symmetry, edge eversion, and tension before every suture placement. |
| 8 | Cut suture tails | Assists by cutting suture tails | Confirm that the knot is secure and wound edges remain well approximated before trimming the suture tails to approximately 5–6 mm unless otherwise indicated. Avoid pulling on the suture while cutting. | Confirms knot security before trimming and leaves appropriate tail length while maintaining wound approximation. | Cuts tails too short or too long; loosens the knot while cutting; cuts the knot accidentally; pulls on the suture while cutting. | Practise stabilizing the knot while trimming the tails so that the knot remains secure after cutting. |
| 9 | Apply dressing after suturing | - | Select an appropriate sterile dressing once bleeding has been controlled. Cover the wound completely without excessive pressure and secure the dressing appropriately. Label the dressing if required by local practice. | Selects a suitable dressing, confirms haemostasis, and applies the dressing securely without contaminating the wound. | Dressing contaminated; dressing too loose or too tight; dressing applied before bleeding is controlled; unsuitable dressing selected. | Practise dressing application that provides complete wound coverage while maintaining sterility and patient comfort. |
| Suture removal | ||||||
| 10 | Clean wound before suture removal | Holds gauze/waste and assists with soaking crusted areas | Using aseptic technique, gently clean the suture line and surrounding skin. Remove dried blood or crusted material carefully without damaging healing tissue and allow the area to dry before removing sutures. | Cleans the wound gently while preserving healing tissue and improving visualization of each suture. | Aggressive cleaning; bleeding; inadequate cleaning; contaminating the cleaned wound. | Practise gentle wound cleansing using minimal pressure while maintaining aseptic technique throughout. |
| 11 | Remove sutures carefully | - | Lift each knot gently with forceps. Cut the suture close to the skin on one side of the knot and withdraw the suture smoothly without pulling the contaminated external strand through the tissue. Remove sutures sequentially while reassessing wound approximation and counting each removed suture. | Removes sutures atraumatically, protects the healing wound, reassesses wound integrity throughout removal, and accurately accounts for all removed sutures. | Pulls contaminated suture through tissue; excessive force; cuts both sides of the suture; retained suture fragments; inaccurate suture count. | Practise slow, deliberate suture removal while continuously assessing wound healing and minimizing tissue trauma. |
| 12 | Reassess wound after removal | - | Say aloud: "Wound is reassessed after suture removal." | |||
References
[edit | edit source]
| Authors | Ian-laurel |
|---|---|
| License | CC-BY-SA-4.0 |
| Organizations | SELF, ECSACONM |
| Cite as | Ian-laurel-1 (2026). "SELF/Perioperative Nursing/Suturing and Suture Removal/Psychomotor Skills Practice Instructions". Appropedia. Retrieved August 2, 2026. |