The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [643]
Any other material will be determined by the nature of the dressing; special features of a dressing should be referred to in the patient’s nursing care plan
Optional equipment
Any extra equipment that may be needed during procedure, for example sterile scissors, stitch cutter, staple remover, sterile adhesive sutures
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient.
To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).
2 Perform procedure using aseptic technique.
To prevent infection (see Chapter 3, (Fraise and Bradley 2009, E).
Procedure
3 Clean the wound with an appropriate sterile solution such as 0.9% sodium chloride.
To prevent infection. (Fraise and Bradley 2009, E).
4 Lift knot of suture with metal forceps. Snip stitch close to the skin. Pull suture out gently towards the side that has been cut. For intermittent sutures, alternate sutures may be removed first before remaining sutures are removed (Pudner 2005).
Plastic forceps tend to slip against nylon sutures. E
To prevent infection by drawing exposed suture through the tissue (Pudner 2005, E).
To ensure wound closure and predict dehiscence (Pudner 2005, E).
5 Use tips of scissors slightly open or the side of the stitch cutter to gently press the skin when the suture is being drawn out.
To minimize pain by counteracting the adhesion between the suture and surrounding tissue. E
Postprocedure
6 Record condition of suture line and surrounding skin (amount of exudate, pus, inflammation, pain, and so on).
To document care and enable evaluation of the wound (Bale and Jones 2006, E; Dealey 2005, E; NMC 2009, C).
7 Use of adhesive skin tapes should be monitored and they are usually left in place until they fall off by themselves.
To improve cosmetic effect and support tensile strength of the wound post suture removal, when indicated (Pudner 2005, E).
Procedure guideline 15.3 Staple removal
Essential equipment
Sterile dressing pack containing gallipots or an indented plastic tray, low-linting swabs and/or medical foam, disposable forceps, gloves, sterile field, disposable bag
Fluids for cleaning and/or irrigation
Hypoallergenic tape
Appropriate dressing
Appropriate hand hygiene preparation
Any other material will be determined by the nature of the dressing; special features of a dressing should be referred to in the patient’s nursing care plan
Detergent wipe for cleaning trolley
Total traceability system for surgical instruments and patient record form
Optional equipment
Any extra equipment that may be needed during procedure, for example sterile scissors, stitch cutter, staple remover, sterile adhesive sutures (E)
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient.
To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).
2 Perform procedure using aseptic technique.
To prevent infection (see Chapter 3) (Fraise and Bradley 2009, E).
Procedure
3 Clean the wound with an appropriate sterile solution such as 0.9% sodium chloride.
To prevent infection (Fraise and Bradley 2009, E).
4 Slide the lower bar of the staple remover with the V-shaped groove under the staple at an angle of 90°. Squeeze the handles of the staple removers together to open the staple.
To release the staple atraumatically from the wound. If the angle of the staple remover is not correct, the staple will not come out freely (Pudner 2005, E).
5 If the suture line is under tension, use free hand to gently squeeze the skin either side of the suture line.
To reduce tension of skin around suture line and lessen pain on removal of staple. E
6 If the wound gapes use adhesive sutures to oppose the wound edges.
To improve the cosmetic effect. E
Postprocedure
7 Record condition of suture line and surrounding skin (amount of exudate, pus, inflammation, pain, etc.).
To document care and enable evaluation of the wound (Bale and Jones 2006, E; Dealey 2005, E; NMC