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Body jewelry can interfere with procedures such as intubation, X-rays, and Foley catheters, warns Diana Meyer, RN, MSN, clinical nurse specialist for emergency services at St. Joseph Hospital in Bellingham, WA. "If jewelry is really in the way of your treatment or diagnostic plan, then you definitely have to remove it." This may be easier said than done, Meyer acknowledges. "Removing the jewelry can be quite frustrating for the uninitiated," she says. Here are some things to consider when removing body jewelry:
• Don’t remove the jewelry unless it’s necessary. Surprisingly, body jewelry often doesn’t need to be removed, says Meyer. "It’s more of a compulsion on our part and may not actually need to come out." For example, chest and nipple piercings do not necessarily need to be removed for electrical therapy, says Meyer. "Their presence is benign unless the paddles are placed directly over the jewelry," she notes. However, chest piercings that consist of long thin metal strips running under the skin may interfere with electrical therapy, Meyer adds. "Obviously, the presence of any metal on the body can wreak havoc with our ability to get clear radiological studies," she says.
If there is a way to preserve the jewelry, do so, advises Rene Steele, RN, an ED nurse at University Hospital in Cincinnati. "Some are very expensive; just as we take care of normal’ jewelry, we should try to take care of that which is not so normal’ as well."
• Ask the patient to remove the jewelry. If the patient is awake and alert, your best bet is to ask them to remove the jewelry, says Meyer. "It does not work like the jewelry that most of us wear."
The following procedures necessitate removal of body piercings:
— Catheterization. The penis piercing known as a "Prince Albert" can make placing a urinary catheter difficult, says Kathleen Flarity, ARNP, MN, CEN, CFRN, ED nurse practitioner at Overlake Hospital in Bellevue, WA. "There is a rod that is placed in some individuals with this piercing, which extends inside the urethra," she notes. "That is a potential injury since it is unyielding, as well as making catherization difficult."
Piercing of the genitals can interfere with catheterization by blocking the meatus, particularly if the head of the penis if pierced, says Reneé Semonin Holleran, RN, PhD, chief flight nurse and clinical nurse specialist at University Hospital in Cincinnati. "Jewelry will have to be removed to prevent the risk of infection in this area."
— Airway management. Facial body piercings can make resuscitation more difficult, says Flarity. "A piercing between the eyebrows can make it difficult to get a good seal with the bag valve mask. Tongue piercings can make intubation more difficult."
Piercings in or around the oral cavity might be hazardous during airway management, says Holleran. "Remove tongue/lip piercings, uvula piercings, and septum piercings." However, Flarity cautions there is a danger of creating a foreign body in the airway with removal, so the removal should be handled very carefully. "Obviously, you don’t want to drop any piece of the jewelry into the mouth," she says.
For example, to remove a tongue piercing (a rod with a ball on either end), Flarity recommends taking two pairs of hemostats and ensuring they are locked into position. Next, hold one ball stationery with the first pair of hemostats, and hold the second ball with the other pair, rotate until it unscrews, and pull the rod out, never letting go with the hemostats, she says.
— Cervical spine immobilization and evaluation. Cheek, chin, and throat piercings may interfere with the ability to stabilize the cervical spine, so jewelry at these sites might need to be removed, says Meyer.
— Application of military anti-shock trousers for pelvic fracture stabilization. Remove navel piercings and any genital piercings, says Holleran. "They could pierce the pants and render them ineffective, as well as, with the pressure exerted by the pants, cause additional injury to the patient," she explains.
— Insertion of a urinary catheter. Remove piercings in the head and body of the penis and any clitoral piercings, since they may interfere with the passing of the catheter, according to Holleran.
— Childbirth. Remove any genital piercings, says Holleran. "In childbirth, it may interfere with the delivery, or it could injure the baby," she explains. "It may also get pulled on, which may cause pain or injury.
— Any type of radiographs, computerized tomography scans and magnetic resonance imaging. All jewelry should be removed for radiographs so they do not interfere with interpretation, says Holleran.
• Become familiar with the various types of jewelry. Learning the correct way to remove the jewelry will expedite nursing or emergency treatments, says Steele. "Take the time to ask if anyone [on the medical staff] knows how to remove the jewelry correctly, in order to prevent further injury," she recommends. Most types of jewelry, known as "barbells" or "labrets," are removed by unscrewing one of the balls at the end of the bar, then pulling the bar through the soft tissue, says Meyer. Nurses tend to be confounded by the "captive bead ring" closure used in many piercings.
"The bead is held in place by the tension of the ring," Meyer explains. Ideally, use a spreader tool, available at body piercing establishments, she says. (For more information, see "Sources and resources," below.) The tool inserts into the middle of the ring and opens it so the bead drops. If you don’t have a spreader tool, take a pair of pliers and spread the ring apart, says Meyer. The bead will drop, and you can pull the ring through the opening.
• Don’t use ring cutters. When you use a ring cutter on a finger, the ring just pulls through, but that’s not the case with body jewelry, she explains. "This will create sharp edges and do some damage trying to pull it through the patient’s soft tissue," says Meyer.
For more information about removal of body piercing jewelry, contact: Kathleen Flarity, ARNP, MN, CEN, CFRN, Emergency Department, Overlake Hospital, 1035 116th Ave. N.E., Bellevue, WA 98004. Telephone: (425) 688-5200. Fax: (425) 688-5667. E-mail: Kflarityr@aol.com.
The Association of Professional Piercers has a Web site (www.safepiercing.com) which includes a consumer’s guide to choosing a piercer and aftercare instructions for facial, body, and oral piercings. For more information on body piercing, contact: Association of Professional Piercers, PMB 286, 5446 Peachtree Industrial Blvd., Chamblee, GA 30341. Telephone: (888) 515-4APP. E-mail: firstname.lastname@example.org.
Anatometal offers ring opening plier to remove captive bead ring jewelry. The cost is $76 plus $5 for shipping. For more information, contact: Anatometal, 411 Ingalls St., Santa Cruz, CA 95060. Telephone: (888) ANOMETAL or (831) 454-9880. Fax: (831) 454-0163. Web: www.anatometal.com. (Click on "tools and accessories" and "ring opening pliers.")