Equipment
Equipment required for tick removal includes the following:
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Gloves
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Isopropyl alcohol or other skin disinfectant
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Fine-toothed forceps
As an option, one of the following over-the-counter tick removal devices may be employed:
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TRIX Tick Removal System - A tick lasso that grasps the mouth parts with a fiber loop
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The Tick Key - A key-sized device with a tapered slot that allows gentle traction to be applied for removal of the tick
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Sawyer Tick Pliers - Cradlehead pliers with an attached magnifier
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Pro-Tick Remedy – A small metal device with a tapered end that is used to grasp the tick and gently pull it away
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Ticked Off – A spoon-shaped device with a notched end that is used to grasp the tick and slide it off with gentle pressure
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Tick Twister – A hook-shaped device with a pronged end that is used to grasp the tick and gently pull it while twisting
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.
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, [9] 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).
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. [9, 10, 11]
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Ixodes scapularis mimicking a nevus at first glance. Image courtesy of Justin Finch, MD.
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Ixodes scapularis close-up. Image courtesy of Justin Finch, MD.
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Ixodes scapularis, tick vector for babesiosis. Courtesy of the Centers for Disease Control and Prevention.
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Typical appearance of erythema migrans, the bull's-eye rash of Lyme disease.
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Alopecia areata affecting the arms.
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Grasp the tick as close to the skin surface as possible and pull upward with steady, even traction.
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Bulls-eye rash
