Skill List > Staple removal
Clinical Alert
Elsevier Clinical Skills covers the principles of this procedure. You must follow local policies and procedures regarding technique, equipment used and documentation.
Authors:
Based on: Nicol: Essential Nursing Skills 4E
Written by: Janet Hunter MA BSc (Hons) PGCE RN; Karen Rawlings-Anderson BA (Hons) MSc DipNEd RN
Last updated: August 2018

Positioning of staple remover under staple.
Learning Objective
After reading the skill overview, watching the video, following up some of the references/web sites and completing the self-test quiz you should be ready to be assessed in practice in staple removal.

Introduction

Surgical staples maybe used instead of traditional sutures. They are quicker to apply than sutures, but may result in a less favorable cosmetic outcome. Some studies suggest that they may also be more painful on insertion and removal compared to sutures (Iavazzo et al. 2011, Tseng et al. 2017). Staples are made from surgical stainless steel or titanium and as such minimise tissue reaction. Iavazzo et al. (2011) suggest that the use of staples is associated with fewer wound infections compared with the use of sutures. The decision whether to use sutures or staples will be based on the extent, depth, and site of the wound.

Removal of staples should be timed to reduce the risk of the appearance of permanent scarring, but not so soon as to cause the wound to reopen. The surgeon will determine the timing of staple removal and this will vary according to the site of the wound. 

An aseptic dressing technique should be used when removing staples. Aseptic non-touch technique (ANTT) is a practical method employed to maintain asepsis when carrying out any invasive procedure that bypasses the body’s natural defenses, for example, wound care, cannulation, or venepuncture. Using correct aseptic technique will help to minimise the risk of introducing contamination into the exposed area. It includes setting up and ensuring a controlled safe working area to help maintain the asepsis of the key parts and key sites (Clare & Rowley 2018).

ANTT requires healthcare professionals to identify the key parts of invasive devices or sterile fluids that come into contact with susceptible or sterile body sites during clinical procedures. Key parts are the parts of equipment (e.g. the tip of a needle, or the sterile inside surface of a dressing) that if contaminated by infectious materials increase the risk of infection. ANTT means avoiding (either directly or indirectly) touching the key parts of the equipment used (and the patient), during the procedure, and is perhaps the single most important component in achieving asepsis and preventing SSIs by healthcare professionals (Clare and Rowley 2018). ANTT also incorporates using effective hand hygiene, non-touch technique, and wearing appropriate personal protective equipment.

Correct staple removal technique is essential to sustain good results after wound closure. If the wound begins to gape during removal of the staples, removal should be stopped and advice sought. The edges of the wound can be pulled back together and held in place by skin closure strips (e.g. Steristrips).

In general, stapled wounds should be left undisturbed, with the dressing applied at the time of the operation in place until staple removal, unless there are signs of infection in the patient (e.g. raised temperature) or in the wound itself. Disturbing the dressing can disturb the newly forming epithelium and allow the entry of organisms. Wound infection can slow the rate of healing and result in more scarring. 

Preparation and safety

  • Explain the procedure to the patient to gain consent and cooperation.
  • Check patient comfort (e.g., position, convenience, need for toilet). Adjust the bedclothes to permit easy access to the wound, but maintain warmth and dignity. Draw screens around the bed and ensure adequate light. Clear the bed area, close windows, and turn off the fan. If there are concerns about patient safety, leave the screens only partly drawn until you return.
  • Inspect the wound for signs of healing. Assess the wound to check it is appropriate for staple removal, and for signs of infection (redness, heat, pain, exudate), inadequate analgesia, or any complications leading to possible wound opening. Record the results of the observation in the patient’s nursing notes. 
  • If the wound looks inflamed or if there is any exudate (pus) present, seek advice from an experienced nurse. It may be necessary to remove just one or two staples to allow the pus to drain.
  • Consult the care plan to determine when the staples are due for removal, and the dressing type.
  • Perform hand hygiene. An apron should be worn. 
  • Additional protective clothing may be necessary if indicated by the patient’s condition.

Procedure

  1. Follow the procedure for the aseptic dressing technique to prepare the trolley and open the aseptic field.
  2. Rationale – Asepsis is the state of being free from living pathogenic microorganisms. Aseptic non-touch technique (ANTT) must be used in order to protect the patient from healthcare acquired infections (HCAI) (infections acquired as a result of healthcare interventions).
  3. Taking care not to touch the aseptic field, open the staple remover and drop carefully onto aseptic field. 
  4. Rationale – Keeps areas of potential contamination to the minimum by using ANTT.
  5. If appropriate put on non-sterile gloves and loosen the dressing and remove it. Drop it into the orange waste bag and remove non-sterile gloves.
  6. Rationale – Gloves are worn to prevent contact with body fluids (Loveday et al. 2014). 
  7. Perform hand hygiene. Make sure that your hands are completely dry before proceeding.
  8. Rationale – In order to prevent cross-infection hands must be cleaned before and after patient contact and before preparations for aseptic technique (Loveday et al. 2014).In order to prevent cross-infection hands must be cleaned before and after patient contact and before preparations for aseptic technique (Loveday et al. 2014).
  9.  Carefully open the sterile gloves without touching the aseptic field. Taking care not to touch the outside of the gloves, put on the sterile gloves. Pick up the first glove by the wrist part that is folded back and put the glove on. Pick up the second glove by putting your gloved fingers under the cuff and put the glove on. Then adjust over your fingers to get a good fit. Pick up the glove packaging from the middle and place on the bottom shelf of the trolley.
    Rationale – Your hands must only touch the inside of the gloves; the outside of the gloves must remain sterile. 
  10. Take staple remover and slide the lower part of it under the centre of the staple. Squeeze the handles together until the staple ends pull out of the wound edges.
     Rationale – It is important to ensure the handles are fully squeezed together to avoid causing trauma to the fragile tissues around wound margins. Incorrect technique may result in increased discomfort.  
  11. Place each staple in the gallipot or waste bag.
     Rationale – To ensure correct disposal of waste.
  12. Once all the staples are removed, discard the staple remover into sharps bin, wrap all discarded items in the aseptic field and place in the orange waste bag.
    Rationale – To ensure safe disposal of sharps and potentially contaminated waste. 
  13. Remove your sterile gloves and place them in the orange waste bag.
     Rationale – To ensure safe disposal of clinical waste.   
  14. Remove the orange waste bag from the trolley and fold over the top of the bag to seal it.
     Rationale – To prevent environmental contamination by containing all waste before leaving the bedside. 
  15. Replace the bedclothes and leave the patient comfortable. If necessary adjust the height of the bed.
     Rationale – The position required for staple removal may have caused discomfort. Patient should be left in a safe and comfortable position.
  16. Dispose of equipment as shown for the aseptic dressing technique procedure.
     Rationale – Clinical waste is disposed of appropriately. 
  17. Remove apron and discard in clinical waste bin.
     Rationale – Clinical waste is disposed of appropriately. 
  18. Perform hand hygiene.
     Rationale – In order to prevent cross-contamination.
  19. Document as per local policy.
     Rationale – To ensure continuity of care and accurate reporting.

Ongoing care, monitoring and support

  • Return any unused items to the stock cupboard
  • It is not necessary to clean the trolley again, unless it has become wet or contaminated with body fluids, but this may be required so check local policy.

Documentation and reporting

  • All details of the care that has taken place and actions should be recorded in the nursing documentation. This should include number of staples removed, condition of the skin and information given to patient.
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