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.