Body Piercing: Issues and Challenges for Nurses

Kym A. Halliday


J Foren Nurs. 2005;1(2):47-56. 

In This Article

Medical Implications of Body Piercing

It is important to be aware of who is performing body piercings in the community and under what conditions (Armstrong, 1996). Many jurisdictions do not regulate body modification practices. Depending on local policies, body-piercing services may be obtained from tattoo studios, flea markets, dedicated piercing studios, and in personal residences (Armstrong, 2004).

Nurses have many patient care opportunities in which to educate consumers on safe piercing environments. Clean, well-lit facilities are one indication of good infection control practices. The employees should exhibit good hygiene, and hand-washing facilities should be easily accessible. Glove use, with frequent changes as indicated, is also important to infection control. The piercing artist should be willing and able to explain the infection control procedures used in the studio (APP, 2002; Cartwright, 2000).

Basic wound care techniques used for body piercings are usually called "aftercare." Aftercare techniques are not only used for the fresh piercing; these techniques should be re-initiated whenever the piercing fistula has become disrupted through injury or exhibits signs of infection/renewed inflammation (C. Shull, personal communication, June 28, 2004).

As with any wound, piercing sites should only be handled with freshly cleansed hands to decrease the risk of contamination. Recommended aftercare techniques vary slightly according to the piercing artist and local policies. Serous exudate is a normal part of the healing process. Jewelry, and the exterior piercing site, should be thoroughly cleansed of all crust and debris. Basic care includes saline soaks and use of soap and water cleansing a minimum of two times a day (APP, 2002; Cartwright, 2000). Warm compresses made of sea salt and warm water are recommended during healing (APP, 2002). This same sea salt solution can be used to irrigate the piercing to ensure removal of residual cleansing agents. Jewelry should then be gently rotated to ensure free movement within the healing fistula. At this time, barbell hardware should be tightened (Armstrong, 2004). There is no literature available on the risks or benefits of plain soap versus antibacterial soaps related to piercing care.

Facial piercings that enter the oral cavity require general and specific aftercare. Oral piercing aftercare includes the use of ice chips for swelling (Cartwright, 2000). Alcohol-free, antiseptic mouthwash is recommended after every oral intake that is not simple water. Oral tobacco use inhibits the healing process (Cartwright, 2000).

Fresh piercings are open wounds and can be conduits of infection. The risk of site infection tends to increase with poor aftercare (Armstrong, 2004), or poor piercing artist technique (Stirn, 2003). Jewelry is left in place during treatment of localized infection (Cartwright, 2000). After appropriate cleansing, ¼ inch gauze can be placed around the post at the piercing site. Ends of gauze should be short enough to inhibit entanglement during normal activities, but long enough to allow wicking of infectious exudate. Patient education on proper wound care, follow up, and nutrition should be provided. Systemic antibiotics may be indicated if the infection is severe or if there are signs of cellulitis extending from the original site. (D. Munro, personal communication, September 15, 2003).

Organisms implicated in piercing-related infections tend to be related to the location of the piercing. Pseudomonas has been reported at ear and cartilaginous piercings (Arm strong, 2004; Hanif, Frosh, Ghufoor, Rivron, & Sandhu, 2001; Stirn, 2003; Watson, Cambell, & Pahor, 1987). Haemophilus has caused life-threatening complications after oral piercings (Akhondi & Rahimi, 2002; Arm strong, 2004).

Staphylococcus aureus and group A streptococcus have been cultured from all piercing sites (Fisman, 1999). Increased viral transmission of condlyomas and hepatitis has been reported (Fisman, 1999; Stirn, 2003). Additional documented risks include HIV from lack of procedural asepsis and the increased potential for viral transmission through the wound of a fresh piercing (Stirn, 2003).

Airway compromise has also been reported (Hardee, Mallya, & Hutchinson, 2000). This is especially significant during physical or sexual assault when loss of all or part of hardware into air passages can lead to foreign body aspiration (Girgis, 2000; Miller, 2003). Other risks include swelling of the upper airway that can occur as part of the healing process, or in response to infection (Koenig & Carnes, 1999; Miller, 2003; Stirn, 2003). Jewelry aspiration by infants can also occur during breastfeeding if part of the mother's hardware dislodges during latch-on and suckling (Stirn, 2003).

Body jewelry can interfere with emergent medical care. Common procedures that can be subsequently delayed or inhibited as a result of body jewelry and related piercings are intubation, positive-pressure-ventilation (PPV), electrical therapy, radiological imaging studies, urinary catheterization, use of anti-shock trousers, and spinal immobilization (Armstrong, 2004).

Attempts at airway management can be inhibited by some piercings. Some facial piercings can interfere with effective PPV mask placement. Numerous or large oral piercings can interfere with attempts at oral airway placement. Use of traditional earrings at nasal piercing sites can cause the affected nare to become impassable. Oral jewelry can become loose, detach, and place the wearer at risk for hardware aspiration. Airway management accommodations need to be made until the jewelry can be removed and the airway secured. These airway management modifications are provider- and patient-dependent. Nasal intubation can be provided if airway management is hindered by oral hardware. In extreme cases, cricothyrotomy can be performed.

Electrical therapies, such as defibrillation or electrocautery, can also have diminished or unexpected effects with some piercings. Metal body piercings can divert electrical current from the intended target. This can decrease defibrillation effectiveness. Additionally, burn injuries can occur if the electrical current is attracted to the conductive piercing (Armstrong, 2004; Larkin, 2004; Stirn; 2003).

Most simple radiographs are not affected by body piercings. Some oral, nape, and facial piercings can interfere with odontoid visualization during attempts at cervical spine clearance (Koenig & Carnes, 2003). Body jewelry can interfere with soft tissue imaging (Armstrong, 2004). When the patient wishes to maintain a piercing, large diameter suture can be placed to maintain patency of the fistula. In non-emergent situations, patients can contact their piercing artist for temporary, radiolucent hardware (Larkin, 2004).

Transurethral piercings can interfere with usual urinary catheterization procedures (Armstrong, 2004). If it is not possible to safely remove the piercing, a pediatric feeding tube can be used to bypass or enter the piercing jewelry to allow catheterization. Since there is no retention balloon on feeding tubes, care should be taken to maintain catheter placement during patient movement.

Though anti-shock trousers are being used less frequently in emergency medicine, abdominal or genital piercings can render these devices inoperable. When inflated, these devices exert significant pressure on the lower extremities, genitals, and the lower half of the abdomen. There is the risk that damaged metal body jewelry can puncture these inflatable devices and render them unable to maintain adequate pressure (Armstrong, 2004).

Anterior and posterior neck surface piercings are becoming more common. During cervical spine immobilization, these body piercings can interfere with cervical collar placement (Armstrong, 2004).


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