Tick Bite Nurse Management Guidelines

Red Flag Exclusion Criteria

  • Child at risk of significant harm

  • Suspected non-accidental injury

  • Unplanned repeat ED presentation

  • One or more of the following (signs and symptoms of envenomation / tick paralysis / allergy / anaphylaxis)

    • Non-localised rash

    • Blurred vision

    • Muscle weakness

    • Any facial paralysis

    • Fever

    • Flu-like symptoms

    • Headache

    • Abdominal pain

    • Vomiting

  • Known allergy to tick bites (see below)

  • History of workplace injury

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

Additional Observations

If limb affected, conduct full set of neurovascular observations

Additional History

  • Allergy to tick bites

  • Tetanus immunisation status

Management Principles

  1. If the patient has a history of allergic reactions to tick bites, seek medical support. In these individuals ticks should be removed as soon as possible, but only by a doctor and where resuscitation facilities are readily available.

  2. Otherwise, remove tick if still present – see below. Manual removal of ticks by forceps is the only method recommended by NSW Health.

Tick Removal

  • Using fine tipped tweezers or forceps, grasp tick as close to the patient’s skin as possible.

  • Using a smooth, steady upward motion pull tick straight out of skin (don’t bend or twist while removing)

  • Avoid other methods of removal such as methylated spirits or using heat to make the tick detach from the skin.

    Figure 1- NSW Ministry of Health Tick Alert

Note: the favoured sites for ticks are behind ears, back of head, groin, axilla and back of knees

  1. After removal, clean area where tick was located with appropriate antiseptic solution.

  2. Cold compress can be applied to reduce pain and swelling

  3. Administer analgesia as per Pain (any cause) NMG if required

  4. Provide patient with Tick Discharge Information Sheet

  5. Advise patient to seek immediate medical advice if severe pain, headache, fever, aching joints, abdominal pain and / or vomiting develops

References / Further Resources

  1. Australian Resuscitation Council (2012). Guideline 9.4.3 Envenomation - Tick Bites and Bee, Wasp and Ant Stings Australian Resuscitation Council, Melbourne

  2. Centers for Disease Control and Prevention (2012) Ticks Centers for Disease Control and Prevention, Atlanta

  3. Needham, G.R. (1985) Evaluation of five popular methods for tick removal Pediatrics 75(6):997-1002

  4. Department of Health (2015) Tick bite prevention Factsheet Australian Government Department of Heatlh, Canberra

  5. NSW Ministry of Health (2013) Ticks NSW Ministry of Health, Sydney

  6. Pitches, D.W. (2006) Removal of ticks: a review of the literature Euro Surveill 11(33)

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