Tick Removal

How to remove a tick

• Tweezers/forceps-grasp tick as close to skin surface as possible-if no tweezers, use paper or cloth to protect fingers during extraction

• Pull straight up gently-firmly -steady pressure-do not jerk or twist

• Do not squeeze, crush, puncture tick body-fluids may contain infectious agents

• Disinfect skin thoroughly after removing tick-wash hands with soap and water

• If mouth parts remain in the skin—leave it—they will be expelled spontaneously

Patient teaching

• Transmission of Lyme-tick needs to be attached 2-3 days—removal of tick within in this time frame prevents infection (Up to Date 2019)

• After tick removal and cleansing-observe area for the development of of erythema migrans (EM) (bulls-eye rash) for 30 days. Document bite on calendar.

• Components of tick saliva can cause transient erythema, not to be confused with EM

Tick Prophylaxis: when?

• Tick attached for more than 2-3 days

• Worried patient…often not sure of time of bite

• Old guideline for adults: Doxycycline 100mg bid x 7 days

• New guideline: Doxycycline 200mg once

• Children <45kg can have 4.4mg/kg liquid doxycycline with no teeth staining concerns

Prevention of tick exposure

• Avoid areas with shrubs or long grass and use an EPA approved tick replellent like DEET or picaridin

• Spray your clothes with pemethrin and wear light colored garments that cover your arms and legs, tucking your pants in to your socks

Lyme Conundrums

• Should I get titers for presence of Lyme disease?

  No antibodies for 2 weeks; after 1 month get IgG or combination IgG/IgM (IgM alone not reliable). Not used to measure treatment response.

• Can I vaccinate for Lyme disease?

  Lymerix no longer produced, insufficient consumer demand

  If vaccinated prior to 2002.. protection wanes over time..considered not protected

For detailed information please access this publication:

https://www.cdc.gov/ticks/tickbornediseases/TickborneDiseases-P.pdf