Removing Staples....

  1. I had a great day today, but did have a problem removing someone's staples.

    Lady is s/p R TKR, and that alone is bizzare, I have never had a surgeon want us to remove staples for TKR. I have done lots of hips and other areas, but never a knee, so maybe that is part of it.

    I had her seated with her legs elevated, made sure she was comfortable. Her knee was very edematous in the first place. So, I start taking out the sutures, I started in the more edematous area, taking out every other. This lady was coming out of her chair. After about ten out, she was seriously starting to freak out. I was talking to her the whole time, having her take slow deep breaths, and gave her a break.

    I moved to the top of the incision, and it was easier to get the remover under the staples, but even thought these staples practically popped out themselves, she was still very sensitive, crying now, etc...

    I'm thinking OMG lady, you are freaking ME out, and I am starting to drip sweat!

    I got 34 of 40 staples out, but due to the edema, I truly did not think it was wise to take the rest out, the incision line in that particular areas was not crusted/scabbed like the other area and didn't look like it was really knitting well. No s/s infection whatsoever. I mean it honestly seemed like it was more than just an anxiety attack. Plus this lady has had several surgeries and has had staples removed before and said it never hurt her (made me feel like she was implying I didn't know what I was doing?? Not sure she meant it that way, but who knows?)

    So, I called surgeon, and we agreed to finish the last 6 staples early next week. If it stil looks taut, I am sending her to surgeon early to remove the rest.

    Has anyone ever had this happen? To me, there is a problem if someone is expereincing that much pain w staple removal. I know my technique was OK, I am always extremely gentle.

    Have you noticed that knee staples are more sensitive?

    Would you have just gone ahead and taken the rest out?

    Did I do OK?
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  2. 18 Comments

  3. by   sunnygirl272
    knee staples are more touchy, as it's more flexybendy....(which you know...duh..lol...) i would prolly havecalled the md and told them i was only doing qo staple because it was not knitting...and made her an appt for early nextweek...even with knee staples beingmore touchy, that does sound excessive discomfort....possible infection brewing under there....aall th emore reason to push for an appt....let them hurt her!!!
  4. by   hoolahan
    Thanks for the feedback sunny!! By next week, we'll reallly have to eval the site before taking out any sutures. It might not even be me.

    Her nurse is one of the crankiest people I know. I am sure she will B&M b/c she wanted to d/c her to PT only after this visit. So I am sure she will do her typical berating of me in the office at peak time of staff presence. Jusy makes me laugh though. I usually just ignore her and say "Whatever you say hon..." Just to tweak her. I'll have to save my ammo for that day, "Uh, like you told the family of X to use desitin for a stage 2 sacral decub??" You should have seen this thing. She won't like that either cause I called doc and got an "order" for duoderm. She is really L_A_Z_Y!!!!!!
  5. by   LilgirlRN
    I concur with sunnygirl.
  6. by   sunnygirl272
    Originally posted by hoolahan
    Thanks for the feedback sunny!! By next week, we'll reallly have to eval the site before taking out any sutures. It might not even be me.

    Her nurse is one of the crankiest people I know. I am sure she will B&M b/c she wanted to d/c her to PT only after this visit. So I am sure she will do her typical berating of me in the office at peak time of staff presence. Jusy makes me laugh though. I usually just ignore her and say "Whatever you say hon..." Just to tweak her. I'll have to save my ammo for that day, "Uh, like you told the family of X to use desitin for a stage 2 sacral decub??" You should have seen this thing. She won't like that either cause I called doc and got an "order" for duoderm. She is really L_A_Z_Y!!!!!!
    Bwahahhah...desitin?!?!?!?! anyhooo....point out to her that it's :
    1) more cost effective
    2) better use of nursing resources
    3) better PR

    to do a few more SN visits now and monitor what is doubtless either a seroma or an infection(or soon-to-be infection) and jump on it with the MD before it's nashty...

    than to d/c sn visits, go PT only, and have her open for QD or BID packing when they end up having to open it back up...and then will need PT all over again....
  7. by   Maerzie
    It sounds like you did just fine. I have, however, noticed a difference in staple removers. One slips under the staple very easily, and the other just isn't designed correctly and seems like it might hurt more--don't know how to explain the difference I noticed. I think it was a good idea to leave a few in. I ALWAYS also apply steri-strips (writing a V.O. for them if there isn't an order yet)just as added insurance, especially in a stressed area, such as the knee, and also on other wounds, especially if the wound looks "iffy" or the patient is quite fat. In home care, some patients over-exert or??? any number of things and the nurse isn't there watching every move. It's just for your own "CYA" also.

    Nursie Me :kiss
  8. by   hoolahan
    NursieMe,

    First of all welcome to the forum, haven't seen you post here before.

    But you have a point there! These staple removers were different than the usual ones I am used to, very cheesy, not a good "spring action" effect. Strange that you should mention that. Just another difference in homecare vs hospital, it all depends on what supplier is auth'd, as far as what is delivered.

    And I did use steri-strips. Didn't mention it, b/c I figured that was just standard, and I was too lazy to type any more!
  9. by   sphinx
    We remove staples post TKR all the time....yeah, it always seems to be a real senstive area. Some people do seem to have a lower pain threshold than most, but sounds like you did the right thing. It's one thing when you have a nervous jumpy pt whose wound is obviously well healed, and another when your patients is in a lot of pain and the wound is more edematous than usual and doesn't appear to be knitting. I've called the doc about leaving some staples in before, and never had a problem. Usually by my next visit, the wound is healed better and the staples come out no problem, either that or the patient has seen the doctor in the meanwhile.....
  10. by   renerian
    Any knee I have done has been much more sensative to the procedure. I usually take every other one out and see if it looks okay. If it doesn't then I call the doc and CYA.
    renerian
  11. by   patience0131
    how long until the flesh will grow over the staples
  12. by   CapeCodMermaid
    In the SNF setting we take staples out all the time and some times it's easier than others. Most of the time we can guess the surgeon by the way the staples look.
    I'll never forget one guy I had....in his mid 50's...macho type. His knee was healing perfectly. I went in to take out his staples and before I even touched him, he started to holler. I took out one staple and he screamed..."This is worse than having a baby!!!" I looked at him and said "...and you'd know this how???" I offered him a bullet to bite and he said "Oh, you're right...I'm being a baby"
    Just remember, it's not always you or your technique or the equipment. Some people just like to make a commotion about everything.
  13. by   slackdog
    I had knee replacement surgery Sept 5th........Had a hip put in about 11 yrs ago and removing staples was pretty easy procedure......but when the nurse started removing my knee staples........it was like FIRE.....like she was ripping them out......had to stopped her 3 times.....I broke out in a sweat and almost became nauseated...that 30 seconds or so was the worse pain of the whole operation......I know the nurse was NOT trying to hurt me......she tried to remove them extremely fast?....I have doc appointment soon and I will let the doc know how painful this procedure was.....he left the room somewhat in a hurry knowing that this was going to be painful........and I'm not blaming the nurse...my thinking is......this is 2007 and these kind of procedures should be relatively painless.......I checked with several other people that had knee replacement surgery and they did not complain about lots of pain when the their staples were removed.......

    slackdog
  14. by   TazziRN
    One technique I learned after my c-section that I've told my pts with staples: put bacitracin ointment on them daily, it prevents or minimizes any crusty sticking between the skin and staples. It will still hurt in the knees but at least there won't be that extra pinch with each staple pulled.

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