Each country sets its own laws on what registered nurses -- or RNs -- can and cannot do. These laws determine the scope of nursing practice within the country. Because suturing is considered a minor surgical procedure, it doesn't fall within the general scope of nursing duties unless your country specifically allows it. Countries more often allow advanced practice nurses to suture than RNs without an advanced practice degree.
Suturing means closing a wound with stitches, using material such as silk or catgut. Laws that address whether a nurse can perform suturing often also address whether or not the nurse can staple wounds shut or close wounds with an adhesive. Laws might also define the knowledge required for a nurse to place sutures. A nurse who sutures, for example, must understand the potential complications of the procedure, recognize adverse reactions and act appropriately if they occur.
Suturing a wound is the traditional method of primary closure. The broad range of suture materials available also makes it extremely versatile (Richardson, 2004). The choice of suture and needle will be determined by the location of the wound, the thickness of the surrounding skin, and the amount of tension that is likely to be exerted on it (Mackay-Wiggan et al, 2002). Suture materials are classified as natural or synthetic and may be absorbable or non-absorbable.
Absorbable sutures degrade rapidly and are mainly used in the deep tissue layers of a wound to minimise the risk of haematoma formation or infection occurring in dead space (Wyatt et al, 2003). They are also used for closing wounds to lips, tongue, or mouth. Non-absorbable sutures are used to close the wound edges at other sites.
It is usual to select a reverse cutting needle for suturing, which is designed for use on tough tissue such as skin (Smithing, 2002). Needles have three sections: the point, the body or mid-section, and the swage, where the suture material is attached. On reverse cutting needles the cutting edge is located on the outer curve of the body and is directed away from the wound edges preventing further trauma and the risk of the suture pulling through the edge of the wound (Mackay-Wiggan et al, 2002).
If your facility asks you to start suturing patients, check your country's law first to make certain you're covered if anything goes wrong. Some facility allow RNs to suture only under certain conditions. In North Carolina,USA , for example, nurses cannot place sutures that involve muscle, tendons or blood vessels. In 2012, a Nevada State Board of Nursing survey reported that 24 percent of states allow RNs to place sutures, while 18 percent deemed that it was not within the scope of practice for an RN. Another 18 percent said that it was in the scope of practice for registered nurse first assistants -- advanced practice nurses who work alongside surgeons in the operating room -- to place sutures. The rest had no policy on suturing.
Advanced practice nurses, such as nurse practitioners or nurse-midwives, can suture in most states. For nurse-midwives, the ability to sew up tears or repair an episiotomy -- a cut made to widen the vaginal opening during birth -- is an essential part of their job description. To suture, you need to know not only how to place sutures but also what type of suture material and needle to use. Advanced practice nurses in some states can learn to do more advanced suturing procedures.
RNs can remove sutures even if they can't place them, under the direction of a physician. The RN must assess whether or not the wound has healed well enough for suture removal and follow any written orders from physicians for suture removal. In some cases, the attending physician must examine the wound to ensure that the stitches are ready for removal. He can then delegate removal to the RN. Some hospitals have written policies that specify procedures to follow when removing sutures.
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