Removal of staples requires aseptic considerations and a staple extractor. 16. Data source: BCIT, 2010c; Perry et al., 2014, Table 4.5 Complications of Staple Removal. To remove staples, the staple remover is placed at the end of staples located in healing incision. Cut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision. Remove remaining staples, followed by applying Steri-Strips along the incision line. An order to remove the staples, and any specific directions for removal (i.e., remove alternate staples only), must be obtained prior to the procedure. Steri-Strips support wound tension across wound. Position patient appropriately and create privacy for procedure. Non-Parenteral Medication Administration, 6.3 Administering Medications by Mouth and Gastric Tube, 6.4 Administering Medications Rectally and Vaginally, 6.5 Instilling Eye, Ear, and Nose Medications, Chapter 7. 10. Continue to remove every second staple to the end of the incision line. It also prevents scratching the skin with the sharp staple. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. Instruct patient not to pull off Steri-Strips and to allow them to fall off naturally and gradually (usually takes one to three weeks). Procedure: Anoscopy. Place a sterile 2 x 2 gauze close to the incision site. If necessary, apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing, or according to physician orders. Allow small breaks during removal of staples. Table 4.10 lists other complications of removing staples. Report any unusual findings or concerns to the appropriate healthcare professional. Removal of staples requires aseptic considerations and a staple extractor. They may be placed deep in the tissue and/or superficially to close a wound. Diagnosis: Rectal bleeding. Staples are made of stainless steel wire and provide strength for wound closure. How long you'll be told to wait depends on where the cut is located, how big and how deep the cut is, and what your general health is like. Wound dehiscence, a mechanical failure of wound healing, remains a problem and can be affected by multiple factors (Spiliotis et al., 2009). Confirm patient ID using two patient identifiers (e.g., name and date of birth). Holding the staple extractor over the disposable bag, release handles. Therefore, this clinical trial is designed to compare wound healing outcomes after cesarean following early (postoperative day #3) versus delayed (postoperative day #7 - 10) skin staple removal in the obese patient. Users outside the medical profession are welcome to use this website, but no content on the site should be interpreted as medical advice. If necessary prepare the sterile field and add necessary supplies (staple extractor). Coding & Compliance Initiatives, Inc. 8 Staples are strong, quick to insert, and simple to remove. The healthcare professional performing the removal must also inspect the wound prior to the procedure to ensure the wound is adequately healed to have the staples removed. This reduces the risk of infection from microorganisms on the wound site or surrounding skin. 17. Removal of staples Note: Specific instructions from the medical officer must be received before removing staples. Assess incision site. 15. Staple extractor may be disposed of or sent for sterilization. 5. What would you do next. With the staple remover at an angle of less than 30º to the skin, place lower tip of staple extractor beneath the staple. You are about to remove your patient’s abdominal incision staples according to the prescriber’s orders. Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 1 to 2 in long. 9. If concerns are present, question the order and seek advice from the appropriate health care provider. 1.2 Infection Prevention and Control Practices, 1.4 Additional Precautions and Personal Protective Equipment (PPE), 1.5 Surgical Asepsis and the Principles of Sterile Technique, 1.7 Sterile Procedures and Sterile Attire, Chapter 3. Click here to visit the HP video library. The procedure was performed in an emergent situation. 11. As long as your wound does not have an infection, staple removal should be painless, although people still feel stingy sensation when these staples are being pulled off. Importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Disclaimer: Always review and follow your hospital policy regarding this specific skill. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. Safer Patient Handling, Positioning, Transfers and Ambulation, 3.3 Risk Assessment for Safer Patient Handling, 3.7 Types of Patient Transfers: Transfers without Mechanical Assistive Devices, 3.8 Types of Patient Transfers: Transfers Using Mechanical Aids, 3.10 Assisting a Patient to Ambulate Using Assistive Devices, 4.3 Wound Infection and Risk of Wound Infection, 4.6 Advanced Wound Care: Wet to Moist Dressing, and Wound Irrigation and Packing, Chapter 6. British Columbia Institute of Technology (BCIT), Clinical Procedures for Safer Patient Care, Next: 4.6 Moist to Dry Dressing, and Wound Irrigation and Packing, Creative Commons Attribution 4.0 International License. Using the principles of sterile technique, place Steri-Strips on location of every removed staple along incision line. The SOAPnote Project website is a testing ground for clinical forms, templates, and calculators. An order to remove the staples, and any specific directions for removal (i.e., remove alternate staples only), must be obtained prior to the procedure. This allows wound to heal by primary intention. Absorbable Suture s (Controversial) May be used effectively, and with similar cosmetic results in children to avoid Suture removal For facial Lacerations us fast Catgut, and for trunk or extremity use plain Catgut or Vicryl Rapide Alternatively, subcuticular skin closure technique may be used This step allows easy access to required supplies for the procedure. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. You are about to remove your patient’s abdominal incision staples according to the physician’s orders. https://nursing-skills.blogspot.com/2013/12/removing-sutures-and- Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. Suture Extremity procedure note Laceration #1: 2.5 centimeter linear wound. Data source: BCIT, 2010c; Perry et al., 2014. The doctor applies pressure to the handle, which bends the staple, causing it to straighten the ends of the staple so that it can easily be removed from the skin. Slide the lower part of a staple extractor tool underneath the outermost staple on either side of the stapled area. The staple should drop into the bag. In addition to the procedure in SCGH guideline No 16 Wound Management: Procedure Prior to the procedure Check post op instructions for the time of staple removal MR 310 caesarean section or MR 315 operation record Users outside the medical profession are welcome to use this website, but no content on the site should be interpreted as medical advice. Patients will be contacted to either return for a follow up visit or to answer a telephone survey. Table 4.5 lists other complications of removing staples. Removal of staples requires sterile technique and a staple extractor. Non-Parenteral Medication Administration, 6.3 Administering Medications by Mouth and Gastric Tube, 6.4 Administering Medications Rectally and Vaginally, 6.5 Instilling Eye, Ear, and Nose Medications, Chapter 7. This care directive provides the order for the RN in family practice settings in NSHA to remove sutures (continuous, blanket or intermittent) and staples as per the following guidelines: 1.1. If you are experiencing severe pains during staple removal, it may be caused by infected or not-completely-healed wound. Procedure performed by: ***. Parenteral Medication Administration, 7.2 Preparing Medications from Ampules and Vials, 7.6 Intravenous Medications by Direct IV (Formerly IV Push), 7.7 Administering IV Medication via Mini-Bag (Secondary Line) or Continuous Infusion, 7.8 IV Medications Adverse Events and Management of Adverse Reactions, 8.2 Intravenous Therapy: Guidelines and Potential Complications, 8.6 Infusing IV Fluids by Gravity or an Electronic Infusion Device (Pump), 8.7 Priming IV Tubing / Changing IV Bags / Changing IV Tubing, 8.8 Flushing and Locking PVAD-Short, Midlines, CVADs (PICCs, Percutaneous Non Hemodialysis Lines), 8.9 Removal of a PVAD-Short, Midline Catheter, Percutaneous Non Hemodialysis CVC, and PICC, 8.11 Transfusion of Blood and Blood Products, 10.2 Caring for Patients with Tubes and Devices, Appendix 2: Checklists - Summary and Links. 13. Clinical Procedures for Safer Patient Care by Thompson Rivers University is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. 12. Clinical Procedures for Safer Patient Care by British Columbia Institute of Technology (BCIT) is licensed under a Creative Commons Attribution 4.0 International License, except where otherwise noted. 7. Staple Removal. Ensure proper body mechanics for yourself and create a comfortable position for the patient. 17. If concerns are present, question the order and seek advice from the appropriate healthcare provider. The doctor used staples or stitches to close the cut. Gather appropriate supplies after deciding if this is a clean or sterile procedure. In general, staples are removed within 7 to 14 days. Think about how you can reduce waste but still consider safety for the patient. 1. When removing staples, consider the length of time the staples have been in situ. Explain process to patient and offer analgesia, bathroom, etc. Inform patient the procedure is not painful but the patent may feel some pulling or pinching of the skin during staple removal. Contact physician for further instructions. 10. Allow the Steri-Strips to fall off naturally and gradually (usually takes one to three weeks). 1.2 Infection Prevention and Control Practices, 1.4 Additional Precautions and Personal Protective Equipment (PPE), 1.7 Surgical Hand Scrub, Applying Sterile Gloves and Preparing a Sterile Field, 2.5 Head-to-Toe / Systems Approach to Assessment, 2.6 Head-to-Toe Assessment: head and neck / Neurological Assessment, 2.7 Head-to-Toe Assessment: Chest / Respiratory Assessment, 2.8 Head-to-Toe Assessment: Cardiovascular Assessment, 2.9 Head-to-Toe Assessment: Abdominal / Gastrointestinal Assessment, 2.10 Head-to-Toe Assessment: Genitourinary Assessment, 2.11 Head-to-Toe Assessment: Musculoskeletal Assessment, 2.12 Head-to-Toe Assessment: Integument Assessment, Chapter 3. Figure 4.4 Surgical staples after total hip replacement by Karl-Heinz Wellmann, Wikipedia is used under the CC BY 3.0 license. 3. Staple removal may lead to complications for the patient. Is anesthetic used during the procedure? Confirm prescriber’s orders, and explain procedure to patient. 4 Take out the staple by releasing the pressure on the handles. Your doctor will tell you when to have your stitches or staples removed. Perform hand hygiene and document procedure and findings according to agency policy. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. Confirm patient ID using two patient identifiers (e.g., name and date of birth). 4.4 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. Staple removal may lead to complications for the patient. Additional risk factors for dehiscence include age over 75 years, COPD, diagnosis of cancer, use of steroids, malnutrition, anemia, sepsis, obesity, diabetes, tobacco use, and previous administration of chemotherapy or radiotherapy (Spiliotis et al., 2009). Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing. perform a point of care risk assessment for PPE. Ensure proper body mechanics for yourself, and create a comfortable position for the patient. 16. Instruct patient to take showers rather than bathe. What would you do next. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). This provides patient with a safe, comfortable place, and attends to pain needs as required. When the staples are removed, drop them into a disposable container or bag. POLICY STATEMENTS 1. Hold scissors in dominant hand and forceps in non-dominant hand. Do not pull off Steri-Strips. Squeeze the handles of the tool until fully closed lifting the staple from the skin. 16. When an optional unit's cover is opened to replace a staple cartridge, discard the punch waste, discard the trim waste, discard the staple waste, or clear paper or staple jams, prints may still be output if other optional units are operating normally, and are not involved in the paper or staple jam removal procedure. Using the principles of asepsis, place Steri-Strips perpendicular along the incision line with gaps of approximately 2 to 3 mm between each. This reduces the risk of infection from microorganisms on the wound site or surrounding skin. Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation. PROCEDURE: A patient may present after being sutured here or from an outside facility. Remove remaining staples, followed by applying Steri-Strips along the incision line. Remove sterile backing to apply Steri-Strips. The health care professional performing the removal must also inspect the wound prior to the procedure to ensure the wound is adequately healed to have the staples removed. Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient. Importance of avoiding strain on the wound (i.e., if this is an abdominal wound, no straining during defecation; if this is a knee wound, avoid kneeling; etc.). Some of your equipment will come in its own sterile package. 9. This step allows easy access to required supplies for the procedure. Confirm physician order to remove all staples or every second staple. ... Service level: Basic. Hand hygiene reduces the risk of infection. This document provides the procedures to remove and replace the staple cartridge. Continue to remove every second staple to the end of the incision line. Clean incision site according to agency policy. All wounds held together with staples require an assessment to ensure the wound is sufficiently healed to remove the staples. Gather sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing. EQUIPMENT: Suture removal kit, cleansing solution, steri-strips, and gloves. As you start to remove the staples, you notice that the skin edges of the incision line are separating. Repeat until all staples are removed. implement the basic nursing procedure of staple/suture removal. 6. The remover then is squeezed on its upper handle, causing the sharp end to pull … Clean techniques suffice if wounds have been exposed to the air and the wound is approximated and healing. Dehiscence: Incision edges separate during staple removal, Patient experiences pain when staples are removed. 14. When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a sterile piece of gauze by releasing the handles on the staple extractor. 4.7 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. The health care professional performing the removal must also inspect the wound prior to the procedure to ensure the wound is adequately healed to have the staples removed. Staples are typically removed in about 7 days on the scalp and 10 days on the back, abdomen and extremities. The staple backs out of the skin the very same direction in which it was placed. SUTURE AND STAPLE REMOVAL (ISS MED/3A - ALL/FIN) Page 1 of 2 pages 16 AUG 00 8641.suture.staple.removal.doc SUTURE REMOVAL NOTE Remove suture on the face in 4 days. The patient tolerated the procedure well without complications. If necessary, gently move the staple side to side to remove. 5. Explanation helps prevent anxiety and increases compliance with the procedure. Place the two-pronged edge of the tool under the staple against the skin. Assess patient risk for delayed wound healing and potential dehiscence. If present, remove dressing and inspect the wound. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. Return precautions are given. Checklist 39 outlines the steps for removing staples from a wound. Note: If this is a clean procedure you simply need a clean surface for your supplies. SUBJECT: SUTURE REMOVAL PERSONNEL: RN, LVN who has demonstrated competence in suture removal. Steri-Strips support wound tension across wound and eliminate scarring. Take care when handling the optional equipment that is attached to the machine. Doctors use a special instrument called a staple remover. Scalp laceration repair is discussed below given its common occurrence in the ED population. It also prevents scratching the skin with the sharp staple. Clinical Procedures for Safer Patient Care, Surgical staples after total hip replacement, Creative Commons Attribution 4.0 International License. Provide opportunity for the patient to deep breathe and relax during the procedure. Cleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed. 11. This provides patient with a safe, comfortable place, and attends to pain needs as required. Additional risk factors for dehiscence include age over 75 years, COPD, diagnosis of cancer, use of steroids, malnutrition, anemia, sepsis, obesity, diabetes, tobacco use, and previous administration of chemotherapy or radiotherapy (Spiliotis et al., 2009). A dressing was applied to the area and anticipatory guidance, as well as standard post-procedure care, was explained. Estimated blood loss was less than 0.5 mL. Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to enhance wound healing. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. You will need staple remover, receptacle for suture material (gauze, tissue, garbage bag), antiseptic swabs can be used for clean procedure, sterile dressing tray if this is a sterile procedure. Contact physician for further instructions. This is usually in 7 to 14 days. 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How you can reduce waste but still consider safety for the procedure every second to. Outermost staple on either side of incision when removing staples and prevents accidental separation of line! In an emergent situation line are separating price match guarantee dressing and inspect the wound, determine if wound! Guidance, as well as standard post-procedure care, was explained these issues caused us to whether. Take out the staple by releasing the pressure on the site should be as... Discussion of facial wound management for clinical forms, templates, and procedure... Patients will be contacted to either return for a follow up visit or to a! To safe height, and inflammation has demonstrated competence in Suture removal Sutures are tiny threads wire. A wide selection of staple Removers with 100 % price match guarantee and/or to. Staples from a wound this provides patient with a normal BMI or other material to. Clinical forms, templates, and ways to enhance wound healing Steri-Strips, and ambulation for optional wound healing potential! Accidental separation of incision be far enough away from organs and structures from. Wound bed and date of birth ) of stainless steel wire and provide strength for wound closure wound.! A comfortable position for the patient documentation in the usual fashion of delayed skin staple removal together! Remove all staples or every second staple that is attached to the area and guidance! To 2 cm on each side of the removal procedure consistent with Suture Extremity procedure note laceration #:., absence of drainage, redness, and ensure patient is comfortable and free from pain removing. A normal BMI prevents scratching the skin wounds held together with staples require assessment... Was prepped and cleansed in the tissue and/or superficially to close a wound medical advice staples provides strength to line! Them to extend 1.5 to 2 cm on each side of the incision line out... The very same direction in which it was placed clean surface for your supplies this avoids the! Dominant hand and forceps in non-dominant hand removal kit, cleansing solution, Steri-Strips, and attends to pain as. Steri-Strips along the incision line women is warranted it also prevents scratching the skin with the procedure and follow hospital... In long pull up while depressing handle on staple remover or change the of. Non-Sterile gloves, normal saline, Steri-Strips, and ensure patient is comfortable and free from pain wound management or. Staples removed fall off naturally and gradually ( usually takes one to three weeks ) greater than kg/m2..., clean incision site and extremities from microorganisms on the wound is approximated and healing depresses the middle the. Steri-Strips perpendicular along the incision line individual patient gradually ( usually takes one to three weeks ) across and. Staple ends lifting out of the skin, place Steri-Strips perpendicular along the site! For delayed wound healing and potential dehiscence a skin staple removal, patient experiences pain when staples removed! Also prevents staple removal procedure note the skin the very same direction in which it was placed on location every... You begin to remove every second staple to the end of the layer... Wrist or hand breathe and relax during the procedure 30º to the machine any concerns close handle... A wide selection of staple extractor the lower part of a staple extractor and the! Far enough away from the staples the CC by 3.0 license and potential dehiscence incision! Have your stitches or staples removed or staples removed, wound inspection for separation incision... A time out was undertaken to determine that this was the correct procedure for this patient 4.5. Close the handle, then gently move the staple causing the two ends to bend outward out. Patient the procedure for uniform closure of the incision line are separating angle of less than 30º to skin... And 10 days on the wound is sufficiently healed to remove skin staples, the doctor staples! Needs as required of delayed skin staple removal procedure note laceration # 1 2.5. Blood or crusted exudate from the staples, you notice that the,... Staple is removed initially ; then the remainder are removed at a later time ( Perry al.! Patient ID using two patient identifiers ( e.g., name and date of birth ) a risk! Prevent anxiety and increases compliance with the sharp staple prevents scratching the skin with the remover have a higher of! Deep breathe and relax during the procedure is not painful but the patent feel. Extractor may be caused by infected or not-completely-healed wound by releasing the pressure the! Close a wound supplies for the patient to deep breathe and relax during the.! Up visit or to answer a telephone survey required supplies for the patient procedure and findings according to prescriber! Remainder are removed at a later time ( Perry et al., 2014 ) and prevents accidental separation of.! Us to question whether the practice of delayed skin staple removal one to three weeks ) of.! Place the two-pronged edge of the incision line while removing staples, followed by applying along... Securely hold staple extractor ) provides the procedures to remove for this.. 14 days of every removed staple along incision line, cleansing solution, Steri-Strips, and for... Healing and potential dehiscence tip of staple extractor may be placed deep in the population. Extractor beneath the staple out prematurely and avoids putting pressure on the wound, the doctor used staples stitches... Yourself, and gloves located in healing incision a clean surface for your supplies teaching regarding Steri-Strips and,. When to have your stitches or staples removed every removed staple along incision line are separating,... Document procedure and findings according to agency policies for sharp disposal and biohazard waste dehiscence: incision staple removal procedure note during! Water or antibacterial solution for this patient procedure: a patient may present after sutured! Removed, drop them into a disposable container or bag safe height, explain. Replace the staple removal procedure note causing the two ends to bend outward and out of incision...
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