Wound Care, Suture and Staple Removal, Minor Procedures and Supports

This is Unit Fifteen of Medical Assistant Prep. Unit Fourteen ended with a procedure stopped at the first sign of trouble. This unit applies the same discipline to wounds: how they heal, how they are dressed, how sutures and staples come out, and how minor procedures and supports are prepared. Carry one idea through this lecture. In wound care, checking after each step is what lets you stop in time, and stopping is often the most important thing you do. A constructed suture removal near the end shows that idea at work. By the end you will be able to describe how wounds heal and what slows them. To describe drainage and report infection and complications. To change a dressing and remove sutures and staples. And to prepare for minor procedures and supports.

Four entries on healing: three ways, four phases, common wound types, and what slows healing.

Closed, open, delayed.

MAS 351 Three Ways Wounds Heal

Wounds heal in one of three ways: by primary, secondary or tertiary intention. Primary intention means the wound was closed with sutures, staples or glue; secondary means it was left open to fill in; tertiary means it was left open or reopened, often for infection, and closed later. Open wounds heal more slowly and carry more risk of infection.

Bleeding stops to scar.

MAS 352 Four Phases of Healing

Wound healing moves through four phases: hemostasis, inflammation, proliferation and maturation. Bleeding stops, white blood cells clean the wound, new tissue and blood vessels fill it, and collagen strengthens it; a wound typically heals in four to five weeks, often leaving a scar. New tissue is fragile, so handle healing wounds gently during dressing changes.

Treatment differs.

MAS 353 Common Types of Wounds

Wound types differ in cause and care, so treatment for one can harm another. Common types include skin tears from friction or shear, often in fragile older skin, as well as venous ulcers, arterial ulcers, diabetic foot wounds and pressure injuries. Remove adhesive bandages gently from fragile skin to avoid causing a skin tear.

Age, weight, habits.

MAS 354 What Slows Healing

Several factors can slow wound healing and raise the risk of complications. Older age alters the inflammatory response; obesity, alcohol use and smoking all impair healing and increase infection risk. Record these factors carefully in the health history, because they help the provider plan the patient's care.

Four entries on observation: drainage types and amounts, signs of infection, and complications to report at once.

Clear to pus.

MAS 355 Describing Wound Drainage

Wound drainage is described with standard terms. Serous drainage is clear and watery; sanguineous drainage is fresh blood; serosanguineous is watery with a little blood; purulent drainage is thick, yellow or green pus. Small amounts of serous drainage are normal early on; purulent drainage suggests infection and is reported.

Scant to large.

MAS 356 How Much Drainage

The amount of drainage is described as scant, small, moderate or large. Scant means the wound is moist but the dressing shows no measurable drainage; moderate covers a quarter to three quarters of the dressing; large covers more than three quarters. Record both the type and the amount at every dressing change.

Local signs.

MAS 357 Signs of Wound Infection

Wounds are watched for signs of infection at every change. Local signs include redness, an area of hardened tissue around the wound, pain, swelling, and purulent yellow or green drainage. Report signs of infection promptly, because infection can spread beyond the wound to the whole body.

Three to report now.

MAS 358 Complications to Report at Once

Three common wound complications are a hematoma, infection and dehiscence, and each is reported immediately. A hematoma is a collection of blood under the skin; dehiscence is the separation of a closed wound's edges, which can happen suddenly with coughing or straining. If wound edges separate, cover the wound and get the provider at once.

Seven entries on wound procedures: dressing changes, cleaning direction, sutures and staples, closure strips, and stopping.

Old dressing out, new one on.

MAS 359 A Simple Dressing Change

A simple dressing change keeps the wound clean and the old dressing contained. Confirm the order, clean your hands, identify the patient and gather only what you need. Gloved, remove the outer then inner dressing, wrapping it in your glove as the glove comes off. Clean your hands, put on new gloves, and assess appearance, drainage and odor. Clean the wound as directed with moistened gauze, one piece per stroke. Change gloves again and apply the sterile dressing without touching its wound side. Secure it, clean your hands and document. The glove change matters because the old dressing contaminates the gloves that touched it.

Cleaner to less clean.

MAS 360 Clean From Cleaner to Less Clean

When cleaning a wound, work from the cleanest area toward the less clean, so germs are not carried back. A sutured incision line is considered the least contaminated area, so clean it first, using a fresh moistened gauze for each stroke, in straight lines moving away from it. Never reuse a gauze for a second stroke.

Threads and steel.

MAS 361 Sutures and Staples

Sutures and staples hold a wound's edges together while it heals by primary intention. Sutures are threads or other material sewn through tissue; staples are stainless steel, strong and quick to place and remove, but they may leave more scarring. Removal happens only on the provider's order.

One knot at a time.

MAS 362 Removing Interrupted Sutures

Interrupted sutures come out one at a time with sterile scissors and forceps, on order. Confirm the order, explain the patient may feel pulling but not pain, and check for even closure without drainage, redness or swelling. Clean the incision as directed. Lift the knot with forceps, cut close to the skin on one side of the knot only, and pull the suture out by the knot in one smooth motion, so the outside part never passes through tissue. Remove every second suture first, checking after each, then the rest, adding closure strips if ordered. Never cut both sides of the knot. If the edges begin to open, stop and notify the provider.

Let the handle work.

MAS 363 Removing Staples

Staples come out with a sterile extractor, without pulling on the wound. Confirm the order, explain the patient may feel pulling or pinching, and inspect the wound. Clean the incision and set sterile gauze nearby. Slide the extractor's lower tip under a staple and close the handle fully, without lifting or tilting your wrist, so the staple bends and both ends leave the skin. Lift it away onto the gauze. Remove every second staple first, then the rest if the wound stays closed, adding closure strips if ordered. Pulling up while squeezing tears the skin, and you stop if the edges separate.

Support after removal.

MAS 364 Adhesive Closure Strips

After sutures or staples come out, adhesive closure strips may be applied across the incision to support it. Using no-touch technique, cut strips long enough to extend about one and a half to two inches on each side of the incision. Document the strips you applied along with the appearance of the incision.

When edges separate.

MAS 365 Stop if the Wound Opens

During suture or staple removal, check the wound after each one, and stop if the edges begin to separate. Leave the remaining sutures or staples in place, cover the wound, and notify the provider, who decides what to do next. Finishing the removal on a wound that is opening can turn a small problem into dehiscence.

Seven entries on procedures and supports: preparation, cryotherapy, biopsy, sprains, splints, and two constructed cases.

Room, patient, field.

MAS 366 Preparing for a Minor Procedure

For minor office procedures, such as repairing a laceration, the medical assistant prepares the room, the patient and the sterile field. Open sterile supplies correctly, add items without contaminating the field, and prepare the skin as the order and the practice's policy direct. The procedure itself is the provider's; your role is a safe field, ready supplies and a comfortable patient.

Freezing abnormal tissue.

MAS 367 Cryotherapy

Cryotherapy uses extreme cold, from a very cold liquid or an instrument called a cryoprobe, to freeze and destroy abnormal tissue. Substances such as liquid nitrogen are used; freezing is one of several ways warts can be removed. Extreme cold injures any tissue it touches, so handle the materials exactly as trained.

Container ready and labeled.

MAS 368 Biopsy Specimens

A biopsy is the removal of cells or tissue so that a pathologist can examine them. During an office biopsy, the medical assistant has the specimen container ready and labeled, and hands it to the provider when asked. Label every specimen container at once; unit seventeen covers specimen labeling in full.

Rest, ice, compression, elevation.

MAS 369 Rest, Ice, Compression, Elevation

Sprains and strains are often treated with four steps remembered as RICE. Rest the injured area, ice it, compress it with an elastic bandage or other device, and elevate the limb. Apply a compression bandage only as ordered and as trained, and report any concern about the limb to the provider.

Casts, splints and braces.

MAS 370 Splints and Casts

A fracture is a broken bone, and treatment often includes a cast or a splint. Splints and braces also support injured or weak joints; the provider orders the device, and the medical assistant helps apply it only as trained. Report any new or increasing pain or other concern about a limb in a support device.

The moment she stopped.

MAS 371 A Suture Removal

A constructed case pays off the opening idea. Ten days after a forearm repair, the provider orders suture removal. The assistant confirms identity and order, explains he may feel pulling but not pain, removes the dressing and changes gloves. The edges look even, with no drainage, redness or swelling. She cleans the line first, a fresh gauze per stroke, then removes sutures by lifting the knot, cutting one side close to the skin and drawing it out by the knot, taking every second one first and checking after each. After the third, one end begins to gape. She stops, leaves the rest, covers the wound and tells the provider, who leaves the others a few more days and has her apply closure strips. She documents everything. Finishing would have looked efficient and could have reopened the wound.

A laceration repair, prepared.

MAS 372 Preparing for a Laceration Repair

A second constructed case keeps the assistant to her role in a laceration repair. A woman has cut her hand on a kitchen knife, and the provider decides on sutures. The assistant confirms identity and asks about allergies, including latex, medications and tape. She opens the sterile tray away from herself first, touching only the outer edges, and drops gauze onto the field from a peeled pouch, keeping the edge and anything below the tabletop out of use. The provider prepares the skin and repairs the cut while she hands supplies, reassures the patient and watches that no one reaches across. Afterward she applies the ordered dressing, drops sharps into the container, gives the approved instructions, schedules removal and documents who did the repair. A careful field is a real contribution to care.

Look at what you can now do. You can describe the three ways wounds heal, the four phases, and the factors that slow healing. You can describe drainage by type and amount, and report infection, a hematoma or dehiscence at once. You can change a dressing with a glove change between old and new, and remove sutures and staples on order, checking after each. And you can prepare for minor procedures and supports, staying within your role. Unit Sixteen turns to administering medications: routes, injections and vaccines.