Staple Removal – Clinical Procedures for Safer Patient Care
Staples are made of stainless steel wire and provide strength for wound closure. The wound location sometimes restricts their use because the staples must be far enough away from organs and structures. The aesthetic outcome may not be as desirable as a suture line, but staples are strong, quick to insert, and simple to remove.
Removal of staples requires sterile technique and a staple extractor. An order to remove the staples, and any specific directions for removal, must be obtained prior to the procedure. The health care professional performing the removal must also inspect the wound prior to the procedure to ensure the wound is adequately healed to have the staples removed. Usually every second staple is removed initially; then the remainder are removed at a later time (Perry et al., 2014). In general, staples are removed within 7 to 14 days.
Checklist 36 outlines the steps for removing staples from a wound.
Checklist 36: Staple Removal
Disclaimer: Always review and follow your hospital policy regarding this specific skill.
Safety considerations:
Perform hand hygiene.
Check room for additional precautions
Introduce yourself to patient.
Confirm patient ID using two patient identifiers (e.g., name and date of birth).
Explain process to patient and offer analgesia, bathroom, etc.
Listen and attend to patient cues.
Ensure patient’s privacy and dignity.
Assess ABCCS/suction/oxygen/safety
Steps
Additional Information
1. Confirm physician orders, and explain procedure to patient. Explanation helps prevent anxiety and increases compliance with the procedure. Inform patient the procedure is not painful but the patent may feel some pulling or pinching of the skin during staple removal. 2. Gather appropriate supplies. Gather sterile staple extractors, sterile dressing tray, non-sterile gloves, normal saline, Steri-Strips, and sterile outer dressing. 3. Position patient appropriately and create privacy for procedure. Ensure proper body mechanics for yourself and create a comfortable position for the patient. 4. Perform hand hygiene. This reduces the risk of infection. 5. Prepare the sterile field and add necessary supplies (staple extractor). This step allows easy access to required supplies for the procedure. 6. Remove dressing and inspect the wound. Visually assess the wound for uniform closure of the edges, absence of drainage, redness, and inflammation.
After assessing the wound, determine if the wound is sufficiently healed to have the staples removed. If concerns are present, question the order and seek advice from the appropriate health care provider.
7. Apply non-sterile gloves. This reduces the risk of contamination. 8. Clean incision site according to agency policy. This reduces the risk of infection from microorganisms on the wound site or surrounding skin.
Cleaning also loosens and removes any dried blood or crusted exudate from the staples and wound bed.
To Remove Staples (start with every second staple). 9. Place lower tip of staple extractor beneath the staple. Do not pull up while depressing handle on staple remover or change the angle of your wrist or hand. Close the handle, then gently move the staple side to side to remove. The closed handle depresses the middle of the staple causing the two ends to bend outward and out of the top layer of skin. 10. When both ends of the staple are visible, move the staple extractor away from the skin and place the staple on a sterile piece of gauze by releasing the handles on the staple extractor. This avoids pulling the staple out prematurely and avoids putting pressure on the wound. It also prevents scratching the skin with the sharp staple. 11. Continue to remove every second staple to the end of the incision line. Alternating removal of staples provides strength to incision line while removing staples and prevents accidental separation of incision line. 12. Using the principles of sterile technique, place Steri-Strips on location of every removed staple along incision line. Cut Steri-Strips to allow them to extend 1.5 to 2 cm on each side of incision.
Remove sterile backing to apply Steri-Strips.
Steri-Strips support wound tension across wound and eliminate scarring.
This allows wound to heal by primary intention.
13. Remove remaining staples, followed by applying Steri-Strips along the incision line. Steri-Strips support wound tension across wound and eliminate scarring. 14. Apply dry, sterile dressing on incision site or leave exposed to air if wound is not irritated by clothing, or according to physician orders. This reduces risk of infection. 15. Position patient, lower bed to safe height, and ensure patient is comfortable and free from pain. This provides patient with a safe, comfortable place, and attends to pain needs as required. 16. Complete patient teaching regarding Steri-Strips and bathing, wound inspection for separation of wound edges, and ways to enhance wound healing. Instruct patient to take showers rather than bathe.
Instruct patient not to pull off Steri-Strips and to allow them to fall off naturally and gradually (usually takes one to three weeks).
Instruct on the importance of not straining during defecation, and of adequate rest, fluids, nutrition, and ambulation for optional wound healing.
17. Discard supplies according to agency policies for sharp disposal and biohazard waste. Staple extractor may be disposed of or sent for sterilization. 18. Perform hand hygiene and document procedure and findings according to agency policy. Report any unusual findings or concerns to the appropriate health care professional. Hand hygiene reduces the risk of infection. Data source: BCIT, 2010c; Perry et al., 2014
Video 4.4
Special Considerations:
Confirm physician order to remove all staples or every second staple. All wounds held together with staples require an assessment to ensure the wound is sufficiently healed to remove the staples.
Staple removal may lead to complications for the patient. When removing staples, consider the length of time the staples have been in situ. Wound dehiscence, a mechanical failure of wound healing, remains a problem and can be affected by multiple factors (Spiliotis et al., 2009). Obese patients (greater than 30 kg/m2) have a higher risk of dehiscence than patients with a normal BMI. Additional risk factors for dehiscence include age over 75 years, COPD, diagnosis of cancer, use of steroids, malnutrition, anemia, sepsis, obesity, diabetes, tobacco use, and previous administration of chemotherapy or radiotherapy (Spiliotis et al., 2009). Table 4.5 lists other complications of removing staples.
Table 4.5 Complications of Staple Removal
Complication
Solution
Unable to remove staple from tissue Contact physician for further instructions. Dehiscence: Incision edges separate during staple removal Stop removing staples.
Apply Steri-Strips across open area.
Notify physician.
Patient experiences pain when staples are removed Allow small breaks during removal of staples.
Provide opportunity for the patient to deep breathe and relax during the procedure.
Data source: BCIT, 2010c; Perry et al., 2014
Critical Thinking Exercises
You are about to remove your patient’s abdominal incision staples according to the physician’s orders. As you start to remove the staples, you notice that the skin edges of the incision line are separating. What would be your next steps?
Your patient informs you that he is feeling significant pain as you begin to remove his staples. What would you do next?
How to Remove Surgical Staples: 8 Steps (with Pictures)
in a vehicle to reach my surgeon. My sister a qualified nurse will assist me in no time.Thanks again. "
..."
more
"Thanks. This seems easy enough to do at home. After a back operation, the last thing I need now is to travel 56km
Surgical Staples Removal: Here's What You Should Know • Drugwatcher.org
Around 12 million wounds are treated each year in emergency departments in the United States. When it comes to wound closure, doctors consider two major options depending on the body part that’s affected: stitches or surgical staples.
For minor wounds, suturing is the most common method of closure. However, doctors have been leaning more on the use of staples lately. After all, these medical devices have been heavily marketed as time savers and are believed to be more convenient compared to stitches when it comes to wound closure.
Upon removal, however, surgical staples require a special tool, unlike stitches which only require a pair of scissors to remove. With staples, it’s also harder to align the edges of a wound. This opens the possibility for wound dehiscence or re-opening of the surgical wound.
Aside from these, however, surgical staplers and staples have also been involved in several malfunction incidents. In fact, the adverse events reported about these medical devices already gave rise to several surgical stapler lawsuits being filed across the country.
Reports of surgical stapler malfunctions are a cause for concern for any patient. But when it comes to staples removal, is there anything else you should prepare yourself for?
Read the article to find out.
When should staples be removed?
In general, staples are removed within 7 to 14 days. It can also depend, however, on several factors, including:
where your wound is located
the size of your wound
how deep your wound is
your overall health
Furthermore, staples are used for complex wounds that are located on the scalp, trunk, arms, and legs. How long you’ll be told to wait may also vary depending on the surgical site. Particularly, the interval between application of the staples and their removal is as follows:
Scalp – 7 to 10 days
Trunk and upper extremities – 7 days
Lower extremities – 8 to 10 days
Staples on other areas of the body, including the back or belly or over a joint may also need to stay longer, often for a week or two. Be sure to follow your doctor’s instructions and be there when it’s time to remove your staples.
More importantly, never try to remove staples yourself at home. Removing staples is a procedure that should only be done by a licensed medical professional. Your doctor will follow appropriate procedures and medical tools to safely remove the staples while avoiding complications.
Removing Staples
Staple removal requires a sterile technique and a staple extractor. The medical professional doing the removal must also carefully check the wound before the procedure. They must ensure that the wound has healed enough to allow for the removal of staples.
The proper technique in doing the procedure is also important to promote wound healing and to avoid infection, pain, and damage to healing tissue.
In general, when removing your staples, your doctor will follow these steps:
You will be asked to either sit or lie down during the procedure.
Place the lower part of the extractor under a staple.
Squeeze the handles of the staple extractor to close the device. This will bend the staple in the middle. Wiggle it side to side until the edges come out of the skin.
Gently move the staple away from the surgical site once both edges are visible.
Dispose of the staple in a clean sheet of gauze.
Check for wound dehiscence. If none occurs, remove all remaining staples.
Apply adhesive strips on the area of removal to prevent dehiscence.
The surgical site may still feel tender after the staples are removed. Normally, it should feel better after a few minutes or a couple of hours after the procedure.
Other staples may also stay inside your body permanently. This is mostly done to keep internal organ tissues connected and protected from further damage.
What To Expect After The Procedure
As with sutures or stitches, staples can cause scarring. However, staples can lead to more scarring because they don’t require meticulous cosmetic repair.
This is also the reason why doctors don’t use them on a patient’s face or neck. Scars fade over time. However, in patients who scar easily, the scar from staple use may be more noticeable than one from a suture.
This is especially true if the staples are left in place for a longer period of 5 to 15 days, depending on the location.
It’s important to keep the area clean and follow your doctor’s instructions on proper wound care.
Risks and Complications
Difficult removal – Staples that have become embedded in the skin may lead to difficulty in removal. Proper initial placement of the staples as well as timely removal of the devices should avoid this complication in most patients.
In rare cases, however, staples can become completely lodged in the skin. In this case, radiographs may be required to locate the buried staple.
After local anesthesia, an incision can be made over the embedded staple so that removal can be done.
Pain during staple removal – If a patient experiences pain when staples are removed, the doctor can allow small breaks during the procedure.
They can also provide the patient more time to calm themselves by breathing and relaxing during the process.
Wound infection – Infection is a common complication that a patient may experience after surgery. Some symptoms that are indicative of a wound infection include fever, redness or swelling, pain, warmth at the incision site, and foul-smelling drainage from the wound.
If you experience these symptoms, call your doctor immediately. Infection can also result in a wide array of complications such as increased scarring, delayed wound healing, and longer recovery time.
Wound dehiscence – This may occur due to several reasons. Some risk factors include age, diabetes, smoking, and even an inexperienced surgeon. Increased physical activity after surgery may also put you at risk for wound reopening.
Activities such as sneezing, coughing, and lifting may put pressure on your wound and can cause them to split open.
What You Can Do
According to the U.S. Food and Drug Administration (FDA)’s Manufacturer and User Facility Device Experience (MAUDE) database, between 2011 and 2018, they received 41,000 adverse event reports related to the use of surgical staplers and staples.
However, an investigative report by Kaiser Health News revealed the existence of a hidden database where 56,000 more reports were kept secret from the public.
Recently, the FDA reclassified surgical staplers and staples for internal use as a Class II device. This means that these devices will now be subject to stricter requirements before they can obtain approval from the regulating agency.
This reclassification reflects the large number of adverse event reports, serious injuries, and deaths related to the use of surgical staplers and staples in previous years.
If you or a loved one underwent surgery with the use of medical staplers or staples and suffered from complications such as infection, internal bleeding, and organ damage, among others, you may have a case against the manufacturer of the device that was used on your surgery.
Contact us today if you wish to know more about how you can pursue legal action. We’re here to assist in finding the right surgical stapler attorney for you.
