Sedation for suture removal?!?

[Lumberg]

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I had a complaint filed against me for "abuse" after I removed simple interrupted sutures from a 2yo F "without adequate sedation". Papoosed her, had a tech hold her head and removed the sutures. Kid and mom were both going nuts but it went smoothly otherwise. Am I off base here? Do any of you use procedural sedation for simple suture removal? I explained risks of sedation to mom who was seemingly on board in the treatment room but then complained. I just don't see sedating anyone for essentially a painless, though frightening, procedure. Thoughts?

 

[GeneralVeers]

I had a complaint filed against me for "abuse" after I removed simple interrupted sutures from a 2yo F "without adequate sedation". Papoosed her, had a tech hold her head and removed the sutures. Kid and mom were both going nuts but it went smoothly otherwise. Am I off base here? Do any of you use procedural sedation for simple suture removal? I explained risks of sedation to mom who was seemingly on board in the treatment room but then complained. I just don't see sedating anyone for essentially a painless, though frightening, procedure. Thoughts?

I agree with you completely. I would not even consider moderate sedation for something simple like a suture removal. Everything is a balance of risks and benefits. Sedating a small child always entails some risk.

 

[WerdSalid]

Depending on the location and extent of the initial laceration itself, I probably woudn't have sedated the child for suture PLACEMENT.

 

[Cerberus]

I don't sedate for suture removal or placement (aside from a little versed if they are really going nuts).

 

[The White Coat Investor]

You did sedate them. You used brutane. 🙂

Seriously though, it would have to be a very unusual case for me to consider sedation for suture removal. I bet you couldn't even bill for it as it would be part of the original procedure.

 

[Birdstrike]

I had a complaint filed against me for "abuse" after I removed simple interrupted sutures from a 2yo F "without adequate sedation". Papoosed her, had a tech hold her head and removed the sutures. Kid and mom were both going nuts but it went smoothly otherwise. Am I off base here? Do any of you use procedural sedation for simple suture removal? I explained risks of sedation to mom who was seemingly on board in the treatment room but then complained. I just don't see sedating anyone for essentially a painless, though frightening, procedure. Thoughts?

Sadly, I've been there, many times. Completely ridiculous, but not surprising at all.

 

[kungfufishing]

Sadly, I've been there, many times. Completely ridiculous, but not surprising at all.

Oh, yeah I always sedate these. Great risk to benefit ratio. Sarcasm. I had a complaint kind of like this from a parent with out of control kids who wanted one sedated for physical exam because couldn't bear to hold her still.


Who are these people? I mean, do you ever wonder if there is some parallel entitled reality inhabited by 60% of the population?

 

[xaelia]

Absorbable sutures.

 

[Apollyon]

I'm just waiting right now for the total spaz to sign up for SDN expressly and exclusively to respond to y'all in this thread, talking out of their ass about why their little darling needs the sedation, ignoring all the risks of sedation, and how we're all sucky doctors with no heart or compassion or brains or skill. The said poster will also archly avoid commenting on their lack of parenting skills, taking it to be just natural for children to run hog wild, without a whit of discipline.

 

[Winged Scapula]

Absorbable sutures.

👍

 

[lucky_deadman]

Absorbable sutures.

Especially if on the face and require sedation/brutane for placement.

The other way out of the headache is to "strongly recommend" they get sutures removed in PCP's office. Most prefer this if they know they will get an ED facility charge even if no doctor bill for the removal.

 

[Tiger26]

Absorbable sutures.

i love 6.0 fast gut

 

[Stitch]

I don't sedate for suture removal or placement (aside from a little versed if they are really going nuts).

Me neither. It's just not worth it. Can you imagine if you had sedated this kid and something had happened?? These people are idiots, and it just proves how America views medicine as a drive through service. They want to call all the shots and take no responsibility. I hope your admin is reasonable about this.

 

[TooMuchResearch]

I'm just waiting right now for the total spaz to sign up for SDN expressly and exclusively to respond to y'all in this thread, talking out of their ass about why their little darling needs the sedation, ignoring all the risks of sedation, and how we're all sucky doctors with no heart or compassion or brains or skill. The said poster will also archly avoid commenting on their lack of parenting skills, taking it to be just natural for children to run hog wild, without a whit of discipline.

Amazing...I was just about to comment on how you are all terrible doctors. Thanks for covering it for me! 👍

/sarcasm

 

[keeping-it-real]

How could you be so insensitive to mommy's little snowflake?

 

[AmoryBlaine]

This is one of those situations where I sometimes imply that I don't understand what people are talking about.

"You wanted her sedated? Hmmm I don't know what you mean by that."

 

[GeneralVeers]

This is why I hate pediatrics. I don't mind the children, it's just that the parents are ***ing nightmares to deal with!

 

[Lumberg]

This is one of those situations where I sometimes imply that I don't understand what people are talking about.

"You wanted her sedated? Hmmm I don't know what you mean by that."

I wish I was smart enough to have thought of that.
I use absorbable sutures in the face almost exclusively but this pt was repaired at OSH. Mom had taken her to her pediatrician who refused to do it and directed her to our ED where the above hilarity ensued. Thanks for all the replies, good to know that there's some sanity left in our world.

 

[KeyserSoze84]

I had a complaint filed against me for "abuse" after I removed simple interrupted sutures from a 2yo F "without adequate sedation". Papoosed her, had a tech hold her head and removed the sutures. Kid and mom were both going nuts but it went smoothly otherwise. Am I off base here? Do any of you use procedural sedation for simple suture removal? I explained risks of sedation to mom who was seemingly on board in the treatment room but then complained. I just don't see sedating anyone for essentially a painless, though frightening, procedure. Thoughts?

that's ridiculous....i would completely agree with you and do not see the need for sedation for suture removal...tell that 2yo to suck it up!

 

[WerdSalid]

To me, the REAL insanity in the whole situation is that the pediatrician refused to remove the sutures. seriously?

 

[Stitch]

To me, the REAL insanity in the whole situation is that the pediatrician refused to remove the sutures. seriously?

Yeah, that's definitely crap. We get a few offices around here that won't do it. I'm told it's because they can't bill for it, and so they dump it on us.

This whole debacle reminds me of the two page letter of complaint I got for not ordering a CBC and BMP on a 4 year old who vomited twice. The worst part was that mom was a doc. 🙄

 

[docB]

This kind of situation serves to illustrate the problem with our over regulated, "customer service" oriented climate. This complaint is just patently ridiculous. However we all know that a letter to admin will result in a lot of inconvenience for everyone and something along the lines of "You should have handled this better." to the doc. And that's for a letter to admin. A letter to the board would be much worse. The situation continues to deteriorate.