II. Indications
- Ring trapped on a swollen finger
III. Precautions
- Neurovascular compromise (e.g. finger ischemia) warrants rapid removal techniques with ring destruction
IV. Technique: General
- Elevate the finger
- Apply a Skin Lubricant
- Apply soap and water
- Lubricating Jelly (e.g. surgilube)
- Strap compression technique (see below, preferred method)
- Glove Technique
- Cut off the entire fingertip of a glove
- Slide the proximal glove fingertip beneath the ring
- Use the glove proximal end, with equal circumferential pressure to slide the ring distally over the glove tip
- Hemostat technique
- Lubricate finger as above
- Use 2 hemostats to grasp ring at points separated at 180 degree
- Apply equal pressure at each hemostat and rock the finger back and forth to gently slide it over the finger distally
- Ring cutter
V. Technique: Strap compression technique (preferred)
- Obtain long, narrow strap or string (best if elastic narrow strap)
- Oxygen mask strap (or other narrow elastic band)
- Penrose drain (1/4 inch)
- Phlebotomy tubing
- Umbilical tape
- Silk ties
- Kite string
- Wrap the finger tightly
- Thread the strap or string under the ring
- Apply tight, close loops spiraling with 50% overlap from proximal (adjacent to ring) to distal (towards fingertip)
- Continue wrapping until the most swollen parts of finger are compressed
- Wait 5 to 15 minutes
- Consider immersing finger in cold water bath while waiting
- Remove the ring
- Unwrap the strap/string from the proximal end (under ring)
- As the strap or string is unwound the ring is pulled over the swollen tissue
- Resources
- Oxygen Mask Strap technique
VI. Technique: Tungsten Carbide or Titanium Ring Removal using Vice Grip
- Precautions
- Titanium or Tungsten Carbide rings will not typically respond to standard techniques (e.g. ring cutters)
- Wear Eye Protection (titanium parts will disperse widely)
- When gradually applied with this technique, the vice grip shatters the ring without finger injury
- Apply vice grip
- Adjust vice grip so that closes and locks without significant force over ring
- Gradually tighten the vice grip
- Tighten the vice grip 1/4 turn, reapply and clamp to locking position, then release
- Continue to tighten, test and rotate clamp position in stepwise fashion until the ring shatters
- Resources
- YouTube Video of Technique
VII. References
- Warrington (2024) Crit Dec Emerg Med 38(1): 26