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From a recent patient experience questionaire we carried out, a recurring theme was the the great discomfort patients felt on removal of the stitches at the Hickman exit site at 21 days.
I understand the rational for keeping the stitches in for that length of time, but wondered if anyone knew of research that had been done that proved this length of time was essential?
I also wondered if anyone removed the stitches earlier and if they had any problems of lines "falling out"?
Does anyone use devices other than stitches to hold the line in place until the cuff is gripped in place by the patients tissue?
Edited: Feb 24, 2009 @ 9.20pm
Hi Gordon,
At my facility the policy/protocol is to remove the ENTRANCE suture 7 days post insertion and the EXIT suture at 30 days.
Personally I have not encountered a line falling out from absence of suture. At 30 days the dancron cuff is adhered securely and with the 'stress loop' in place, unless the line is infected it should remain safe and secure.
Hope this helps,
Justin
Thanks Justin.
I've only ever used the 21 days for exit site stitch removal and have never known a line to fall or be pulled out.
I am getting info that would suggest, that the length of time the stitch is in should not make a difference to the amount of discomfort the patient experiences due to the nature of the stitch material. If this is so then the only benifit in having the stitch in for less time will be the potential reduction in infection/irritation that seems to happen the longer the foreign material is holding the line in place.
So I'm still wondering, is it safe to remove the stitch before 21 days and does anybody have experience of doing so?
When I worked in Oncology/haematology, it occasionally became nescessary to remove the sutures securing the central lines earlier than recommended due to extreme inflammation at the suture sites. When this had been the case, we would try and ensure double looping of the line( length of line allowing )under the dressing to give a bit more leeway in the event of accidental pulling or tugging of the line. I was never faced with the event of a patients line falling out when stitches had been removed early.
Hi
in relation to this topic, does anyone have experience of Hickman or Groshong lines being inserted without the use of any sutures, and being held with a fixation device instead. If so, were the there any problems with migration of the line? We currently remove the exit sutures at 21 days.
Thanks
Alison