How to remove staples and use steri strips

[crawlyberry]

Hey yall....still a newbie on the surgery floor...I made a HUGE mistake yesterday and have been crying all day about it. I was to remove staples from and abdominal incision that was ota. I wiped the area with the benzo sticks, started to remove the staples and then when I go to just about the last 6, the patients incision started to split open. OMG!!!! I thought I was to put the strips on last, but was informed by the doctor that I really messed up and wouldnt give me the opportunity to ask how I was supposed to do it. I didnt learn this in school, and the only one I watched that staples were ever taken out of had maybe one or two sterstrips applied in areas that werent so secure looking. Can anyone help me out? I am so mortified, I hope that I havent prolonged this patients healing process..

[dani_girl]

I just learned this on our surg floor (am floating).. they count the staples (prior to removal) then remove every OTHER ONE, then put steri-strips in there place (like after you do 3 or 4) then do the remaining..

then when done.. count what you have.. this is a last ditch to make sure you didn't cover a staple..

[core0]

we saw some subcutaneous tissue...no infection...but again what is the proper way to doing it? I lost most of my nursing books during Katrina and the ones I have now dont address it...

My opinion, you didn't do anything wrong. This is one of two issues. Either the staples came out too early or the wound was going to open no matter what you did. This is a relatively normal issue with wounds and not anyone's fault. Here is an article that describes removing staples. Suprise - its exactly how you did it. The way you did it is how I remove staples.

http://findarticles.com/p/articles/mi_qa3689/is_200002/ai_n8884203/pg_1?tag=artBody;col1

In reality in my opinion steri-strips are mostly voodoo. We have surgeons that swear by them and those that don't use them. The superficial dehiscence rate in our clinic is the same.

Here is an article that talks about wound healing and dehiscience:

http://rn.modernmedicine.com/rnweb/article/articleDetail.jsp?id=433110

Notice that the article talks about two reasons - poor surgical technique and removing staples too early. Not applying steri-strips is not one of them.

To be honest if I have any doubt about the wound I would take out the staples myself. In fact I like to take the staples out myself anyway so I can assess the wound. There is a trick that you can do to put steris between the staples and then take the staples out. When I was younger and stupider I used to believe this helps. However, now that I am no longer young I have come to understand this really doesn't do anything.

BTW applying steri strips to an open wound is a big no-no. Once the wound opens its contaminated and must close by second attention. All applying steri-stips does is substantially increase the chance of infection. Unless the fascial layer is involved (in that case its definitely a surgeon error) this is a cosmetic problem that should be managed from a infection standpoint (wet to dry until it granulates in - maybe consider wound vac if its big). I would tell you to check your policy, but most policies are a collection of whatever superstition your local surgeons happen to believe in.

Buck up you did nothing wrong. Of course you would never get a surgeon to admit that:rolleyes:.

David Carpenter, PA-C

[koala_bear]

i work at a surgical unit too and only those rns certified by the hospital in staple removal are allowed to take them out. pas do that too. i'm sorry this happened to you though. how many days post-op was your patient?

[TurismoDreamin]

Well....you definitely made the incision OTA...there's no harm in asking if you're unsure.

[Straydandelion]

I would take out every other one placing a steri strip where the staple was removed, then if all looks good, take out the rest one at a time, placing steri strips. If any part looks as if it was coming open, I would leave the rest of the staples and call the doctor. The ortho docs were very particular about procedures such as this and there SHOULD have been something written in the floor's policy and procedure book. You are new to the floor, and the charge nurse didn't go over the procedure with you?

[CABG patch kid, BSN, RN]

Okay so you take out every other one and then what do you do? If all staples need to be taken out and they wanted the strips to be used?

The correct way is to take out every other staple or suture and observe the incision for dehisence as you remove them. That way if the incision isn't really healed up, you'll notice before taking them all out. Also, you should apply the steri strips as you take the sutures, don't wait until you have all the sutures out before you apply them. Maybe the last staple removal you saw was on a smaller incision? Abdominal incisions usually have the most stress on them and are most prone to dehisce, so using good technique on them is even more important.

**I didn't read the second page of this thread before posting. Sorry for being repetitive!

[allele, LPN]

Every facility has their own policy, but I usually take out every other staple, if the incision looks "iffy" at that point I'll apply the steris where I removed the staples and request the rest of the staples be taken out another day, the next day or so. Sometimes it's even ordered to be done this way. But I've gotta tell ya, I don't think any of this would have helped your patient's incision, it sounds like it was bound to happen! Abdominal incisions seem to dehisce quite frequently, in fact I rarely see other incsions dehisce as often! Chalk this one up as experience, the next time you're supposed to take them out, bring the charge nurse in with you and ask for guidance. Good luck to you!!

[cookie102]

Okay so you take out every other one and then what do you do? If all staples need to be taken out and they wanted the strips to be used?

i start by taking out every other one, and as i do i replace it with a steri strip,,,,as i go along if the incision looks like it may separate , i stop and don't remove any more and call the MD,,,,,i honestly think that from the sounds of it , that incision was going to open up regardless of whether you put the strips on as you went along or not.....surgeons are "tough" ones,,,when something goes wrong that are so quick to blame someone,,,and often it is no ones fault, just a surgery gone bad......how long had the staples been in place? did the pt have underlying disease processes like diabetes? so many factors.

don't beat yourself up over it,,,,

[TiredMD]

My opinion, you didn't do anything wrong. This is one of two issues. Either the staples came out too early or the wound was going to open no matter what you did. This is a relatively normal issue with wounds and not anyone's fault.

Agreed, with the one caveat that if you've never done something before, you need to have someone with you who has.

In reality in my opinion steri-strips are mostly voodoo. We have surgeons that swear by them and those that don't use them. The superficial dehiscence rate in our clinic is the same.

I'm with you, the things are fake, and I think they often do more harm than good (like when people decide to peel them off on their own, re-opening the wound).

There is a trick that you can do to put steris between the staples and then take the staples out. When I was younger and stupider I used to believe this helps. However, now that I am no longer young I have come to understand this really doesn't do anything.

Or the other stupid idea of "take every other staple out today and see what it does". What's wrong with people these days, that they want to pull staples out at the first possible moment? They're staples, they can sit for a while, and you're gonna get a scar any way. It doesn't hurt anything to leave them in for a good 2-3 weeks.

BTW applying steri strips to an open wound is a big no-no. Once the wound opens its contaminated and must close by second attention. All applying steri-stips does is substantially increase the chance of infection. Unless the fascial layer is involved (in that case its definitely a surgeon error) this is a cosmetic problem that should be managed from a infection standpoint (wet to dry until it granulates in - maybe consider wound vac if its big).

More importantly, the wound was contaminated once it split, then they closed over the contaminated wound without a washout. That's a great way to turn a superficial wound infection into an abscess. Should've just packed it and sent 'em home.

[EJSRN, BSN, RN]

I didn;t know we could remove staples????

[Keepstanding, ASN, RN]

there, there my dear. you will learn from this experience and never do it again. cheer up now !

praiser :heartbeat

[Faeriewand, ASN, RN]

I had no idea that this could happen and I work (still orienting) on a med surg floor. (Well I guess I had SOME idea it could happen because I studied it for NCLEX but never experienced this IRL) We removed staples when I was a student, the instructor right there with us. I thought it was no big deal until I read this! I've removed them on the hip and in ob/gyn after C/S and put on steri-strips per MD orders. How often do abdominal wounds dehisce? I am reading both of those articles now plus going to my book Med/Surg Made Incredibly Easy. I just got this book. Looks good so far. Thanks for starting this thread. I learned something today