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When Rene Steele, RN, had to place a catheter in a male patient who had his penis pierced, he would not allow the procedure to be done. "He refused to let me take it out because he was afraid the piercing would close up," she recalls. After Steele, an ED nurse at University Hospital in Cincinnati, explained the infected piercing was the probable cause of his inability to urinate, the patient allowed her to remove the jewelry and proceed.
Another patient swallowed a tongue piercing and came in complaining of abdominal pain, reports Diana Meyer, RN, MSN, CCNS, CCRN, CEN, clinical nurse specialist for emergency services at St. Joseph Hospital in Bellingham, WA. "Unfortunately, it didn’t make it all the way through her intestinal tract and caused a serious infection," she explains.
If you haven’t seen a patient with a body piercing yet, you probably will soon, says Reneé Semonin Holleran, RN, PhD, chief flight nurse and clinical nurse specialist at University Hospital. "It’s safe to say that the trend of body piercing will continue, even in the rural areas," she predicts. "I continue to be amazed at the adults who get body piercings." Here are ways to change your practice when caring for patients with body piercings:
• Resist the urge to judge. Body piercing now is commonplace in mainstream society, notes Meyer. "You should take it in stride and develop an attitude of acceptance toward patients with body piercings," she says.
• Realize that jewelry can exacerbate traumatic injuries. Eyebrow piercings and earrings have caused injury when pulled during fights, says Holleran. Also, the objects can tear the skin, she adds. Carefully assess the location of jewelry if holes are present in the tongue, nose, or other areas of the face, Holleran says. "The jewelry may become loosened and easily aspirated or fall down into the back of the patient’s mouth," she warns. Care must be taken when rapidly removing clothing during resuscitation if piercings are present, advises Holleran. When jewelry is pulled, it can tear the skin. "Localized tissue injury is the biggest risk. Also, there is the risk for scarring when chunks of skin are removed."
• Be aware of potential for infections. Often, problems stem from the patient failing to properly clean their piercing as instructed to prevent infection, says Steele. "There is a great deal of care that goes into caring for a piercing," she says.
The biggest complication with body piercing is probably infection, Holleran agrees. "Patients have developed serious cellulitis from piercing, particularly in areas with poor circulation or where poor technique has been used." The development of cellulitis can lead to loss of tissue, extremity function, and systemic infection, says Holleran. "Cellulitis could also lead to chronic wound infections as well," she adds.
The following are risk factors for cellulitis, says Holleran: poor skin preparation for the piercing, dirty equipment, poor wound care after the piercing, and pre-existing conditions such as diabetes and immunosuppression.
If a patient has a minor local infection, it might be advisable to remove the jewelry, says Meyer. However, she cautions if the infection is more extensive, the jewelry should not be removed. "This will only cause the skin to close, while causing abscess development in deeper skin structures," she explains. A better management plan is to leave the jewelry in and allow drainage of purulent material to continue, says Meyer.
• Ask if piercings were done by a professional. While professional piercers follow an aseptic surgical technique, piercings done with a spring-loaded "gun" place a person at risk for infectious disease, warns Meyer. The guns are infrequently sterilized and not easily cleaned, she explains. If piercings were done by an unlicensed individual, you should include some additional screening in the patient’s care for HIV and hepatitis so you can recommend prophylactic care, if needed, says Meyer.
• Consider airway management. Airway management problems may occur with a patient with a tongue piercing who has facial injuries, says Steele. (See "Should you remove body jewelry?" in this issue.) Objects in the patient’s tongue, around the mouth, and in the nose could cause potential airway obstruction by aspiration of the object, notes Holleran. "Anything that is in the patient’s mouth may interfere with one’s ability to manage their airway in a crisis," she warns.
For more information about body piercing injuries, contact:
• Reneé Semonin Holleran, RN, PhD, University of Cincinnati Medical Center, P.O. Box 670736, Cincinnati, OH 45267. Telephone: (513) 584-7522. Fax: (513) 584-4533. E-mail: firstname.lastname@example.org.
• Diana Meyer, RN, MSN, CCNS, CCRN, CEN, Emergency Services, St. Joseph Hospital, 2901 Squalicum Parkway, Bellingham, WA 98225. Fax: (360) 715-4118. E-mail: email@example.com.
• Rene Steele, RN, University Hospital, 234 Goodman St., Cincinnati, OH 45267. Telephone: (513) 584-8148. E-mail: firstname.lastname@example.org.