Monday, 1 November 2010

SKIN STAPLE AND CLIP REMOVAL

Skin staples or clips may be used instead of standard sutures to close lacerations or surgical wounds. Because they can secure a wound more quickly than sutures, they may substitute for surface sutures when cosmetic results aren't a prime consideration, such as in abdominal closure. When properly placed, staples and clips distribute tension evenly along the suture line with minimal tissue trauma and compression, facilitating healing and minimizing scarring. Because staples and clips are made from surgical stainless steel, tissue reaction to them is minimal. Usually, physicians remove skin staples and clips, but some facilities permit qualified nurses to perform this procedure.
Skin staples and clips are contraindicated when wound location requires cosmetically superior results or when the incision site makes it impossible to maintain at least a 5-mm distance between the staple and underlying bone, vessels, or internal organs.
Equipment
Waterproof trash bag • adjustable light • clean gloves, if needed • sterile gloves • sterile gauze pads • sterile staple or clip extractor • povidone-iodine solution or other antiseptic cleaning agent • sterile cotton-tipped applicators • optional: butterfly adhesive strips or Steri-Strips, compound benzoin tincture or other skin protectant.
Prepackaged, sterile, disposable staple or clip extractors are available.
Preparation of equipment
Assemble all equipment in the patient's room. Check the expiration date on each sterile package and inspect for tears. Open the waterproof trash bag, and place it near the patient's bed. Position the bag to avoid reaching across the sterile field or the wound when disposing of soiled articles. Form a cuff by turning down the top of the bag to provide a wide opening, then preventing contamination of instruments or gloves by touching the bag's edge.
Implementation
  • If your facility allows you to remove skin staples and clips, check the physician's order to confirm the exact timing and details for this procedure.
  • Check for patient allergies, especially to adhesive tape and povidone-iodine or other topical solutions or medications.
  • Explain the procedure to the patient. Tell him that he may feel a slight pulling or tickling sensation but little discomfort during staple removal. Reassure him that because his incision is healing properly, removing the supporting staples or clips won't weaken the incision line.
  • Provide privacy, and place the patient in a comfortable position that doesn't place undue tension on the incision. Because some patients experience nausea or dizziness during the procedure, have the patient recline if possible. Adjust the light to shine directly on the incision.
  • Wash your hands thoroughly.
  • If the patient's wound has a dressing, put on clean gloves and carefully remove it. Discard the dressing and the gloves in the waterproof trash bag.
  • Assess the patient's incision. Notify the physician of gaping, drainage, inflammation, and other signs of infection.
  • Establish a sterile work area with all the equipment and supplies you'll need for removing staples or clips and for cleaning and dressing the incision. Open the package containing the sterile staple or clip extractor, maintaining asepsis. Put on sterile gloves.
  • Wipe the incision gently with sterile gauze pads soaked in an antiseptic cleaning agent or with sterile cotton-tipped applicators to remove surface encrustations.
  • Pick up the sterile staple or clip extractor. Then, starting at one end of the incision, remove the staple or clip. (See Removing a staple.) Hold the extractor over the trash bag, and release the handle to discard the staple or clip.
  • Repeat the procedure for each staple or clip until all are removed.
  • Apply a sterile gauze dressing, if needed, to prevent infection and irritation from clothing. Then discard your gloves.
  • Make sure the patient is comfortable. According to the physician's preference, inform the patient that he may shower in 1 or 2 days if the incision is dry and healing well.
  • Properly dispose of solutions and the trash bag, and clean or dispose of soiled equipment and supplies according to facility policy.
Special considerations
  • Carefully check the physician's order for the time and extent of staple or clip removal. The physician may want you to remove only alternate staples or clips initially and to leave the others in place for an additional day or two to support the incision.
  • When removing a staple or clip, place the extractor's jaws carefully between the patient's skin and the staple or clip to avoid patient discomfort. If extraction is difficult, notify the physician; staples or clips placed too deeply within the skin or left in place too long may resist removal.
  • If the wound dehisces after staples or clips are removed, apply butterfly adhesive strips or Steri-Strips to approximate and support the edges, and call the physician immediately to repair the wound. (See Types of adhesive skin closures.)
  • You may also apply butterfly adhesive strips or Steri-Strips after removing staples or clips even if the wound is healing normally to give added support to the incision and prevent lateral tension from forming a wide scar. Use a small amount of compound benzoin tincture or other skin protectant to ensure adherence. Leave the strips in place for 3 to 5 days.
Home care
If the patient is being discharged, teach him how to remove the dressing and care for the wound. Instruct him to call the physician immediately if he observes wound discharge or any other abnormal change. Tell him that the redness surrounding the incision should gradually disappear and that after a few weeks, only a thin line will be visible.

Documentation
Record the date and time of staple or clip removal, number of staples or clips removed, appearance of the incision, dressings or butterfly strips applied, signs of wound complications, and the patient's tolerance of the procedure.