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Tick Removal Periprocedural Care

  • Author: Steven Brett Sloan, MD; Chief Editor: Erik D Schraga, MD  more...
 
Updated: Feb 11, 2016
 

Equipment

Equipment required for tick removal includes the following:

  • Gloves
  • Isopropyl alcohol or other skin disinfectant
  • Fine-toothed forceps

As an option, one of the following over-the-counter tick removal devices may be employed:

  • TRIX Tick Removal System - A tick lasso that grasps the mouth parts with a fiber loop
  • The Tick Key - A key-sized device with a tapered slot that allows gentle traction to be applied for removal of the tick
  • Sawyer Tick Pliers - Cradlehead pliers with an attached magnifier
  • Pro-Tick Remedy – A small metal device with a tapered end that is used to grasp the tick and gently pull it away
  • Ticked Off – A spoon-shaped device with a notched end that is used to grasp the tick and slide it off with gentle pressure
  • Tick Twister – A hook-shaped device with a pronged end that is used to grasp the tick and gently pull it while twisting
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Patient Preparation

For simple, uncomplicated tick removal, anesthesia is generally unnecessary. The use of lidocaine (subcutaneously or topically) may actually irritate the tick, causing it to regurgitate its stomach contents.

The patient should be in a comfortable position that allows the clinician easy access to the tick. The room should be well lit.

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Monitoring and Follow-up

Persons who have undergone tick removal should up to 30 days of monitoring for signs and symptoms of tick-borne diseases,[6] such as the occurrence of a skin lesion at the site of the tick bite (which may suggest Lyme disease; see the images below) or a temperature higher than 38°C (which may suggest human granulocytic ehrlichiosis [HGE] or babesiosis).

Typical appearance of erythema migrans, the bull's Typical appearance of erythema migrans, the bull's-eye rash of Lyme disease.
Bulls-eye rash Bulls-eye rash

Although routine use of either antimicrobial prophylaxis or serologic testing after a tick bite is not recommended, some experts recommend antibiotic therapy for patients bitten by Ixodes scapularis(Ixodes dammini) ticks that are estimated to have been attached for longer than 48 hours (on the basis of the degree of engorgement of the tick with blood), in conjunction with epidemiologic information regarding the prevalence of tick-transmitted infection.

However, accurate determination of the species of tick and assessment of the degree of engorgement are not possible on a routine basis, and the data are insufficient to demonstrate the efficacy of antimicrobial therapy in this setting.[6, 7, 8]

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Contributor Information and Disclosures
Author

Steven Brett Sloan, MD Associate Professor, Department of Dermatology, University of Connecticut School of Medicine; Residency Site Director, Connecticut Veterans Affairs Healthcare System; Assistant Clinical Professor, Yale University School of Medicine

Steven Brett Sloan, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Connecticut State Medical Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Journal of the American Academy of Dermatology;Up to Date;Medical Review Institute of America.

Chief Editor

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Acknowledgements

Andrew K Chang, MD Associate Professor, Department of Emergency Medicine, Albert Einstein College of Medicine, Montefiore Medical Center

Andrew K Chang, MD is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Neurology, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References
  1. McGinley-Smith DE, Tsao SS. Dermatoses from ticks. J Am Acad Dermatol. 2003 Sep. 49(3):363-92; quiz 393-6. [Medline].

  2. Demicheli V, Debalini MG, Rivetti A. Vaccines for preventing tick-borne encephalitis. Cochrane Database Syst Rev. 2009 Jan 21. CD000977. [Medline].

  3. Kunze U. Conference report of the 10th meeting of the international scientific working group on tick-borne encephalitis (ISW-TBE): combating tick-borne encephalitis: vaccination rates on the rise. Vaccine. 2008 Dec 9. 26(52):6738-40. [Medline].

  4. Banzhoff A, Broker M, Zent O. Protection against tick-borne encephalitis (TBE) for people living in and travelling to TBE-endemic areas. Travel Med Infect Dis. 2008 Nov. 6(6):331-41. [Medline].

  5. De Boer R, van den Bogaard AE. Removal of attached nymphs and adults of Ixodes ricinus (Acari: Ixodidae). J Med Entomol. 1993 Jul. 30(4):748-52. [Medline].

  6. Wormser GP, Nadelman RB, Dattwyler RJ, et al. Practice guidelines for the treatment of Lyme disease. The Infectious Diseases Society of America. Clin Infect Dis. 2000 Jul. 31 Suppl 1:1-14. [Medline].

  7. Volkman D. Prophylaxis after tick bites. Lancet Infect Dis. 2007 Jun. 7(6):370-1. [Medline].

  8. Dennis DT, Meltzer MI. Antibiotic prophylaxis after tick bites. Lancet. 1997 Oct 25. 350(9086):1191-2. [Medline].

  9. Oteo JA, Martinez de Artola V, Gomez-Cadinanos R, et al. [Evaluation of methods of tick removal in human ixodidiasis]. Rev Clin Esp. 1996 Sep. 196(9):584-7. [Medline].

  10. des Vignes F, Piesman J, Heffernan R, et al. Effect of tick removal on transmission of Borrelia burgdorferi and Ehrlichia phagocytophila by Ixodes scapularis nymphs. J Infect Dis. 2001 Mar 1. 183(5):773-8. [Medline].

  11. Gammons M, Salam G. Tick removal. Am Fam Physician. 2002 Aug 15. 66(4):643-5. [Medline].

  12. Stewart RL, Burgdorfer W, Needham GR. Evaluation of three commercial tick removal tools. Wilderness Environ Med. 1998 Fall. 9(3):137-42. [Medline].

  13. Needham GR. Evaluation of five popular methods for tick removal. Pediatrics. 1985 Jun. 75(6):997-1002. [Medline].

 
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Ixodes scapularis mimicking a nevus at first glance.
Ixodes scapularis close-up.
Ixodes scapularis, tick vector for babesiosis. Courtesy of the Centers for Disease Control and Prevention.
Typical appearance of erythema migrans, the bull's-eye rash of Lyme disease.
Alopecia areata affecting the arms.
Grasp the tick as close to the skin surface as possible and pull upward with steady, even traction.
Bulls-eye rash
 
 
 
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