II. Technique: Manual Tick Extraction

  1. Tools
    1. Blunt angled forceps with medium size to fine tips
    2. Angled or curved instruments may allow for easier grasping of tick
    3. Specific Tick Removal devices
      1. Sawyer Tick Pliers (B & A Products)
      2. Pro-Tick Remedy (SCS Limited)
      3. Ticked Off (Ticked Off, inc.)
  2. Removal
    1. Grasp tick as close to embedded mouth as possible (closest to skin), and avoid crushing
    2. Gently pull perpendicular to skin without twisting and tick will eventually release
  3. Post-extraction care
    1. Retained parts of mouth or head may be left and will fall away in the subsequent days
      1. No need to dig for tiny retained parts (although significant retained parts can lead to complications)
    2. Apply antiseptic to extraction sites (e.g. Alcohol, betadine, hibiclens)
    3. Observe for complication signs (e.g. local infection)
    4. See Lyme Disease for Post-exposure Prophylaxis

III. Technique: Excisional Tick Removal

  1. Inject local Anesthetic (e.g. Lidocaine 1% with Epinephrine) deep to Tick Bite site, raising a skin wheel
  2. Use a scalpel (e.g. #15) to incise a small circle around tick attachment site (e.g. 3 mm diameter)
    1. Punch Biopsy 3 mm could also be used (if tick fits within punch)
  3. Avoid touching or manipulating the tick to prevent reflux of tick mouth contents into bite site
  4. Suture wound after excision as needed with typically 1 Suture
    1. Small incisions of 3 mm or less do not require suturing

IV. Precautions: Methods to avoid

  1. Avoid using sharp forceps
  2. Avoid crushing or puncturing tick body (or otherwise manipulating tick significantly prior to removal)
  3. Do not apply solvents to tick
  4. Do not apply Lidocaine, gas, or vaseline to tick (ineffective and risk of local reaction)
  5. Do not apply hot match or nail to tick
  6. Do not twist tick head to remove
  7. Do not thread Suture Needle through tick

V. Complications: Retained tick parts (e.g. head)

  1. Skin Granuloma
  2. Cellulitis or abscess

VI. References

  1. Green and Millsap (2016) Crit Dec Emerg Med 30(1): 4
  2. Hensley and Swaminathan in Herbert (2016) EM:Rap 16(7): 7-9
  3. Haynes in Pfenninger (1994) Procedures, p. 125-6
  4. Warrington (2020) Crit Dec Emerg Med 34(7): 22
  5. Gammons (2002) Am Fam Physician 66:643-6 [PubMed]

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