Tracheostomy Stay Suture Removal
Stay sutures should be removed within 7 days of the tracheostomy procedure by cutting the sutures at the skin level and gently pulling them out. 1
Timing of Removal
The evidence strongly supports early removal of stay sutures:
- Remove within 7 days post-operatively as part of standardized tracheostomy care 1
- For surgical tracheostomies, removal should occur after the tract has begun to mature but before complications develop
- The French guidelines specify that care during days 0-4 should focus on monitoring for hemorrhage and infection, with subsequent care including daily fixation checks 2
Removal Technique
The actual removal procedure is straightforward:
- Cut the sutures at the skin surface where they exit
- Gently pull the sutures out from the tracheal attachment point
- Apply a polyurethane foam dressing after suture removal to prevent pressure ulcers 1
Critical Safety Considerations
Failure to remove stay sutures can lead to serious complications:
- Retained sutures can migrate into the glottic airway, causing airway compromise, infection, and laryngospasm 3
- Case reports document sutures retained for 2 weeks to 2 years after decannulation, requiring surgical removal 3, 4
- A 17 cm-long internalized stay suture was found 2 years post-decannulation in one case 4
Post-Removal Care Protocol
After stay suture removal (part of the standardized bundle that reduced pressure ulcers from 10.93% to 1.29%):
- Place hydrocolloid dressing under the tracheostomy flange initially 1
- Switch to polyurethane foam dressing after suture removal 1
- Maintain neutral head positioning 1
- Continue daily scar examination and cleansing with isotonic saline 2
Common Pitfall
The most critical error is forgetting to remove stay sutures entirely. While stay sutures are valuable for preventing fatal unexpected decannulation 5, they must be actively tracked and removed. Document their placement clearly in the medical record and establish a system to ensure timely removal within the 7-day window.