II. Technique: Manual Tick Extraction
- Tools
- Blunt angled forceps with medium size to fine tips
- Angled or curved instruments may allow for easier grasping of tick
- Specific Tick Removal devices
- Sawyer Tick Pliers (B & A Products)
- Pro-Tick Remedy (SCS Limited)
- Ticked Off (Ticked Off, inc.)
- Removal
- Grasp tick as close to embedded mouth as possible (closest to skin), and avoid crushing
- Gently pull perpendicular to skin without twisting and tick will eventually release
- Post-extraction care
- Retained parts of mouth or head may be left and will fall away in the subsequent days
- No need to dig for tiny retained parts (although significant retained parts can lead to complications)
- Apply antiseptic to extraction sites (e.g. Alcohol, Betadine, Hibiclens)
- Observe for complication signs (e.g. local infection)
- See Lyme Disease for Post-exposure Prophylaxis
- Retained parts of mouth or head may be left and will fall away in the subsequent days
III. Technique: Excisional Tick Removal
- Inject Local Anesthetic (e.g. Lidocaine 1% with Epinephrine) deep to Tick Bite site, raising a skin wheel
- Use a scalpel (e.g. #15) to incise a small circle around tick attachment site (e.g. 3 mm diameter)
- Punch Biopsy 3 mm could also be used (if tick fits within punch)
- Avoid touching or manipulating the tick to prevent reflux of tick mouth contents into bite site
-
Suture wound after excision as needed with typically 1 Suture
- Small incisions of 3 mm or less do not require suturing
IV. Precautions: Methods to avoid
- Avoid using sharp forceps
- Avoid crushing or puncturing tick body (or otherwise manipulating tick significantly prior to removal)
- Do not apply solvents to tick
- Do not apply Lidocaine, gas, or vaseline to tick (ineffective and risk of local reaction)
- Do not apply hot match or nail to tick
- Do not twist tick head to remove
- Do not thread Suture Needle through tick
V. Complications: Retained tick parts (e.g. head)
- Skin Granuloma
- Cellulitis or abscess
VI. References
- Green and Millsap (2016) Crit Dec Emerg Med 30(1): 4
- Hensley and Swaminathan in Herbert (2016) EM:Rap 16(7): 7-9
- Haynes in Pfenninger (1994) Procedures, p. 125-6
- Warrington (2020) Crit Dec Emerg Med 34(7): 22
- Gammons (2002) Am Fam Physician 66:643-6 [PubMed]