5. 14. 10. Scalp laceration repair is discussed below given its common occurrence in the ED population. Your doctor will tell you when to have your stitches or staples removed. Steri-Strips support wound tension across wound. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. 1. 11. The nurse reviews chart or documentation from outside facility for suture removal instructions. Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing. Place the two-pronged edge of the tool under the staple against the skin. Clean techniques suffice if wounds have been exposed to the air and the wound is approximated and healing. Explanation helps prevent anxiety and increases compliance with the procedure. Assess patient risk for delayed wound healing and potential dehiscence. 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 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. Diagnosis: Rectal bleeding. 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. Gather appropriate supplies after deciding if this is a clean or sterile procedure. Table 4.10 lists other complications of removing staples. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. The patient’s laceration was prepped and cleansed in the usual fashion. implement the basic nursing procedure of staple/suture removal. 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. Contact physician for further instructions. To remove intermittent sutures, hold scissors in dominant hand and forceps in non-dominant hand. Staple extractor may be disposed of or sent for sterilization. This is usually in 7 to 14 days. Staples are made of stainless steel wire and provide strength for wound closure. The SOAPnote Project website is a testing ground for clinical forms, templates, and calculators. Staples are typically removed in about 7 days on the scalp and 10 days on the back, abdomen and extremities. Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation. The timing of suture/staple removal must be consistent with Remove remaining staples, followed by applying Steri-Strips along the incision line. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. Remove sterile backing to apply Steri-Strips. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. They may be placed deep in the tissue and/or superficially to close a wound. 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. Explanation helps prevent anxiety and increases compliance with the procedure. 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. All templates, "autotexts", procedure notes, and other documents on these pages are intended as examples only. When the staples are removed, drop them into a disposable container or bag. Provide opportunity for the patient to deep breathe and relax during the procedure. Disclaimer: Always review and follow your agency policy regarding this specific skill. Cut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision. Data source: BCIT, 2010c; Perry et al., 2014. Professional Healthcare, Inc. 2 of 2 G180 Surgical Staple Removal 14. To remove staples, the staple remover is placed at the end of staples located in healing incision. 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. When removing staples, consider the length of time the staples have been in situ. Inform patient the procedure is not painful, but the patent may feel some pulling or pinching of the skin during staple 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. 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. They may be placed deep in the tissue and/or superficially to close a wound. 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. Instruct patient to take showers rather than bathe. Click here to visit the HP video library. 13. 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. Discard supplies according to agency policies for sharp disposal and biohazard waste. Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to enhance wound healing. Wiggle the staple gently side to side until it comes out of the skin. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. 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). Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing, or according to physician orders. The staple remover is sterilized using boiling water or antibacterial solution. 10. 15. Suture Extremity procedure note Laceration #1: 2.5 centimeter linear wound. Is anesthetic used during the procedure? 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. 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. Repeat until all staples are removed. As you start to remove the staples, you notice that the skin edges of the incision line are separating. This allows for dexterity with suture removal. Contact physician for further instructions. 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. Explain process to patient and offer analgesia, bathroom, etc. Hand hygiene reduces the risk of infection. What would be your next steps? 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. 2. Close the handle, observe the staple ends lifting out of the skin. In general, staples are removed within 7 to 14 days. The doctor used staples or stitches to close the cut. • 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. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. 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