Preparation

• Hemostat or tweezers
• Gloves (non-sterile)
• Chlorhexidine (or other approved skin cleanser)

Procedure Steps

Step 1: Health history and physical exam of the site

Step 2:  Wash hands, don gloves

Step 3: Cleanse the area with chlorhexidine

Step 4: Grasp the tick

Use a hemostat or tweezers to grasp the tick as close to the embedded site as possible. Avoid squeezing or crushing the tick.

Step 5: Remove the tick

Apply steady traction upward and perpendicular to the skin. Twisting counter clockwise may facilitate removal.

Do not twist the tick or use a jerking motion as this may cause the mouth-parts to break off and remain embedded in the skin.

Step 6: Assess site for remaining tick mouth-parts

Thoroughly clean the bite area with soap and water. If tick mouth parts are left behind, a biopsy or excision may be necessary.

Step 7: Dispose of the tick

Dispose of the tick by flushing it down the toilet, placing it in a sealed container, wrapping it tightly in paper, or putting it in rubbing alcohol. Never crush a tick with your fingers.

Aftercare

• Monitor for tick borne disease, review tick guidelines for the local area.
• Provide patient education on prevention:
  • Examine yourself and pets for ticks
  • Stay to the centre of hiking trails or paths
  • Wear light-coloured clothing with long sleeves and pants to make it easier to see ticks crawling on your clothing
  • Tuck clothing in where possible
  • Use an appropriate tick repellent
  • Launder clothing that has been worn outdoors

Patient Education

Follow-up

• As needed if signs and symptoms of infection or tick-borne disease develop.

Key Takeaways

• All embedded ticks must be removed.
• Prevention is key to preventing tick bites.