Back to top

Insect Bites and Stings Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • Suspected snake bite, Red Back or Funnel Web spider bite

  • Allergic response (any of the following)

    • Difficulty / noisy breathing

    • Swelling of lips, tongue, face, eyes

    • Swelling / tightness in throat

    • Difficulty talking and / or hoarse voice

    • Difficulty swallowing

    • Pain distal from bite / sting site

    • Vomiting

    • Abdominal pain

    • Wheeze or persistent cough

    • Generalised erythema or urticarial rash

  • Past history of severe allergic reaction or known allergy to an insect bite or sting

  • Signs of envenomation / neurotoxic paralysis (any of the following)

    • Drooping of eye lids (ptosis)

    • Decrease / paralysis of eye movements (ophthalmoplegia)

    • Limb weakness

    • Respiratory abnormalities

  • History of workplace injury

  • Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observation Charts

NOTE: separate NMG for Tick Bite and Marine Creatures

Additional Observations

If limb affected, conduct a full set of neurovascular observations

Additional History

  • Full history of bite or sting:

    • Date and time

    • Location / size of injury

    • Possible perpetrator

    • First aid treatment prior to ED including NSW Ambulance

  • Tetanus immunisations

  • Consider contacting Poisons Information (13 11 26) for further guidance

Management Principles

  1. Remove insect and stinger if still attached to skin

  2. When removing stingers, use a sideways scraping motion to avoid further envenomation

  3. Inspect patient’s clothing and remove any other insects and stingers

  4. Apply a cold pack at 20 minute on / off intervals for pain relief and to reduce swelling

  5. Provide further analgesia as required according to pain scale – refer to Pain (any cause) NMG

  6. Consider administration of Tetanus Toxoid as per immunisation history and Tetanus Toxoid Standing Order

  7. Document assessment findings, interventions and outcomes

References / Further Resources

  1. NSW Health (2013) Snakebite and Spiderbite Clinical Management Guidelines 3rd Edition, NSW Ministry of Health, Sydney

  2. Australasian Society of Clinical Immunology and Allergy (2013) Health Professional Information Paper Anaphylaxis Australasian Society of Clinical Immunology and Allergy Inc., Australia

  3. NSW Poisons Information Centre - 131 126 or visit

© Agency for Clinical Innovation 2023