A time out was undertaken to determine that this was the correct patient and the correct procedure for this patient. This reduces the risk of infection from microorganisms on the wound site or surrounding skin. Ensure proper body mechanics for yourself and create a comfortable position for the patient. Clinical Procedures for Safer Patient Care, Surgical staples after total hip replacement, Creative Commons Attribution 4.0 International License. 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). 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 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. Data source: BCIT, 2010c; Perry et al., 2018. What would you do next. It also prevents scratching the skin with the sharp staple. Gather appropriate supplies after deciding if this is a clean or sterile procedure. 12. 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. Place the two-pronged edge of the tool under the staple against the skin. 18. Staple extractor may be disposed of or sent for sterilization. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. They may be placed deep in the tissue and/or superficially to close a wound. 15. 1. 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. The SOAPnote Project website is a testing ground for clinical forms, templates, and calculators. Explain process to patient and offer analgesia, bathroom, etc. Confirm prescriber’s orders, and explain procedure to patient. 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. Explain process to patient and offer analgesia, bathroom, etc. 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. To remove intermittent sutures, hold scissors in dominant hand and forceps in non-dominant hand. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. This is usually in 7 to 14 days. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). Clean incision site according to agency policy. 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. Contact physician for further instructions. 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. 3. This allows wound to heal by primary intention. If necessary, gently move the staple side to side to remove. 4.7 Suture Removal Sutures are tiny threads, wire, or other material used to sew body tissue and skin together. 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. 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. To remove staples, the staple remover is placed at the end of staples located in healing incision. 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. 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). 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. 6. 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. Cut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision. 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. Click here to visit the HP video library. This provides patient with a safe, comfortable place, and attends to pain needs as required. Staples are made of stainless steel wire and provide strength for wound closure. Discard supplies according to agency policies for sharp disposal and biohazard waste. Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation. Explanation helps prevent anxiety and increases compliance with the procedure. 15. 16. 16. 17. This provides patient with a safe, comfortable place, and attends to pain needs as required. They may be placed deep in the tissue and/or superficially to close a wound. 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. 10. 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 What would be your next steps? Gather sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing. 4 Take out the staple by releasing the pressure on the handles. Ensure proper body mechanics for yourself, and create a comfortable position for the patient. The patient’s laceration was prepped and cleansed in the usual fashion. If you are experiencing severe pains during staple removal, it may be caused by infected or not-completely-healed wound. Your patient informs you that he is feeling significant pain as you begin to remove his staples. Apply appropriate sized Steri-Strips to provide support on either side of the incision, generally 1 to 2 in long. Diagnosis: Rectal bleeding. 5. Staple removal may lead to complications for the patient. This allows wound to heal by primary intention. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). 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. Confirm patient ID using two patient identifiers (e.g., name and date of birth). Slide the lower part of a staple extractor tool underneath the outermost staple on either side of the stapled area. The staple remover is sterilized using boiling water or antibacterial solution. Staple Removal. Your doctor will tell you when to have your stitches or staples removed. Importance of adequate rest, fluids, nutrition, and ambulation for optional wound healing. When removing staples, consider the length of time the staples have been in situ. Procedure performed by: ***. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. Your patient informs you that he is feeling significant pain as you begin to remove his staples. 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. Assess patient risk for delayed wound healing and potential dehiscence. Suture Extremity procedure note Laceration #1: 2.5 centimeter linear wound. Using the principles of asepsis, place Steri-Strips perpendicular along the incision line with gaps of approximately 2 to 3 mm between each. The patient tolerated the procedure well without complications. 7. Checklist 39 outlines the steps for removing staples from a wound. Squeeze the handles of the tool until fully closed lifting the staple from the skin. 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. Hand hygiene reduces the risk of infection. 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. Remove sterile backing to apply Steri-Strips. Take care when handling the optional equipment that is attached to the machine. Removal of staples requires sterile technique and a staple extractor. Holding the staple extractor over the disposable bag, release handles. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. Take care when handling the optional equipment that is attached to the machine. Staples are typically removed in about 7 days on the scalp and 10 days on the back, abdomen and extremities. These issues caused us to question whether the practice of delayed skin staple removal in obese women is warranted. Coding & Compliance Initiatives, Inc. 8 Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to enhance wound healing. Staples are strong, quick to insert, and simple to remove. This step allows easy access to required supplies for the procedure. If necessary, clean incision site according to agency policy. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. After assessing the wound, determine if the wound is sufficiently healed to have the staples removed. The doctor used staples or stitches to close the cut. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only. Removal of staples requires sterile technique and a staple extractor. Cleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed. 13. note: When applicable, special installation instructions are provided for an assembly at the end of the removal procedure. Provide opportunity for the patient to deep breathe and relax during the procedure. Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. 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. Is anesthetic used during the procedure? Contact physician for further instructions. 16. 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. ... Service level: Basic. POLICY STATEMENTS 1. Procedure Note: Universal precautions were observed.An anoscope was easily passed. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove. Assess incision site. 9. After cleansing the wound, the doctor will gently back out each staple with the remover. Report any unusual findings or concerns to the appropriate healthcare professional. Think about how you can reduce waste but still consider safety for the patient. This allows for dexterity with suture removal. Allow small breaks during removal of staples. 10. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing, or according to physician orders. Table 4.5 lists other complications of removing staples. Hold scissors in dominant hand and forceps in non-dominant hand. When removing staples, consider the length of time the staples have been in situ. 8. 11. 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. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. Procedure: Anoscopy. Estimated blood loss was less than 0.5 mL. implement the basic nursing procedure of staple/suture removal. PROCEDURE: A patient may present after being sutured here or from an outside facility. What would you do next. Disclaimer: Always review and follow your hospital policy regarding this specific skill. Wound dehiscence, a mechanical failure of wound healing, remains a problem and can be affected by multiple factors (Spiliotis et al., 2009). Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. Staple removal may lead to complications for the patient. Provide opportunity for the patient to deep breathe and relax during the procedure. As you start to remove the staples, you notice that the skin edges of the incision line are separating. Data source: BCIT, 2010c; Perry et al., 2014. 2. 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. 9. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. Removal of staples requires aseptic considerations and a staple extractor. Data source: BCIT, 2010c; Perry et al., 2014, Table 4.5 Complications of Staple Removal. Return precautions are given. Place a sterile 2 x 2 gauze close to the incision site. The staple backs out of the skin the very same direction in which it was placed. 13. 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. This helps the cut heal and reduces scarring. 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. Instruct patient to take showers rather than bathe. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. Removal of staples Note: Specific instructions from the medical officer must be received before removing staples. Using the principles of sterile technique, place Steri-Strips on location of every removed staple along incision line. Patients will be contacted to either return for a follow up visit or to answer a telephone survey. The remover then is squeezed on its upper handle, causing the sharp end to pull … • 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. 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. As you start to remove the staples, you notice that the skin edges of the incision line are separating. 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