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CHAPTER 32 Skin Integrity & Wound Healing
Procedure 32-12B ■ Removing Staples
1. Perform hand hygiene. Don non- sterile gloves. 2. After cleansing the wound or inci- sion, position the staple remover so that the lower jaw is on the bottom. 3. Place both tips of the lower jaw of the remover under the staple.
6.Continue to lift slightly as you gently squeeze the handles together to close. Spreads the ends of the staples apart, freeing them from the skin. 7. Lift the reshaped staple straight up from the skin. 8. Remove alternate staples and check the tension on the wound. 9. If there is no significant pull on the wound, remove the remaining staples. Where there are many staples over an area of stress (abdomen, legs), the remaining staples are often removed a day or two later after ensuring the inci- sion remains intact. 10. Place the removed staples on a piece of gauze. Staples are small and can be easily lost. Keeping them in one place prevents this. 11. Apply a dressing or adhesive clo- sures, if needed. 12. Dispose of the removed staples in the sharp container. Ends of the staples are sharp and should be handled with care. 13.Remove gloves and perform hand hygiene.
What if . . . ■ A staple gets stuck?
Gently manipulate the staple with the remover until it is perpendicular to the skin. When the skin is stapled, the edges of the staple are crimped to hold the incision together. For the staple to be removed, those edges must be reshaped and straightened. If one edge of the staple is reshaped and the other is not, continuing to remove it can cause pain and tissue trauma. ■ The incision needs a dressing once the staples or sutures have been removed? New surgical incisions should be cov- ered with a sterile dressing the first 24 to 48 hours, but not necessarily after that time.Apply a dressing if you are concerned about soiling or per your institution’s policy. In a healing incision, epithelial resurfacing is complete in 24 to 48 hours.Though only a few cells thick, this epithelium is enough to keep the wound closed and provide a bac- terial barrier.
Removing staples
4. Ensure the staple is perpendicular to the plane of the skin. If not, repo- sition the staple with the tips of the lower jaw and apply gentle pressure, causing it to straighten the ends for easier removal. 5. Lift slightly on the staple, ensuring that it stays perpendicular to the skin.
Evaluation ■ Note whether the incision is well approximated after the procedure. ■ Ensure that the patient verbalized understanding of the treatment. ■ Inspect the wound daily. Patient Teaching ■ Instruct the patient of signs and symptoms of wound infec- tions (i.e., redness, drainage) and the need to report these findings. ■ Instruct the patient that he may be able to shower once sutures or staples are removed, if approved by the health- care provider.
Documentation The following is an example (many agencies use wound care flow sheets): Sample Documentation 00/00/0000 1815 Staples removed from abdominal midline incision. Incision edges well approximated without erythema, drainage, or swelling. Dry dressing applied. Patient tolerated the procedure without discomfort. Discussed purpose of staple removal with patient.Will continue to monitor wound daily. —M. Dali, RN
Practice Resources Sanja & Ramesh (2017).
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