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8.14 Removal of T‐fasteners

This usually takes place 10 days post‐gastrostomy insertion unless dissolvable fasteners have been used, and it should be done after inspection of the gastrostomy site.

Essential equipment

  • Personal protective equipment
  • Sterile procedure pack containing gallipot, low‐linting gauze, sterile gloves and sterile field
  • 0.9% sodium chloride solution
  • Sterile metal forceps
  • Stitch cutter

Pre‐procedure

ActionRationale

  1. 1.
    Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
    To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [126], C).
  2. 2.
    Wash hands with soap and water or alcohol‐based handrub and apply personal protective equipment.
    Hands should be cleaned before and after each patient contact ([115], C).
  3. 3.
    Assist the patient into a supine position if the patient is able.
    To ensure patient comfort. E
  4. 4.
    Perform the procedure using aseptic technique.
    To prevent infection (Loveday et al. [91], R).

Procedure

  1. 5.
    Prepare a tray or trolley and take it to the bedside. Clean hands as above. Open the sterile pack and prepare the equipment.
    To reduce the risk of contamination of the contents (NICE [119], C).
  2. 6.
    Decontaminate hands and apply sterile gloves.
    To reduce the risk of cross‐infection ([115], C).
  3. 7.
    Clean the surrounding skin with an appropriate sterile solution such as 0.9% sodium chloride.
    To prevent infection and remove excess debris. E
  4. 8.
    Check the condition of the surrounding skin.
    To assess for any excoriation of the skin. E
  5. 9.
    Lift the external knot of the T‐fastener with metal forceps and cut the suture underneath the cuff, close to the skin. Remove the cuff and the metallic/plastic tag. Repeat on each T‐fastener.
    To remove the suture; plastic forceps tend to slip against nylon sutures. E
    To ensure removal of each fastener. E
  6. 10.
    Clean the skin with appropriate sterile solution such as 0.9% sodium chloride.
    To prevent infection and remove excess debris. E
  7. 11.
    After T‐fasteners have been removed, secure the fixation plate 1–2 cm away from the skin (if applicable). Do not cover the gastrostomy site with a new dressing unless there is a heavy discharge or leakage from the stoma site.
    To encourage wound healing. E

Post‐procedure

  1. 12.
    Record the condition of the skin surrounding the gastrostomy site.
    To document care and enable evaluation of the gastrostomy site (NMC [126], C).
  2. 13.
    Remove and dispose of any equipment.
    To reduce the risk of cross‐infection. E
  3. 14.
    Record the procedure in the patient's notes.
    To maintain accurate records (NMC [126], C).
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