Staple Removal: November 2025 Competency

This station validates safe, aseptic staple removal and post-removal wound care for post-operative incisions in the home and inpatient hospice settings. Clinicians will demonstrate correct assessment, technique, and verbalize documentation consistent with Tufts Medicine Care at Home policy and the provider’s order.

Infection Prevention & Safety

• Hand hygiene before and after; appropriate PPE based on wound status and exposure risk.
• Clean (aseptic) technique using sterile staple remover and verbalizing sterile/clean dressings per policy.
• Maintain a clean field; avoid contaminating instruments or the wound bed.

Pre-Removal Assessment (Required)

• Verify the provider’s order (location, number of staples/segments, timing, instructions).
• Confirm patient identity and consent; assess pain level and pre-medicate as ordered/needed.
• Inspect incision for approximation, erythema, edema, drainage, warmth, dehiscence, odor.
• Review co-morbid factors affecting healing (anticoagulation, diabetes, steroids, nutrition).
• If findings suggest poor healing or dehiscence risk, do not remove; notify provider.

What We Validate (Technique)

• Set up supplies on a cleanable surface; open sterile items without contamination.
• Support skin; position the staple remover fully under the staple with the jaw centered.
• Squeeze remover to flatten the staple and lift straight up to avoid tissue trauma.
• Remove staples in an alternating/skip pattern to maintain incision integrity.
• Stop and reassess if wound edges separate; consider leaving remaining staples in place and notify provider.
• Apply Steri-Strips (if ordered/indicated) to support edges; avoid tension or skin shear.
• Apply dressing per order or leave open to air if appropriate and instructed.

When Not to Remove / Pause and Escalate

• No active order, unclear instructions, or discrepancy in site/side or staple count.
• Signs of infection or poor approximation (gapping, drainage, fluctuance, uncontrolled pain).
• Patient reports new systemic symptoms (fever, chills) or significant bleeding risk not addressed.

Supplies at the Station

• Sterile staple remover(s), sterile forceps (if used), verbalize using sterile gauze, Steri-Strips (per order).
• Skin prep (per policy), adhesive remover (optional), ordered dressing materials, tape.
• Gloves, protective pad/underpad, disposal container for removed staples, disinfectant wipes.

Patient Education (Verbalize)

• What to expect during removal; normal mild pulling/tugging sensations.
• Post-removal care: dressing changes, showering/bathing instructions, activity limits.
• When to call: increasing pain, redness, swelling, drainage, fever, or wound separation.

Documentation (Verbalize Elements)

• Order verified (site, number removed/remaining, segments, provider instructions).
• Wound assessment pre- and post-removal; approximation; presence/absence of signs of infection.
• Pain assessment and management; patient tolerance of the procedure.
• Post-care provided (Steri-Strips, dressing type), education, and plan/notifications.

Common Pitfalls to Avoid

• Not centering the remover under the staple, causing skin tearing.
• Removing sequentially without skip pattern on a long incision.
• Proceeding despite poor approximation or unclear orders.
• Inadequate post-support (no Steri-Strips when indicated) leading to edge separation.

Validation process: If the first attempt is not satisfactory, you’ll be directed to review the procedure materials here, and return for a second attempt during your session (as time allows). If still not satisfactory, 1:1 remediation will be scheduled for November 19, 2025 between 8:00 AM and 10:00 AM, per standard process.