note: When applicable, special installation instructions are provided for an assembly at the end of the removal procedure. Clinical Procedures for Safer Patient Care, Surgical staples after total hip replacement, Creative Commons Attribution 4.0 International License. Staple removal may lead to complications for the patient. In general, staples are removed within 7 to 14 days. 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. 14. 2. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. PROCEDURE: A patient may present after being sutured here or from an outside facility. 5. As you start to remove the staples, you notice that the skin edges of the incision line are separating. Squeeze the handles of the tool until fully closed lifting the staple from the skin. ... Service level: Basic. Removal of staples requires aseptic considerations and a staple extractor. Allow small breaks during removal of staples. Required items: required blood products, implants, devices, and special equipment available Patient identity confirmed: arm band Time out: Immediately prior to procedure a "time out" was called to verify the correct patient, procedure, equipment, support staff and site/side marked as required. The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. 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. Confirm physician order to remove all staples or every second staple. 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. Figure 4.4 Surgical staples after total hip replacement by Karl-Heinz Wellmann, Wikipedia is used under the CC BY 3.0 license. This allows wound to heal by primary intention. 15. Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing. 17. After assessing the wound, determine if the wound is sufficiently healed to have the staples removed. Disclaimer: Always review and follow your agency policy regarding this specific skill. 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. 16. The remover then is squeezed on its upper handle, causing the sharp end to pull … If present, remove dressing and inspect the wound. Explanation helps prevent anxiety and increases compliance with the procedure. Remove dressing and inspect the wound. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. Perform hand hygiene and document procedure and findings according to agency policy. Parenteral Medication Administration, 7.2 Parenteral Medications and Preparing Medications from Ampules and Vials, 7.3 Intradermal and Subcutaneous Injections, 7.5 Intravenous Medications by Direct IV Route, 7.6 Administering Intermittent Intravenous Medication (Secondary Medication) and Continuous IV Infusions, 7.7 Complications Related to Parenteral Medications and Management of Complications, 8.3 IV Fluids, IV Tubing, and Assessment of an IV System, 8.4 Priming IV Tubing and Changing IV Fluids and Tubing, 8.5 Flushing a Saline Lock and Converting a Saline Lock to a Continuous IV Infusion, 8.6 Converting an IV Infusion to a Saline Lock and Removal of a Peripheral IV, 8.7 Transfusion of Blood and Blood Products, 10.2 Caring for Patients with Tubes and Attachments. Holding the staple extractor over the disposable bag, release handles. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only. Professional Healthcare, Inc. 2 of 2 G180 Surgical Staple Removal 14. 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. What would be your next steps? 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. Assess incision site. 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. Shop Staple Removers from Staples.ca. Wound dehiscence, a mechanical failure of wound healing, remains a problem and can be affected by multiple factors (Spiliotis et al., 2009). Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 1 to 2 in long. A dressing was applied to the area and anticipatory guidance, as well as standard post-procedure care, was explained. Confirm physician orders, and explain procedure to patient. Steri-Strips support wound tension across wound and eliminate scarring. Explain process to patient and offer analgesia, bathroom, etc. When the staples are removed, drop them into a disposable container or bag. 15. Removal of staples requires sterile technique and a staple extractor. Importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Securely hold staple extractor and move the staple away from the incision site. Report any unusual findings or concerns to the appropriate healthcare professional. You are about to remove your patient’s abdominal incision staples according to the physician’s orders. 14. 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. Dehiscence: Incision edges separate during staple removal, Patient experiences pain when staples are removed. Staples are made of stainless steel wire and provide strength for wound closure. This allows wound to heal by primary intention. 5. Position patient appropriately and create privacy for procedure. 3. 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. Your patient informs you that he is feeling significant pain as you begin to remove his staples. This document provides the procedures to remove and replace the staple cartridge. Wiggle the staple gently side to side until it comes out of the skin. Staples are typically removed in about 7 days on the scalp and 10 days on the back, abdomen and extremities. 18. They may be placed deep in the tissue and/or superficially to close a wound. SUBJECT: SUTURE REMOVAL PERSONNEL: RN, LVN who has demonstrated competence in suture removal. Return precautions are given. The SOAPnote Project website is a testing ground for clinical forms, templates, and calculators. 4 Take out the staple by releasing the pressure on the handles. Clean techniques suffice if wounds have been exposed to the air and the wound is approximated and healing. Using the principles of sterile technique, place Steri-Strips on location of every removed staple along incision line. Procedure performed by: ***. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. 16. 3. Position patient appropriately and create privacy for procedure. Is anesthetic used during the 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. Procedure: Anoscopy. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. 16. Note: If this is a clean procedure you simply need a clean surface for your supplies. 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. Do not pull off Steri-Strips. Gather sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing. Estimated blood loss was less than 0.5 mL. Disclaimer: Always review and follow your hospital policy regarding this specific skill. 12. Contact physician for further instructions. Instruct patient to take showers rather than bathe. Instruct patient not to pull off Steri-Strips and to allow them to fall off naturally and gradually (usually takes one to three weeks). The nurse reviews chart or documentation from outside facility for suture removal instructions. 8. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). This avoids pulling the staple out prematurely and avoids putting pressure on the wound. https://nursing-skills.blogspot.com/2013/12/removing-sutures-and- 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. Place lower tip of staple extractor beneath the staple. Confirm patient ID using two patient identifiers (e.g., name and date of birth). 7. Think about how you can reduce waste but still consider safety for the patient. Data source: BCIT, 2010c; Perry et al., 2014, Table 4.5 Complications of Staple Removal. 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). POLICY STATEMENTS 1. The upper part of the staple remover will push down the middle of the staple, causing the staple ends to pull out of the incision. Click here to visit the HP video library. In general, staples are removed within 7 to 14 days. Observe the wound for signs and symptoms of infection and notify a healthcare professional if any concerns. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. Hand hygiene reduces the risk of infection. Contact physician for further instructions. implement the basic nursing procedure of staple/suture removal. Table 4.10 lists other complications of removing staples. Diagnosis: Rectal bleeding. 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. Clean incision site according to agency policy. This step allows easy access to required supplies for the procedure. What would you do next. 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. Safe Patient Handling, Positioning, and Transfers, 3.6 Assisting a Patient to a Sitting Position and Ambulation, 4.6 Moist to Dry Dressing, and Wound Irrigation and Packing, Chapter 6. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. Discard supplies according to agency policies for sharp disposal and biohazard waste. 12. Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing, or according to physician orders. They may be placed deep in the tissue and/or superficially to close a wound. 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. 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.). This reduces the risk of infection from microorganisms on the wound site or surrounding skin. Continue to remove every second staple to the end of the incision line. Data source: BCIT, 2010c; Perry et al., 2014. Staple extractor may be disposed of or sent for sterilization. With the staple remover at an angle of less than 30º to the skin, place lower tip of staple extractor beneath the staple. Steri-Strips support wound tension across wound. 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