Summary ADVANCED PRACTICE NURSING PROCEDURES

Simple wound closure with the use of stapling devices can be done easily by the nurse practitioner. OVERVIEW • Types of staple material available • Ethicon • 3M • Deknatel RATIONALE • For rapid insertion • To reduce skin allergies • To prevent unsightly wound healing • To promote accelerated wound healing INDICATIONS • Long, linear lacerations • Scalp wounds • Wounds in area of less cosmetic importance • Yellow or green drainage • Chills and fever • Foul odor from wound • Soft tissue swelling may recur. If this happens, return to the office. BIBLIOGRAPHY Cardone DA, Tallia AF. Joint and soft tissue injection. Am Fam Physician. 2002;66(2):283–289. Pfenninger JL, Fowler GC. Procedures for Primary Care Physicians. St. Louis, MO: Mosby; 2019. 82 Section One | Dermatological Procedures CONTRAINDICATIONS • Crush wounds • Ischemic wounds • Highly contaminated wounds ◗ Informed consent required PROCEDURE Staple Insertion Equipment • Antiseptic skin cleanser • 0.9% sodium chloride—250 to 500 mL • Drape—sterile • Gloves—nonsterile • Stapling device • Staples • 1% or 2% lidocaine with epinephrine if the area to be anesthetized is not on a digit, nose, ear, or penis • 3-mL syringe • 27- to 30-gauge, 1-inch needle • 18-gauge, 1½-inch needle • Cotton-tipped applicator—sterile • Topical antibiotic ointment (Bactroban, Bacitracin, or Polysporin) • Nonstick dressing such as Telfa • 4 × 4 gauze—sterile • Tape Procedure • Position the client for comfort with laceration easily accessible. • Irrigate vigorously with 0.9% sodium chloride using 10-mL syringe and 18-gauge needle. • Cleanse a 3-inch-diameter area around the laceration with antiseptic skin cleanser. • Put on gloves. • Infi ltrate wound with 1% or 2% lidocaine. Epinephrine may be used if the wound is not on a digit, ear, nose, or penis. • Approximate the skin edges. • Start in the center of the laceration and work outward to prevent puckering. • Place the stapling device perpendicular to the skin and depress the top handle. • Insert staples perpendicular to the skin at ¼-inch intervals. • Apply topical antibiotic ointment. • Apply nonstick dressing. • Cover with 4 × 4 g