Chapter 18: Wound management
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18.3 Clip removal
Essential equipment
- Personal protective equipment
- Sterile dressing pack containing gallipots or an indented plastic tray, low‐linting swabs and/or medical foam, sterile field and disposable bag
- Fluids for cleaning and/or irrigation
- Appropriate dressing
- Any other materials as 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
- Clip remover
Optional equipment
- Any extra equipment that may be needed during the procedure, for example sterile adhesive sutures
Pre‐procedure
ActionRationale
- 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 [82], C).
- 2.Perform procedure using aseptic technique (i.e. use of a trolley, clean hands, apply apron and gloves).To prevent infection (Fraise and Bradley [33], E).
Procedure
- 3.Clean the wound with an appropriate sterile solution, such as 0.9% sodium chloride, if required.To remove crusts/dry skin to increase the visibility of the clips to be removed (Perry et al. [85], E).
- 4.If the incision line is under tension, use free hand to gently support the skin either side of the surgical incision line.To reduce the tension on the skin around the suture line and lessen pain on removal of the clip. E
- 5.Slide the lower bar of the clip remover with the V‐shaped groove under the clip at an angle of 90°. Squeeze the handles of the clip remover together to open the clip.To release the clip from the wound atraumatically. If the angle of the clip remover is not correct, the clip will not come out freely (Perry et al. [85], E).
- 6.Repeat until all clips have been removed.Clips should all be removed at the earliest possible point to avoid marks from the clips along the incision line (Widgerow [117], E).
- 7.Apply a suitable dressing.To protect the wound from further trauma or contamination and ensure optimum healing (Fraise and Bradley [33], E).
Post‐procedure
- 8.Dispose of waste in orange plastic clinical waste bags and sharps in a sharps bin. Remove gloves and wash hands.To prevent environmental contamination and sharps injury. Orange is the recognized colour for clinical waste (DH [23], C).
- 9.Record the condition of the suture line and surrounding skin (amount of exudate, pus, inflammation, pain, etc.).
