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612 Volume 26, Number 6
Adolescents, who are the fastest growing group ofpierced individuals, have always searched for
ways to identify with their peers and break away fromtheir parents. The renaissance of body piercing hasprovided adolescents with an opportunity to accom-plish this rite of passage.
Patients with body piercing may seek care forreasons directly related to the piercing, such as infec-tion, bleeding, nerve damage, or allergic reactions. Inaddition, body jewelry may create potential hazardsor interference with diagnostic or treatment needs.1,2
Awareness of these hazards and of the precautionsone must take when treating a patient with bodypiercings is essential to providing high-quality pa-tient care.
HistoryFor thousands of years, the decorative alteration ofthe human body has been invested with profound cul-tural and social meaning. Each culture has attachedits own significance, whether religious or magical, tothese adornments. Egyptian pharaohs and Mayanswere some of the first people to pierce their bodies,often for spiritual and virility rituals.3 Roman centuri-ons pierced their nipples as a sign of bravery andfunctionally as a means of attaching cloaks.4 Eng-land’s royalty practiced body piercing during the Vic-torian era.5
Modern attitudes toward persons with bodypiercings can be traced to the writings of CesareLombroso, a criminal anthropologist living in 1896. Heproposed the theory that persons with criminal be-
havior could be identified by their love of ornamenta-tion.6 Because of belief in this theory, combined withWestern religious attitudes condemning the practiceof marking the flesh, distaste toward the practice ofbody piercing remains prevalent. However, this long-practiced form of body adornment is gaining popular-ity in our community. Historically, piercing was an ac-cepted practice, a way of being safe and secure byidentifying with the cultural norm, and was not con-sidered social rebellion. However, given society’s cur-rent perspective of disgust and nonacceptance of thepractice of body piercing, the significance of thispractice has switched from a way of being compliantwith the requirements of traditional society to a man-ifestation of rebellion against traditional society.
The why of piercing Throughout history, the reasons individuals have cho-sen to pierce their bodies have changed very little.The reasons most often cited for piercing are as fol-lows: (1) to indicate one’s affiliation with a clan ortribe; (2) to indicate one’s age group or social ranking;(3) to attain magical powers; (4) to appear fierce andfrightening to one’s enemies; (5) to be attractive toothers and/or oneself; and (6) to enhance sexual stim-ulation for oneself and/or one’s partner(s).7
Diana Meyer, Orange Coast Chapter, is Clinical Nurse Specialist,Emergency Department, Presbyterian Intercommunity Hospital,Whittier, Calif.For reprints, write: Diana Meyer, RN, MSN, CCNS, CCRN, CEN,1034 Feather River Way, Orange, CA 92865; E-mail: [email protected] Emerg Nurs 2000;26:612-4.Copyright © 2000 by the Emergency Nurses Association.0099-1767/2000 $12.00 + 0 18/9/111218doi:10.1067/men.2000.111218
Pediatric UpdateBody piercing: Old traditions creatingnew challengesAuthor: Diana Meyer, RN, MSN, CCNS, CCRN, CEN, Orange, Calif
Section Editors: Deborah Parkman Henderson, RN, PhD, and DonnaOjanen Thomas, RN, MSN
One of the most hazardousplaces for piercing is theuvula. Fortunately piercingthe uvula is very rare, but ifyou see jewelry there, leaveit in. The risk for droppingthe jewelry into the airwayduring removal is very high.
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Meyer/JOURNAL OF EMERGENCY NURSING
Although piercing can be an expression ofuniqueness, it is erroneous to assume that it is just arebellious act. The prominent motivation for piercingis the desire to be accepted into a group that onewants to belong to and, consequently, disassociateoneself from a group one does not want to be con-trolled by. It is also evident that an addiction to pierc-ing develops among devotees. In 1977, Fakir Musafarcoined the term “modern primitive” to describe thespiritual concepts and primal urges that drive personsto explore and experience their body through thepiercing ritual.5 It is the spiritual dimensions of thepain that is experienced and reaching an altered stateof consciousness (probably because of an endorphinrelease) during the act of piercing that create the pas-sion to repeat the process again and again.5
As varied and interesting as a person’s motiva-tion for body piercing may be, understanding this de-sire is not required to incorporate issues relating tobody piercing into our patient care practices. Patientcare usually begins with obtaining a history. Explor-ing the circumstances around the piercing(s) pro-vides important information about potential prob-lems. Patients whose piercings were not done byprofessionals (and often without parental permission)are at risk for infectious complications. Using a non-judgmental approach helps establish a caring rela-tionship and meet the patients’ needs.
Body piercings are found just about anywhere onthe body. Common areas for piercing are the nose,tongue, lip, eyebrow, ear, navel, nipple, and genitalia.One of the most hazardous places for piercing is theuvula. Fortunately piercing the uvula is very rare, but if
you see jewelry there, leave it in. The risk for droppingthe jewelry into the airway during removal is very high.
Clinical implicationsBody piercing and its effects on health are not welldocumented. Complications reflected in the literaturerange in severity from benign superficial infectionand keloids to life-threatening staphylococcal sepsisand hepatitis.8,9
What is an astonished nurse (who hides her as-tonishment well) supposed to do when faced with anarray of interesting body jewelry? The answer de-pends on clinical assessment and location of thepiercing. Hazards/complications caused by piercingsinclude the following:• Any piercings in or around the oral cavity may pre-
sent a hazard during airway control.
• Cheek, chin, and throat piercings may interferewith our ability to stabilize the c-spine, and jewelryat these sites may need to be removed.
• Genital piercings may interfere with urethralcatheterization or childbirth.
Complications reflected inthe literature range inseverity from benignsuperficial infection andkeloids to life-threateningstaphylococcal sepsis andhepatitis.
Figure 1The captive bead ring should be re-moved with a pair of pliers, not a ringcutter.
Figure 2A stud can be removed by un-screwing the ball at the end ofthe bar.
614 Volume 26, Number 6
JOURNAL OF EMERGENCY NURSING/Meyer
• Naval or genitalia piercings become hazardous ifmilitary antishock trousers are inflated.
• Some types of genitalia piercings can interfere withthe placement of a Sager splint.
• Chest and nipple piercings do not necessarily in-terfere with electrical therapy; their presence is be-nign unless the paddles are placed directly over thejewelry.
• Chest piercing that is superficial, with long thinmetal strips running under the skin, may causeproblems with electrical therapy. Obviously thepresence of any metal on the body can wreak havocwith our ability to get clear radiographic studies.
ComplicationsThe risk for piercing-related complications is greaterwhen a nonprofessional or “gypsy piercer” is used.Piercings performed with a spring-loaded “gun,”which is frequently used in mall shops, place the per-son being pierced at risk for infectious disease. Theguns are not easily cleaned and are infrequently ster-ilized.9 Professional piercers follow an aseptic surgicaltechnique that begins with detailed education of theclient about the procedure, risk, consent, and after-care. When there is evidence of infection, a decisionwill have to be made about removal of the jewelry.This decision will be based on the extent of the infec-tion. If the site has a minor local infection, it may beadvisable to remove the jewelry. When the infection ismore extensive, the jewelry should not be removed.Removal of the jewelry will cause the skin to closewhile promoting abscess development in deeper skinstructures. In such cases, it would be better to leavethe jewelry in and allow drainage of purulent materialto continue.1 Unfortunately, many patients removethe jewelry before seeking medical care and thereforepresent with an abscess requiring treatment.
General rules on removal of body jewelryFirst, if jewelry is not in the way, and does not inter-fere with treatment or diagnostic needs, leave italone. If the jewelry must be removed, the ideal firstchoice is to ask the patient to remove it. Body jewel-ry is not constructed in the same way as earrings, andthe process of removal can be quite frustrating for theuninitiated. If the patient is unable to remove the jew-elry himself or herself, here are some helpful hints forremoval of the 2 most common types of jewelry:1. The first common type of jewelry is a captive
bead ring. When in place, this ring appears con-tinuous with a bead on it. Actually, the bead isheld in place by the tension from both sides of thering. To remove this jewelry, take a pair of pliers
and spread the ring apart. The bead will drop,and you will be able to pull the ring through theopening. Do not use a ring cutter to cut throughthe ring. Cutting the ring creates very roughedges that will damage the soft tissue as you pullthe ring through.
2. The second common type of jewelry is a stud,called either a barbell or a labret. This type ofjewelry is removed by unscrewing one of the ballsat the end of the bar and then pulling the barthrough the soft tissue.The proliferation of body piercing into the main-
stream of society challenges us to adapt our patientcare practices. In addition to addressing the physicalneeds of these patients, we must acknowledge thatbody art is a meaningful part of human behavior. Re-gardless of whether we would make the same choic-es, recognizing the artistic potency, both mysteriousand commonplace, of body piercing is a way to beginto develop an attitude of acceptance of patients withbody piercings.
References
1. Armstrong ML. Body piercing: a clinical look. OfficeNurse 1998;11:26-9.2. Wright J. Modifying the body: piercing and tattoos. NursStand 1995;10:27.3. Armstrong ML. You pierced what? Pediatr Nurs 1996;22:236-8.4. Armstrong ML, Ekmark E, Brooks B. Body piercing: pro-moting informed decision making. J School Nurs 1995;11:20-5.5. Vale V, Juno A. Modern primitives. San Francisco:Re/Search Publications; 1989.6. Keesing RM. Cultural anthropology. 2nd ed. New York:Holt, Rinehurst & Winston; 1971.7. Miller JC. The body art book: a complete illustrated guideto tattoos, piercings and other body modifications. NewYork: Berkeley Publishing Group; 1971.8. Simplot TC, Hoffman HT. Comparison between cartilageand soft tissue ear piercing complications. Am J Otolaryn-gol 1998;19:305-10.9. Tweeten SM, Rickman LS. Infectious complications ofbody piercing. Clin Infect Dis 1998;26:735-40.
Submissions to this column are welcomed andencouraged. Contributions can be sent to DeborahParkman Henderson, RN, PhD, 1255 LindaRidge Rd, Pasadena, CA 91103; phone (310) 328-0720; E-mail: [email protected] or Donna Ojanen Thomas, RN, MSN, 2822 E Canyon ViewDr, Salt Lake City, UT 84109; phone (801) 588-2240; E-mail: [email protected].
