WOMEN AND NEWBORN HEALTH SERVICE

King Edward Memorial Hospital

CLINICAL GUIDELINES
OBSTETRICS & GYNAECOLOGY

WOUND CARE
DRESSINGS

REMOVAL OF STAPLES
NOTE: SPECIFIC INSTRUCTIONS FROM THE MEDICAL OFFICER MUST BE RECEIVED BEFORE
REMOVING STAPLES.
The evidence suggests that staples may have a differential effect depending on the type of incision,
vertical or Pfannenstiel. There is still insufficient evidence to determine whether day of staple removal
1
impacts on wound separation .
CONSIDERATIONS
Factors which may delay wound healing, and should therefore be considered prior to the removal of
sutures include:
Diseases, disorders and syndromes, e.g. anaemia, autoimmune disorders, diabetes, previous
surgery in same areas using same suture line
Drugs:- e.g. alcohol, nicotine, steroids, anti-inflammatory, cytotoxic medication
Poor nutritional state:- anaemia, malnutrition, mineral, protein and/or vitamin deficiency
Microenvironment of wound:- e.g. blood supply, humidity, infections
2
Other factors:- obesity, site of wound, dehydration, age .
EQUIPMENT
Trolley
Sterile Dressing pack
Sterile staple remover
Optional equipment e.g. normal saline, steri-strips, gauze

* Removal of Michel Clips as for staples will require the Michel Clip Remover.

PROCEDURE
1
1.1

1.2

1.3

1.4
1.5

DPMS
Ref: 7521

ADDITIONAL INFORMATION

Prior to the procedure

Explain the procedure and obtain verbal
3
consent from the patient.
Check post op instructions for the time of
staple removal MR 310 caesarean
section or MR 315 operation record
Ensure patient privacy and comfort.
Assess the comfort level of the patient.
Address if necessary
Assist the patient into a position which is
comfortable and allows easy access to
the suture line.
Adjust the height of the bed to promote
safe manual handling for the attending
staff member.
Perform hand hygiene and follow a strict
Aseptic Technique for the rest of the
procedure
Ensure the trolley is cleaned prior to use.
Don gloves and protective equipment as
required.

Advise the patient the procedure may cause

slight discomfort e.g. pulling or stinging
3
sensations.

MR 810 analgesia charted

Hand hygiene reduces transmission of

4
microorganisms.

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 1 of 3

PROCEDURE
1.6
1.7
2
2.1

3
3.1

4
4.1
4.2

4.3

4.4

4.5
4.6
4.7

4.8
4.9
5
5.1

Prepare equipment
If a dressing is in place, remove it,
perform hand hygiene and replace gloves
Assessing the suture line
4
Observations should include :
Determination of healing and
approximation of wound edges
Signs of infection
Cleansing of the wound
Consider cleaning the wound with normal
saline only to remove debris or dry exudate
which may cause skin trauma and patient
discomfort during staple removal.
Removal of staples
Place the drape from the dressing pack
between the wound and the operator.
Remove alternative staples first even if all
3
staples are ordered to be removed.

Place the lower jaw of the staple remover

under the staple. Squeeze the handles
together completely which will extract the
3, 4
staple.
Do not lift the stapler while squeezing the
3
handle.
Move the staple away from the skin surface,
then release the pressure on the staple
holder to allow the staple to drop into a
3, 4
disposable container.
Continue this process until all staples are
removed as medically requested.
After the staples are removed assess the
approximation and healing of the skin.
Apply steri-strips across the wound line if
required and there is no obvious infection or
exudate present.
Dispose of soiled and disposable equipment.
Remove gloves and perform hand hygiene.
Post procedure
Document removal of staples in the
patients medical record.
Document wound healing/status in the
patients medical record.
Document how the patient tolerated the
procedure.
Lower the bed if it was raised for the
procedure.

Removal of Staples
Clinical Guidelines Obstetrics & Gynaecology
DPMS Ref: 7521

ADDITIONAL INFORMATION

Advise the patient to assess and report signs

of wound infection e.g. redness, pain and
increased warmth and discharge, and to
notify staff of any signs of wound dehiscence
after suture removal.
Avoids solutions seeping into suture holes.

Note: do not remove remaining staples if

3, 5
dehiscence occurs.
Contact the team
doctor to assess the wound and implement
as management plan.
Squeezing of the handles cause the staple to
bend in the middle and pull the edges from
the skin. The ends of the staple are then
4
extracted from the skin.
This may cause skin trauma and pain for the
patient.

After each staple is removed assess the skin

4
for healing and signs of wound dehiscence.
4
Detects early dehiscence of the skin.
Steri-strips assist securing the wound edges
4
to aid healing.
Ensure the trolley is cleaned after use.

MR 249.61 Caesarean Birth Clinical Pathway

or MR 286 Gynaecology Observation Chart
and MR250 Integrated Progress Notes

King Edward Memorial Hospital

Perth Western Australia

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 2 of 3

CARE IN THE HOME (VISITING MIDWIFERY SERVICE)

Check the VMS summary (referral) for post-operative instructions for the time of staple
removal or contact the ward of discharge.
Ensure patient and staff safety in terms of correct manual handling and posture within the
home environment.
Follow the procedure as documented.
Document the care given and wound healing / status in the patients Caesarean Birth clinical
pathway (MR249.61) or VMS progress notes (MR255).
If concerned regarding the wound:

Discuss with the VMS Coordinator or a core staff member

Discuss with Obstetric or Gynaecology registrar (via KEMH switchboard)
Arrange review in the Emergency Centre at KEMH (if applicable)
Complete the VMS to EC referral form (MR026) and notify the department
Alternatively, the patient may choose to see her local general practitioner or present at an
Emergency Centre closer to her home.

REFERENCES / STANDARDS
1.

Mackeen. A.d., Berghella.V., Larsen.M.L. Techniques and materials for skin closure in caesarean section (Review).
The Cochrane Review,. 2012(11).

2.

Dougherty.L., Lister.S., editors. The Royal Marsden Hospital manual of clinical nursing procedures. 8th ed. West
Sussex- UK: Wiley-Blackwell; 2011.

3.

Pullen RL. Clinical Do's & Don'ts Removing sutures and staples. Nursing 2003;33(10):18.

4.

Bouska Altman G. Removing Skin Sutures and Staples. In: Bouska Altman G, editor. Delmar's Fundermental &
Advanced Nursing Skills. 2nd ed. New York2004.

5.

Nicol M, Bavin C, Bedford-Turner S, et al. Wound Assessment: Removal of skin closures. Nursing Standard.
2001;16(8).

National Standards 1- Care provided by the clinical workforce is guided by current best practice
3- Prevention of Healthcare associated infection
Legislation - Nil
Related Policies - Nil
Other related documents Nil
RESPONSIBILITY
OGCCU
Director of Nursing and Midwifery
Policy Sponsor
September 2009
Initial Endorsement
September 2014
Last Reviewed
Last Amended
September 2017
Review date
Do not keep printed versions of guidelines as currency of information cannot be guaranteed.
Access the current version from the WNHS website.

Removal of Staples
Clinical Guidelines Obstetrics & Gynaecology
DPMS Ref: 7521

King Edward Memorial Hospital

Perth Western Australia

All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual

Page 3 of 3