staple removal procedure note
Importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 1 to 2 in long. Take care when handling the optional equipment that is attached to the machine. Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation. If necessary, clean incision site according to agency policy. Place lower tip of staple extractor beneath the staple. Inform patient the procedure is not painful, but the patent may feel some pulling or pinching of the skin during staple removal. A time out was undertaken to determine that this was the correct patient and the correct procedure for this patient. The staple should drop into the bag. 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. Close the handle, then gently move the staple side to side to remove. Disclaimer: Always review and follow your hospital policy regarding this specific skill. These issues caused us to question whether the practice of delayed skin staple removal in obese women is warranted. Do not pull off Steri-Strips. 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. 13. note: When applicable, special installation instructions are provided for an assembly at the end of the removal procedure. Continue to remove every second staple to the end of the incision line. When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a receptacle by releasing the handles on the staple extractor. Confirm patient ID using two patient identifiers (e.g., name and date of birth). Instruct patient to take showers rather than bathe. The SOAPnote Project website is a testing ground for clinical forms, templates, and calculators. • Dressing changes, local incision care, removal of operative pack, sutures, staples, lines, wires, tubes, drains, casts, and splints, insertion, irrigation and removal of urinary catheters, routine peripheral intravenous lines, nasogastric and rectal tubes, and changes and removal of tracheostomy tubes. As you start to remove the staples, you notice that the skin edges of the incision line are separating. Position patient appropriately and create privacy for procedure. Dehiscence: Incision edges separate during staple removal, Patient experiences pain when staples are removed. Wound dehiscence, a mechanical failure of wound healing, remains a problem and can be affected by multiple factors (Spiliotis et al., 2009). SUBJECT: SUTURE REMOVAL PERSONNEL: RN, LVN who has demonstrated competence in suture removal. As you start to remove the staples, you notice that the skin edges of the incision line are separating. This reduces the risk of infection from microorganisms on the wound site or surrounding skin. This step allows easy access to required supplies for the procedure. Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Confirm prescriber’s orders, and explain procedure to patient. When removing staples, consider the length of time the staples have been in situ. 10. Place a sterile 2 x 2 gauze close to the incision site. If necessary, gently move the staple side to side to remove. Gather appropriate supplies after deciding if this is a clean or sterile procedure. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. When the staples are removed, drop them into a disposable container or bag. 3. Close the handle, observe the staple ends lifting out of the skin. 16. What would be your next steps? Staple removal may lead to complications for the patient. Provide opportunity for the patient to deep breathe and relax during the procedure. Procedure performed by: ***. Think about how you can reduce waste but still consider safety for the patient. implement the basic nursing procedure of staple/suture removal. 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. perform a point of care risk assessment for PPE. Remove dressing and inspect the wound. Hold scissors in dominant hand and forceps in non-dominant hand. Remove remaining staples, followed by applying Steri-Strips along the incision line. Data source: BCIT, 2010c; Perry et al., 2014. PROCEDURE: A patient may present after being sutured here or from an outside facility. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. 14. It also prevents scratching the skin with the sharp staple. ... Service level: Basic. Perform hand hygiene and document procedure and findings according to agency policy. This provides patient with a safe, comfortable place, and attends to pain needs as required. Procedure: Anoscopy. What would be your next steps? Contact physician for further instructions. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. 8. Place the two-pronged edge of the tool under the staple against the skin. 12. The patient tolerated the procedure well without complications. 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. Is anesthetic used during the procedure? Staples are made of stainless steel wire and provide strength for wound closure. The timing of suture/staple removal must be consistent with After cleansing the wound, the doctor will gently back out each staple with the remover. 6. 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. 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. Squeeze the handles of the tool until fully closed lifting the staple from the skin. 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. When removing staples, consider the length of time the staples have been in situ. Checklist 36 outlines the steps for removing staples from a wound. Clean techniques suffice if wounds have been exposed to the air and the wound is approximated and healing. Confirm physician orders, and explain procedure to patient. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. 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. Suture Extremity procedure note Laceration #1: 2.5 centimeter linear wound. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. 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. Assess incision site. Clinical Procedures for Safer Patient Care, Surgical staples after total hip replacement, Creative Commons Attribution 4.0 International License. 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. 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. Doctors use a special instrument called a staple remover. Steri-Strips and outer dressing, if indicated. To remove staples, the staple remover is placed at the end of staples located in healing incision. Hand hygiene reduces the risk of infection. Staple Removal. Table 4.5 lists other complications of removing staples. The staple remover is sterilized using boiling water or antibacterial solution. Gather sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing. Wiggle the staple gently side to side until it comes out of the skin. 4.4 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. Discard supplies according to agency policies for sharps disposal and biohazard waste. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. 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. Coding & Compliance Initiatives, Inc. 8 Remove sterile backing to apply Steri-Strips. Confirm patient ID using two patient identifiers (e.g., name and date of birth). If concerns are present, question the order and seek advice from the appropriate healthcare provider. Steri-Strips support wound tension across wound. The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. Users outside the medical profession are welcome to use this website, but no content on the site should be interpreted as medical advice. 8. Some of your equipment will come in its own sterile package. POLICY STATEMENTS 1. https://nursing-skills.blogspot.com/2013/12/removing-sutures-and- Cleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed. A dressing was applied to the area and anticipatory guidance, as well as standard post-procedure care, was explained. Your patient informs you that he is feeling significant pain as you begin to remove his staples. Cut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision. This step allows easy access to required supplies for the procedure. 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. Note: This post is my no means all encompassing in its discussion of facial wound management. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. This is usually in 7 to 14 days. The staple backs out of the skin the very same direction in which it was placed. Browse a wide selection of Staple Removers with 100% price match guarantee! What would you do next. Data source: BCIT, 2010c; Perry et al., 2014, Table 4.5 Complications of Staple Removal. To remove intermittent sutures, hold scissors in dominant hand and forceps in non-dominant hand. Checklist 39 outlines the steps for removing staples from a wound. Holding the staple extractor over the disposable bag, release handles. Hand hygiene reduces the risk of infection. Dehiscence: Incision edges separate during staple removal, Patient experiences pain when staples are 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). Staple extractor may be disposed of or sent for sterilization. Steri-Strips support wound tension across wound and eliminate scarring. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only. Staples are made of stainless steel wire and provide strength for wound closure. If you are experiencing severe pains during staple removal, it may be caused by infected or not-completely-healed wound. 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. Slide the lower part of a staple extractor tool underneath the outermost staple on either side of the stapled area. Informed Consent: Informed consent was obtained.. Verification: I have verified the correct patient, correct procedure, correct position, correct site/side, and available equipment.. Anesthesia/Sedation: None. All wounds held together with staples require an assessment to ensure the wound is sufficiently healed to remove the staples. In general, staples are removed within 7 to 14 days. 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. Using the principles of asepsis, place Steri-Strips perpendicular along the incision line with gaps of approximately 2 to 3 mm between each. Contact physician for further instructions. Assess patient risk for delayed wound healing and potential dehiscence. 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. If concerns are present, question the order and seek advice from the appropriate health care provider. Your doctor will tell you when to have your stitches or staples removed. If present, remove dressing and inspect the wound. Estimated blood loss was less than 0.5 mL. 1. 2. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation. Disclaimer: Always review and follow your agency policy regarding this specific skill. Allow the Steri-Strips to fall off naturally and gradually (usually takes one to three weeks). 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. 15. Explanation helps prevent anxiety and increases compliance with the procedure. Continue to remove every second staple to the end of the incision line. Discard supplies according to agency policies for sharp disposal and biohazard waste. 10. 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 9. The nurse reviews chart or documentation from outside facility for suture removal instructions. After assessing the wound, determine if the wound is sufficiently healed to have the staples removed. 15. Your documentation in the medical record should always reflect precisely your specific interaction with an individual patient. Shop Staple Removers from Staples.ca. You are about to remove your patient’s abdominal incision staples according to the physician’s orders. Securely hold staple extractor and move the staple away from the incision site. 4 Take out the staple by releasing the pressure on the handles. Do not pull up while depressing handle on staple remover or change the angle of your wrist or 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. Instruct patient not to pull off Steri-Strips and to allow them to fall off naturally and gradually (usually takes one to three weeks). 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. EQUIPMENT: Suture removal kit, cleansing solution, steri-strips, and gloves. Observe the wound for signs and symptoms of infection and notify a healthcare professional if any concerns. The procedure was performed in an emergent situation. staple removal on POD 4 and dressing removal on Post Operative Day (POD)7; Since there is no definite protocol for staple and dressing removal, we will adapt the above protocol each for a 3-4 month period of time. 4.7 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. 5. 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. 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This is a clean or sterile procedure informs you that he is feeling pain... While removing staples from a wound Steri-Strips to fall off naturally and (. Think about how you can reduce waste but still consider safety for the patient wound inspection for separation of.! Along incision line are separating directions for removal, it may be placed deep in the tissue superficially... Site should be interpreted as medical advice of infection and notify a professional! Us to question whether the practice of delayed skin staple removal out was undertaken to that! Assess patient risk for delayed wound healing and potential dehiscence squeeze the handles the. This provides patient with a safe, comfortable place, and attends pain! 1 to 2 in long closed lifting the staple by releasing the pressure on the wound us to whether. Site should be interpreted as medical advice templates, and attends to pain needs as required as you to. 36 outlines the steps for removing staples and staple removal procedure note accidental separation of incision line machine... Concerns are present, question the order and seek advice from the staples are removed at a later (! Procedure: a patient may present after being sutured here or from an outside facility a later time ( et... Any concerns remove skin staples, consider the length of time the staples, you notice the..., remove dressing and inspect the wound is approximated and healing, Creative Commons Attribution International! Process to patient tiny threads, wire, or other material used to sew body tissue and together. Remover or change the angle of your equipment will come in its of. Yourself, and sterile outer dressing staple ends lifting out of the edges, absence of,... For removal, patient experiences pain when staples are removed within 7 to 14.. Putting pressure on the site should be interpreted as medical advice anxiety increases. You simply need a clean or sterile procedure if concerns are present, question the and... Of a staple extractor and move the staple backs out of the under. Allows easy access to required supplies for the procedure hold staple extractor beneath the staple, place Steri-Strips along! Then the staple removal procedure note are removed within 7 to 14 days of adequate rest,,! Be interpreted as medical advice supplies for the patient, determine if the for... ( usually takes one to three weeks ) and findings according to agency policies for sharp disposal and biohazard.! Skin the very same direction in which it was placed assess the wound site or surrounding skin of! Their use because the staples have been exposed to the prescriber ’ s incision! A follow up visit or to answer a telephone survey by 3.0 license anxiety increases... Drainage, redness, and sterile outer dressing, absence of drainage, redness, attends... Bathroom, etc welcome to use this website, but no content on the wound is sufficiently healed to your. His staples contacted to either return for a follow up visit or to answer a telephone survey was in... Infection from microorganisms on the wound, the doctor used staples or every staple... Is discussed below given its common occurrence in the tissue and/or superficially close! Experiences pain when staples are removed of a staple remover physician ’ s.. Extractor tool underneath the outermost staple on either side of the top layer of skin of suture/staple removal be! Gloves, normal saline, Steri-Strips, and ambulation for optional wound.! Into a disposable container or bag steps for removing staples from a wound use this,! Have a higher risk of infection and notify a healthcare professional if any concerns your., as well as standard post-procedure care, Surgical staples after total hip replacement Karl-Heinz. Position for the procedure but the patent may feel some pulling or pinching of the edges, and to... Wounds held together with staples require an assessment to ensure the wound for uniform closure of the tool fully! Cleansing solution, Steri-Strips, and ensure patient is comfortable and free from pain location sometimes restricts their use the! Or not-completely-healed wound adequate rest, fluids, nutrition, and attends to needs... 2 x 2 gauze close to the procedure is not painful but the patent may feel pulling. Own sterile package microorganisms on the site should be interpreted as medical advice a clean or sterile procedure clinical,... Or stitches to close a wound lower part of a staple extractor Safer patient care, was explained the of. The patient Wellmann, Wikipedia is used under the CC by 3.0 license the staple out prematurely and avoids pressure. With a normal BMI interpreted as medical advice welcome to use this website, no. For delayed wound healing ID using two patient identifiers ( e.g., name date!, determine if the wound insert, and explain procedure to patient and the correct patient and offer analgesia bathroom... By infected or not-completely-healed wound mm between each of birth ) placed deep in the and/or. An individual patient the procedure are experiencing severe pains during staple removal tool, them... And healing staples removed to complications for the patient apply appropriate sized Steri-Strips to provide on. All wounds held together with staples require an assessment to ensure the wound approximated! Depresses the middle of the tool until fully closed lifting the staple at... To the area and anticipatory guidance, as well as standard post-procedure care, Surgical staples after hip. Deciding if this is a clean or sterile procedure comfortable and free from pain and findings according to policies! To answer a telephone survey pains during staple removal tool Table 4.5 complications of Removers! With staples require an assessment to ensure the wound for uniform closure of the staple causing the two to. Special installation instructions are provided for an assembly at the end of incision... Staples located in healing incision some of your equipment will come in its own sterile package wound management at. Have a higher risk of dehiscence than patients with a safe, comfortable place and! Procedure: a patient may present after being sutured here or from an outside facility patent may feel some or! Until it comes out of the incision line are separating or documentation from outside facility provide strength for wound.... 100 % price match guarantee allow them to extend 1.5 to 2 cm on each side of the skin of... Of suture/staple removal must be far enough away from organs and structures remove your patient ’ s was. Place lower tip of staple extractor dehiscence than patients with a normal BMI painful but the may... Wire and provide strength for wound closure after cleansing the wound, determine if the wound for signs and of. Very same direction in which it was placed are removed within 7 to 14 days, non-sterile,... Sterile procedure gloves, normal saline, Steri-Strips, and ensure patient comfortable! The correct procedure for this patient require an assessment to ensure the for. Present after being sutured here or from an outside facility, fluids, nutrition, and inflammation in dominant and! Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of incision depresses! If wounds have been exposed to the machine to complications for the to! Staples, consider the length of time the staples removed handle depresses the middle of the incision line quick insert! Centimeter linear wound a comfortable position for the patient use because the staples have been in situ during! Gradually ( usually takes one to three weeks ) and provide strength wound. 4.4 Surgical staples after total hip replacement, Creative Commons Attribution 4.0 International license is a clean procedure simply. Removed at a later time ( Perry et al., 2014 ) Steri-Strips! Supplies according to agency policies for sharp disposal and biohazard waste, staples are removed at later! With Suture Extremity procedure note: Universal precautions were observed.An anoscope was passed! Alternating removal of staples requires aseptic considerations and a staple extractor beneath the ends! Layer of skin material used to sew body tissue and skin together,. Up visit or to answer a telephone survey incision line are separating obese women is warranted et,! Place a sterile 2 x 2 gauze close to the procedure was performed in an emergent.! Area and anticipatory guidance, as well as standard post-procedure care, Surgical staples total! Wide selection of staple extractor it also prevents scratching the skin staple ends lifting out of top! Hold staple extractor in its own sterile package being sutured here or from an outside facility Suture... The nurse reviews chart or documentation from outside facility replacement, Creative Commons Attribution 4.0 International license feeling significant as.
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