Surgical Staple Removal: Procedure (Nursing)

by Samantha Rhea, MSN, RN

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      Slides Staple Removal Nursing.pdf
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      Review Sheet Removal of Skin Staples Post Operatively Nursing.pdf
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    00:04 Hey, guys, welcome to the skill staple removal.

    00:07 So this is a fun skill for the fact that a lot of times in my practice, after my patient gets out of surgery, they may have a lot of staples in their back incision.

    00:17 And when we get to remove this, there's usually a success because the patient's wound has healed.

    00:22 So let me show you how to do the skill.

    00:25 So before we get started, let's take a look at what we're going to need.

    00:28 Well we have a handy dandy, sterile staple removal kit for you.

    00:32 And it's got the appropriate equipment already packaged for us.

    00:36 Next, we're going to need some sort of cleansing agent, whether that be normal saline or whatever your physician requires for staple removal.

    00:45 Also, occasionally, we may need some adhesive strips to make sure that that wound stays approximated and heals nicely.

    00:54 So before we get started, of course, don't forget to perform your hand hygiene.

    00:58 So we need to make sure we provide privacy here for our patient and thoroughly explain this procedure.

    01:04 Now, you can imagine with something in your back or maybe in your incision, you may be concerned that this is going to hurt.

    01:11 So just let your patient know, explain thoroughly about what's going to happen.

    01:17 Now, it's a great idea to go ahead and raise that bed to an appropriate working height and assist the patient in a proper position.

    01:24 So really, what I mean by this is wherever those staples are, we need to position the patient correctly for easy access.

    01:33 Now, again, we want to perform our hand hygiene and put on gloves.

    01:37 Now, if there's a wound dressing, because many times after surgery we put a dressing over the staples to protect it from infection.

    01:46 If we've got one on there, go ahead remove that now.

    01:49 Now, it's really important to assess that incision site.

    01:53 So as you see this image here, we've got all those nice staples but we need a look around those to see if there are signs and symptoms of infection, such as weird drainage, color, pus, redness, swelling, we need to assess that here.

    02:08 Now, if we did remove a dirty, soiled dressing, we also have soiled gloves, so we need to remove these.

    02:15 Perform your hand hygiene again and then make sure you put on new clean gloves.

    02:24 Hey, guys, welcome to the skill staple removal.

    02:27 So before we get started, of course, don't forget your hand hygiene and put on your gloves.

    02:32 Now, before we get any further, let's take a look at what we got here.

    02:36 So I've got my sterile saline, of course, for cleansing.

    02:40 I've also got some gauze pads with me.

    02:43 Now, we also have our adhesive bandage, it's a great idea to go ahead, grab all this stuff up front.

    02:48 And I also have my staple removal kit.

    02:51 Now, I've got my lovely demonstration here, and this is where I'm going to show you how to remove those staples.

    02:57 Now, typically, we're talking about a post surgical wound, just like we've got here, I would have a dressing typically covering those staples.

    03:06 Now, just know, one key tip a lot of times, staples are a little bit more forgiving.

    03:12 So after about a week when the patient's had a back surgery, for example, or some surgery with staples, they will usually give it about a week, they'll cover it and then sometimes let these even open the air.

    03:25 So by the time the patient gets to you, they may or may not have a wound dressing.

    03:30 But if they do, go ahead and take that off now.

    03:33 And of course, we want to go ahead and make sure that we assess the incision site.

    03:37 Now, when we're looking at our incision, if we had a lot of like pus, excessive drainage, if we have any redness or warmth, we want to note that to the physician.

    03:49 Now, again, if the dressing was removed and we did that, we would have soiled gloves on, we would want to pitch those, of course, perform our hand hygiene.

    03:58 And I'm going to go ahead and put on my new gloves now.

    04:06 Now, this is a great time to go ahead and open up your sterile staple removal kit.

    04:10 Now, typically, you're going to have a gauze pad in here and also your staple removal.

    04:16 Now, go ahead and clean that incision site.

    04:19 We're usually going to use, again, some sort of cleansing agent or saline and go from the inner to the outer aspect of that wound.

    04:26 Once we've cleansed that, we can go ahead and take our staple removal and take that and put it underneath the center of the first staple.

    04:35 Now we want to make sure we keep that staple remover stable here, and then we're going to go ahead and compress the handles and extract the edges of the staples.

    04:48 So what kind it does is you've got the staples here and once we compress the middle, you'll see the feet lift up.

    04:55 Now, lift that staple out of the skin once we're ready, and then we're going to repeat this process in succession or as ordered.

    05:04 Now, if need be, and we see any gaps in that incision, this is a great time to go ahead and use those adhesive strips to make sure that gap or that incision stays closed.

    05:15 Now, if necessary or as ordered, go ahead and apply a new clean dressing.

    05:24 Now, once I get all my new gloves, I can go ahead and start opening up my equipment.

    05:36 Now I've got my sterile staple removal kit.

    05:44 Now, I like to keep this kit because I can put my staples in here for collection so I can look at these and count these later.

    05:52 Also, I want to take a moment and show you the staple removal, the device itself.

    05:59 So this thing is really nice and it's really unique.

    06:02 So if you take a look here at this, let me flip this around.

    06:06 So how you know it's the right way up, you see the skinny piece right down here? Those two bottom teeth, the two teeth need to go on the bottom.

    06:17 So this is what's going to see underneath the incision.

    06:21 And then we're going to take these and push these down and it's going to pull up our staples.

    06:26 So just to take a look at these.

    06:28 And again, not regular scissors, this is a special staple removal and you'll have a kit at your facility.

    06:35 So that's what these are going to look like.

    06:37 So now let's go ahead and cleanse our incision site, and it's up to whatever you like to use or whatever is ordered by your physician.

    06:46 I love these sterile gauze packs, they just make it really easy.

    06:52 I'm going to go ahead and open those up and I'm going to go ahead and pour my saline in here just makes it easier for me.

    07:03 So I'm going to take my gauze and I'm going to cleanse from the inner to the outer aspect of the wound.

    07:11 So I would just go inner to outer and then get a new one, toss that.

    07:17 Get in inner to outer and repeat the process.

    07:20 Now, once I've cleaned, now I can dive in and remove the staples.

    07:24 This is kind of a fun skill, know though sometimes when you're removing these, it can kind of tug on the skin a little bit so be conscious of that with your patient.

    07:34 So notice I'm actually right handed. I'm going to use my left hand in here just so you can see a little bit better what I'm doing.

    07:42 So if you notice, again, the two bottom teeth, the feet are going to go on the bottom of the staple.

    07:48 So I'm going to take this and center it underneath that staple in the middle.

    07:54 Now, I want to keep this stable against the skin then I'm going to compress the handles themselves So when I compress it, sometimes you may have to wiggle it up, maybe side to side a little bit and rock it.

    08:08 That's okay, just be gentle, then we've lifted the staple out of the skin.

    08:13 So what you notice here with the staple removal, see how these little feet come up.

    08:19 That's how, you know, it's bent it.

    08:21 The feet come up and remove it from the skin.

    08:24 So, again, I like to use my kit to collect all of those so they're not lost in your patient's bed, for example.

    08:30 And then we're going to repeat this as necessary.

    08:33 So here's a good tip.

    08:35 Any time you're removing staples from a patient's wound, it's a great idea to go every other staple.

    08:43 Reason being is, let's say this stays intact, incision looks good when I take it out, but if it starts splitting open that incision, we need to stop and pause, leave some of those staples in place and check with our physician because they may need to stay in a little longer.

    09:00 So let me go ahead and repeat how I would remove those staples for you.

    09:04 So I'm gonna skip and go to my next staple.

    09:07 And again, feet go on the bottom.

    09:12 I'm going to stable here in the middle, I'm going to compress my handles and sometimes you may need to just rock it out gently.

    09:23 And of course, I've got some dummy demo skin here so sometimes at a patient's skin, it will be a little bit easier to come out as well.

    09:32 But it's not atypical that you may have to rock it from side to side to remove it gently.

    09:37 And I'll do another one for you.

    09:44 Okay, so I'm going to sea the underneath stabilize against the skin, compress those handles and just gently rock it out of the skin.

    09:53 All right. So that's what that's going to look like.

    09:56 Now, let's say that this started to split open or just to help make sure there's no gaps in this incision, we help approximate the wound edges so it will facilitate healing.

    10:09 We may apply adhesive strips.

    10:11 So I'm going to show you that now.

    10:14 Now, the adhesive strips are really nice, it's just another bandage or insurance if you will, to make sure that wound heals nicely and stays closed.

    10:25 So occasionally you may have something in your facility that helps bond these strips to the skin.

    10:32 That's really common so look for that if you have that at your facility.

    10:37 So the whole point of this, again, is after staple removal, it's going to help adhere those edges together.

    10:44 So we typically like to do, is you will see us adhere one side and you want to pull this taut to where the wound edges stay close together and make sure you keep it taut to keep those wound edges together.

    11:02 And then you're going to adhere it like so.

    11:04 So, again, let me show you one more on the top.

    11:07 Actually right down here.

    11:10 So, again, the whole point is you want to put it on one edge of the wound, kind of pull the skin together so you don't have any gaps and then adhere that to the skin.

    11:26 Now, once we've done this, once all the staples are out, if necessary, you want to go ahead and apply a dressing.

    11:33 One special note about adhesive strips, guys, before we go.

    11:37 So let's take a look at these, how we've applied them.

    11:40 So if you take a look at the adhesive strip, we have applied these straight across the wound.

    11:46 You don't want these at a weird angle.

    11:49 You don't want these running up and down the incision.

    11:52 Again, you want them straight across the wound and that's going to help pull tension to help close the wound and facilitate healing.

    About the Lecture

    The lecture Surgical Staple Removal: Procedure (Nursing) by Samantha Rhea, MSN, RN is from the course Surgical Staple Removal (Nursing).

    Included Quiz Questions

    1. Remove every other staple in the incision, then the remaining staples.
    2. Alternate removing a staple from each end of the incision.
    3. Remove the staples proximally to distally.
    4. Determine where in the incision is most likely to dehisce and remove those staples last.
    1. A midline abdominal incision that is proximally dehisced and reddened, with thick yellow-green drainage
    2. A fresh post-op right hip incision that is mildly erythematous and has a scant amount of blood around the staples
    3. A right lower quadrant incision that is oozing a moderate amount of serous drainage
    4. An intact back incision that has dried crust along the staple line
    1. The two prongs at the tip of the staple remover should go against the client's skin and under the staple.
    2. The single prong at the tip of the staple remover should go against the client's skin and under the staple.
    3. The whole tip of the staple remover should go under the staple, and you dig the staple out.
    4. The staple remover should be held at 90 degrees to the staple, and the staple is plucked out.
    1. The nurse should cleanse from the inner to the outer aspect of the incision.
    2. The nurse should cleanse from the outer to the inner aspect of the incision.
    3. The nurse should alternate starting from the inner and outer aspect of the incision every one inch.
    4. The nurse should cleanse the incision distally to proximally.
    1. The nurse should gently wiggle the staple remover side-to-side until the staple comes out of the skin.
    2. The nurse should stop removing staples as they are not ready to come out.
    3. The nurse should use a scalpel to cut out the staple.
    4. The nurse should use an adhesive strip to encourage the staple out of the skin.
    1. Place multiple small strips perpendicular to the incision.
    2. Place one strip directly on top of the incision, covering the area the staples covered.
    3. Place one strip in the middle of the incision at a 90-degree angle.
    4. Place multiple small strips along the incision at the same angle as the incision.
    5. Anchor one end of the strip against the skin and pull the other end taut to encourage wound closure.

    Author of lecture Surgical Staple Removal: Procedure (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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