Checklist 39 outlines the steps for removing staples from a wound. 1. note: When applicable, special installation instructions are provided for an assembly at the end of the removal procedure. Slide the lower part of a staple extractor tool underneath the outermost staple on either side of the stapled area. Staples are typically removed in about 7 days on the scalp and 10 days on the back, abdomen and extremities. 15. 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. 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). Hand hygiene reduces the risk of infection. 4.7 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. 10. This step allows easy access to required supplies for the procedure. Procedure: Anoscopy. Place lower tip of staple extractor beneath the staple. As you start to remove the staples, you notice that the skin edges of the incision line are separating. 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. The staple remover is sterilized using boiling water or antibacterial solution. PROCEDURE: A patient may present after being sutured here or from an outside facility. Staple extractor may be disposed of or sent for sterilization. Professional Healthcare, Inc. 2 of 2 G180 Surgical Staple Removal 14. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. 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. Scalp laceration repair is discussed below given its common occurrence in the ED population. Return precautions are given. 14. Instruct patient not to pull off Steri-Strips and to allow them to fall off naturally and gradually (usually takes one to three weeks). Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation. 6. This reduces the risk of infection from microorganisms on the wound site or surrounding skin. To remove skin staples, use a skin staple removal tool. Provide opportunity for the patient to deep breathe and relax during the procedure. What would you do next. The nurse reviews chart or documentation from outside facility for suture removal instructions. As you start to remove the staples, you notice that the skin edges of the incision line are separating. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. 13. Removal of staples Note: Specific instructions from the medical officer must be received before removing staples. 16. After cleansing the wound, the doctor will gently back out each staple with the remover. You are about to remove your patient’s abdominal incision staples according to the prescriber’s orders. 4.4 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. 15. All wounds held together with staples require an assessment to ensure the wound is sufficiently healed to remove the staples. Ensure proper body mechanics for yourself and create a comfortable position for the patient. Assess incision site. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 1 to 2 in long. Data source: BCIT, 2010c; Perry et al., 2018. 16. Importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Clean incision site according to agency policy. Provide opportunity for the patient to deep breathe and relax during the procedure. Using the principles of sterile technique, place Steri-Strips on location of every removed staple along incision line. Contact physician for further instructions. 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. To remove intermittent sutures, hold scissors in dominant hand and forceps in non-dominant hand. 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. Position patient appropriately and create privacy for procedure. Inform patient the procedure is not painful but the patent may feel some pulling or pinching of the skin during staple removal. Note: If this is a clean procedure you simply need a clean surface for your supplies. Confirm physician orders, and explain procedure to patient. The staple backs out of the skin the very same direction in which it was placed. 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. Report any unusual findings or concerns to the appropriate healthcare professional. It also prevents scratching the skin with the sharp staple. Your doctor will tell you when to have your stitches or staples removed. 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 When removing staples, consider the length of time the staples have been in situ. Using the principles of asepsis, place Steri-Strips perpendicular along the incision line with gaps of approximately 2 to 3 mm between each. Your patient informs you that he is feeling significant pain as you begin to remove his staples. This provides patient with a safe, comfortable place, and attends to pain needs as required. Wound dehiscence, a mechanical failure of wound healing, remains a problem and can be affected by multiple factors (Spiliotis et al., 2009). 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. This allows wound to heal by primary intention. Cleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed. Take care when handling the optional equipment that is attached to the machine. Staple Removal. This is usually in 7 to 14 days. Data source: BCIT, 2010c; Perry et al., 2014, Table 4.5 Complications of Staple Removal. Table 4.10 lists other complications of removing staples. 5. 11. Confirm prescriber’s orders, and explain procedure to patient. What would you do next. Diagnosis: Rectal bleeding. 3. In general, staples are removed within 7 to 14 days. After assessing the wound, determine if the wound is sufficiently healed to have the staples removed. 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. Removal of staples requires aseptic considerations and a staple extractor. Staples are made of stainless steel wire and provide strength for wound closure. 17. Staple removal may lead to complications for the patient. This reduces the risk of infection from microorganisms on the wound site or surrounding skin. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. 1. Gather appropriate supplies after deciding if this is a clean or sterile procedure. They may be placed deep in the tissue and/or superficially to close a wound. 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. Instruct patient to take showers rather than bathe. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. This document provides the procedures to remove and replace the staple cartridge. Take care when handling the optional equipment that is attached to the machine. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. These issues caused us to question whether the practice of delayed skin staple removal in obese women is warranted. The staple should drop into the bag. 2. Position patient appropriately and create privacy for procedure. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. It also prevents scratching the skin with the sharp staple. 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