4.5 Staple Removal

Staples, constructed from stainless steel wire, are widely used for wound closure due to their strength. However, the specific location of the wound can sometimes limit their use as staples need to be placed sufficiently away from vital structures. While they may not provide the best aesthetic result compared to sutures, staples are known for their robustness, ease of insertion, and straightforward removal process.

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Effective staple removal necessitates the use of sterile techniques and a staple extractor. Official orders and specific directions for removal must be confirmed before starting the procedure. The healthcare professional must also inspect the wound to ensure it has healed sufficiently for the staples to be safely removed. Typically, every second staple is extracted first, with the rest being removed at a later stage (Perry et al., 2014). The usual timeframe for staple removal ranges from 7 to 14 days.

Checklist 36 provides a detailed guide for removing staples from a wound.

Checklist 36: Staple Removal

Disclaimer: Always adhere to your hospital's policy regarding this specific procedure.

Safety Considerations:

• Perform hand hygiene.
• Check the room for any additional precautions.
• Introduce yourself to the patient.
• Verify patient identity using two identifiers (e.g., name and date of birth).
• Explain the procedure to the patient and offer analgesia, restroom breaks, etc.
• Listen and respond to the patient's cues.
• Maintain the patient’s privacy and dignity.
• Assess airway, breathing, circulation, consciousness, and safety.
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Steps

Additional Information

1. Confirm physician orders and explain the procedure to the patient. This helps prevent anxiety and increases compliance. Inform the patient they may feel some pulling or pinching during staple removal.

2. Gather appropriate supplies: sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing.

3. Position the patient appropriately and ensure procedural privacy. This guarantees proper body mechanics for the healthcare provider and comfort for the patient.

4. Perform hand hygiene to reduce infection risk.

5. Prepare a sterile field and add necessary supplies like the staple extractor for easy access during the procedure.

6. Remove dressings and inspect the wound for uniform closure, absence of drainage, redness, and inflammation. If the wound hasn’t healed adequately, question the removal order and seek advice from the appropriate provider.

7. Apply non-sterile gloves to minimize contamination risk.

8. Clean the incision site per agency policy to reduce the risk of infection. Cleaning also removes any dried blood or crusted exudate.

To Remove Staples (start with every second staple):

9. Place the lower tip of the staple extractor beneath the staple. Avoid pulling up while depressing the handle or changing wrist angles. Gently move the staple side to side to remove it. The closed handle bends the staple ends outward, allowing removal.

10. When both ends of the staple are visible, move the extractor away from the skin and release the staple onto a sterile gauze to prevent premature pulling and wound pressure. Avoid scratching the skin.

11. Continue removing every second staple up to the end of the incision line to maintain incision strength and prevent accidental separation.

12. Using sterile technique, place Steri-Strips on the site of each removed staple along the incision line. Cut Steri-Strips to extend 1.5 to 2 cm on each side of the incision. These support wound tension and minimize scarring, enabling primary intention healing.

13. Remove remaining staples and apply Steri-Strips along the incision line.

14. Apply a dry, sterile dressing on the incision site or leave it exposed if not irritated by clothing, per physician orders to reduce infection risk.

15. Reposition the patient, lower the bed to a safe height, and ensure comfort, attending to any pain needs.

16. Educate the patient on Steri-Strip care, wound inspection, and hygiene practices to enhance healing. Advise the patient to let Steri-Strips fall off naturally and avoid straining during defecation. Emphasize rest, fluids, nutrition, and ambulation.

17. Dispose of supplies per agency policies for sharp and biohazard waste. The staple extractor can be either disposed of or sent for sterilization.

18. Perform hand hygiene, document the procedure and findings per agency policy, and report any unusual findings to the appropriate healthcare professional.

Data source: BCIT, 2010c; Perry et al., 2014

Special Considerations:

• Confirm physician orders to remove all or every second staple. Assess the wound to ensure it's sufficiently healed before removing any staples.

Staple removal can sometimes lead to complications. Factors such as the duration the staples have been in situ, mechanical failure of wound healing (wound dehiscence), and patient-specific aspects like BMI, age, and preexisting conditions can influence the outcome. Patients with a BMI over 30 kg/m2, those over 75 years old, or those with conditions like COPD, cancer, and diabetes are at a higher risk of dehiscence (Spiliotis et al., 2009). Table 4.5 highlights other complications related to staple removal.

Table 4.5 Complications of Staple Removal

Complication: Unable to remove staple from tissue. Solution: Contact physician for further instructions.

Complication: Dehiscence – incision edges separate during removal. Solution: Stop removing staples, apply Steri-Strips across open area, notify physician.

Complication: Patient experiences pain during staple removal. Solution: Allow short breaks during removal, encourage deep breathing and relaxation.

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Data source: BCIT, 2010c; Perry et al., 2014

Critical Thinking Exercises

1. You are about to remove your patient's abdominal incision staples as ordered by the physician. If you notice the skin edges of the incision separating, what should be your next steps?
2. If your patient reports significant pain as you begin staple removal, how should you proceed?