section name header

Introduction ⬇

Piercings and body jewelry may be present on virtually any body part. The most common sites are the ears, nose, tongue, eyebrows, lips, and umbilicus. Less common sites include the nipples and genitals.1

Depending on the risk to the patient and the medical interventions, the practitioner may order body jewelry removed to reduce the risk of such complications as electrical burns, aspiration, pressure injures, surgical site infection, and tissue injuries.2,3,4,5,6,7 However, urgent medical care should never be delayed for the purpose of attempting to remove body jewelry.

During the process of helping a patient remove body jewelry or removing it from an unconscious patient, it’s important to ensure that the patient isn’t harmed and the patient’s dignity is preserved. Also, you must take steps to avoid damaging the body jewelry during the removal process and to retain the jewelry for reinsertion later.

Equipment ⬆ ⬇

Equipment

Gloves • antiseptic solution • personal belongings envelope • Optional: ring-opening or ring-spreading pliers, ring forceps, ball-grabber, bead tweezer, lubricating gel, inert plastic retainer, sterile dressing.

Implementation ⬆ ⬇

Implementation
  • Verify the practitioner’s order for body jewelry removal, if needed, and review the patient’s medical record for scheduled diagnostic tests and surgical procedures.
  • If required by your facility, ensure that informed consent has been obtained and that the signed consent form is in the patient’s medical record.8,9,10,11
  • Perform hand hygiene.12,13,14,15,16,17
  • Confirm the patient’s identity using at least two patient identifiers.18
  • Provide privacy.19,20,21,22
  • Ask the patient about any body jewelry, especially jewelry that isn’t readily visible. If the patient is unconscious, ask the patient’s family members about known body jewelry, and note the presence of body jewelry during the physical examination.
  • Explain the procedure to the patient and family (if appropriate) according to their individual communication and learning needs to increase their understanding, allay their fears, and enhance cooperation.23 Explain the reason for removing the body jewelry, and encourage the them to ask questions as needed.
  • Determine the type of body jewelry to be removed.
  • Ask the patient how long each piercing has been present, and if it requires a retainer to maintain its patency.
  • Gather and prepare the necessary equipment and supplies.
  • Perform hand hygiene12,13,14,15,16,17 and put on gloves to comply with standard precautions.24,25
  • Ask the patient to remove the jewelry if the patient is able; offer to assist as needed.
  • If the patient is unconscious, remove the body jewelry following the proper technique for the type of jewelry or body piercing present. (See Removing body jewelry.)

NURSING ALERT When removing jewelry from the nostril, nasal septum, cheek, tongue, or lip, use special care to prevent the jewelry from slipping into the airway, which could result in aspiration.26

  • Assess the patient’s skin at the body-piercing site for signs of infection (redness, swelling, purulent drainage), because body jewelry harbors microorganisms that can become trapped in the skin, and removal provides an opportunity for effective removal of microorganisms from the piercing site.26
  • Clean all open wounds and apply a sterile dressing, if needed.
  • Since removing jewelry from a piercing may initiate closure of the piercing or make reinsertion difficult, help the patient insert a plastic retainer (or insert one on an unconscious patient), if necessary, to maintain patency of the piercing.27
  • Clean soiled body jewelry with antiseptic solution, because you should consider all piercings to be contaminated with body fluids.
  • Place the body jewelry in a personal belongings envelope labeled with the patient’s name and identification number; give the envelope to a family member or secure it, as directed by your facility.
  • Remove and discard your gloves28 and perform hand hygiene.12,13,14,15,16,17
  • Document the procedure.29,30,31,32

Special Considerations ⬆ ⬇

Special considerations
  • If the patient refuses to remove body jewelry, notify the practitioner for reevaluation of the risks of proceeding with any scheduled procedures.33
  • During intubation, body jewelry can prevent visualization of the airway, or aspiration can occur if body jewelry located in and around the mouth loosens and dislodges.34
  • Burns can result if metal body jewelry heats up as a result of exposure to electrical currents during electrosurgery or contact with active electrodes in the operating room.2,33
  • Pressure injuries can result if an unconscious patient is positioned on a body part with body jewelry in place.4
  • Traumatic injury can occur if body jewelry accidentally becomes entangled in bedding or caught on equipment.4,33
  • The increased risk of bacteremia during invasive surgical procedures can seed body piercings and can cause local or systemic infection.3,34
  • Urethral tears may occur during urinary catheterization in patients with genital piercings.
  • Body jewelry located on the patient’s face, eyebrows, nose, or mouth should be removed while the patient is sitting upright to minimize the risk of aspiration.
  • For procedures requiring electrocauterization, metal body jewelry located between the active and dispersive electrodes should be removed to minimize the risk of burns in the operating room.2
  • Body jewelry located near the surgical site should be removed preoperatively and before the skin is prepped, because jewelry harbors microorganisms.3
  • Notify the practitioner if your patient has a surface anchor, a type of jewelry placed under the skin. It’s usually made from implant-grade materials that may not need to be removed for medical tests and procedures such as X-rays, magnetic resonance imaging, computed tomography scans, and surgical procedures.27

Complications ⬆ ⬇

Complications

Body jewelry may have rough, burred edges that may damage tissue during removal, creating a possible source of infection. Infection may also result from an incompletely healed piercing. Removing tongue jewelry can result in tissue trauma and create airway management problems.26

Documentation ⬆ ⬇

Documentation

Record any questions that the patient asked and your responses to those questions. Document whether you or the patient removed the body jewelry, the type of body jewelry removed and its location on the body, the condition of the skin at the piercing site, any drainage that you noted at the piercing site, the disposition of the body jewelry, and measures that you took to prevent closure and infection at the site. Document teaching provided to the patient and family (if applicable), their understanding of that teaching, and any need for follow-up teaching.

References ⬆

  1. DesaiN. (2020). Body piercing in adolescents and young adults. In: UpToDate, BlakeD. (Ed.).
  2. Guideline for safe use of energy-generating devices. (2021). In WoodA. (Ed.), Guidelines for perioperative practice, 2021 edition. Denver, CO: AORN, Inc. (Level VII)
  3. Guideline for preoperative patient skin antisepsis. (2021). In WoodA. (Ed.), Guidelines for perioperative practice, 2021 edition. Denver, CO: AORN, Inc. (Level VII)
  4. Guideline for positioning the patient. (2021). In WoodA. (Ed.), Guidelines for perioperative practice, 2021 edition. Denver, CO: AORN, Inc. (Level VII)
  5. DeBoerS., et al. (2008). Body piercing and airway management:

    Photo guide to tongue jewelry removal techniques

    . AANA Journal, 76, 19–23.
  6. DeBoerS., et al. (2006). Managing body jewelry in emergency situations:

    Misconceptions, patient care, and removal techniques

    . Journal of Emergency Nursing, 32, 159–164.
  7. DeBoerS., et al. (2008). Puncturing myths about body piercing and tattooing. Nursing2008, 38(11), 50–54.
  8. The Joint Commission. (2021). Standard RI.01.03.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  9. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Patient’s rights. 42 C.F.R. § 482.13(b)

    .
  10. DNV GL-Healthcare USA, Inc. (2020). PR.2.SR.3. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  11. Accreditation Association for Hospitals and Health Systems. (2020). Standard 15.01.11. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  12. Centers for Disease Control and Prevention. (2002). Guideline for hand hygiene in health-care settings:

    Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force

    . MMWR Recommendations and Reports, 51(RR-16), 1–45. https://www.cdc.gov/mmwr/pdf/rr/rr5116.pdf (Level II)
  13. The Joint Commission. (2021). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  14. World Health Organization. (2009). WHO guidelines on hand hygiene in health care:

    First global patient safety challenge, clean care is safer care

    . https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 (Level IV)
  15. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Infection control. 42 C.F.R. § 482.42

    .
  16. Accreditation Association for Hospitals and Health Systems. (2020). Standard 07.01.21. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  17. DNV GL-Healthcare USA, Inc. (2020). IC.1.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  18. The Joint Commission. (2021). Standard NPSG.01.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  19. The Joint Commission. (2021). Standard RI.01.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  20. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Patient’s rights. 42 C.F.R. § 482.13(c)(1)

    .
  21. Accreditation Association for Hospitals and Health Systems. (2020). Standard 15.01.16. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  22. DNV GL-Healthcare USA, Inc. (2020). PR.2.SR.5. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  23. The Joint Commission. (2021). Standard PC.02.01.21. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  24. SiegelJ. D., et al. (2007, revised 2019). 2007 guideline for isolation precautions:

    Preventing transmission of infectious agents in healthcare settings

    . https://www.cdc.gov/infectioncontrol/pdf/guidelines/isolation-guidelines-H.pdf (Level II)
  25. Accreditation Association for Hospitals and Health Systems. (2020). Standard 07.01.10. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  26. De CuyperC., et al. (2018). Dermatologic complications with body art. Cham, Switzerland: Springer.
  27. Association of Professional Piercers. (2013). Procedure manual 2013 Edition. https://safepiercing.org/wp-content/uploads/2020/10/APP_Procedures_2013_A_Web.pdf
  28. Occupational Safety and Health Administration. (2012). Bloodborne pathogens, standard number 1910.1030 https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_id=10051&p_table=STANDARDS (Level VII)
  29. The Joint Commission. (2021). Standard RC.01.03.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
  30. Centers for Medicare and Medicaid Services, Department of Health and Human Services. (2020). Condition of participation:

    Medical record services. 42 C.F.R. § 482.24

    .
  31. Accreditation Association for Hospitals and Health Systems. (2020). Standard 10.00.03. Healthcare Facilities Accreditation Program:

    Accreditation requirements for acute care hospitals

    . Chicago, IL: Accreditation Association for Hospitals and Health Systems. (Level VII)
  32. DNV GL-Healthcare USA, Inc. (2020). MR.2.SR.1. NIAHO® accreditation requirements, interpretive guidelines and surveyor guidance-revision 20.0. Milford, OH: DNV GL-Healthcare USA, Inc. (Level VII)
  33. RothrockJ. C. (2019). Alexander’s care of the patient in surgery (16th ed.). St. Louis, MO: Elsevier.
  34. DelaisseJ., et al. (2014). Peri-operative management of the patient with body piercings. Journal of Dermatology and Clinical Research, 2(1), 1009.