Ring Removal: Supplies and String Approach

00:01 I will talk you through each of the approaches, but first let me give you a list of the things that you might need to perform the procedure. You want to make sure that you have strings such as dental floss.

00:12 You can also use umbilical tape or Penrose drain.

00:16 You want water soluble lubricant.

00:19 You also want to have a ring cutter with a fresh blade.

00:23 You want protective eye equipment.

00:25 For today I'm going to be using my glasses.

00:27 You want a cold pack or an ice pack? You want an elastic bandage, if you need it.

00:34 Most of the time you're not going to.

00:36 There's not going to be anything open.

00:38 You may need a digital block depending on the severity of the situation, and if you did that, you would need to be thinking about the supplies you need for a digital block, so like the lidocaine, small gauge, needle, syring. You also want the pulse oximeter.

00:56 You also want measuring tape with an end, possibly a ring sizer, a patient drape and sterile gauze.

01:02 And that's all going to be more for the digital block.

01:05 Today, we're not going to be doing a digital block.

01:09 The other thing you want is patient consent.

01:12 You want to make sure you're discussing how you will begin the process of ring removal.

01:18 You want to talk the patient through it.

01:20 You want to let them know that you're using the most conservative approach.

01:24 You have to think sometimes these are heirloom rings that people are wearing.

01:29 So be very cognizant of that and make sure that you're making the patient very comfortable. You also want to talk to them about the potential risk of using a digital block, and the risk of using the ring cutter as well.

01:42 And if your facility requires a consent, you want to make sure that you're getting consent. You want to gather all your supplies, you want to prepare your working area, and you want to make sure you perform hand hygiene. Because the finger is more than likely going to be a little painful, the patient may even be a little anxious, we want to make sure that we make the patient comfortable. So if they're more comfortable laying down and maybe working on their finger, whatever position makes them comfortable, give them as much information as you can about the procedure.

02:16 Then you're going to elevate the extremity for 5 to 10 minutes to reduce edema as well as applying a cold pack, and so this may require you using an elastic bandage to keep the cold pack around the finger for 10 to 15 minutes.

02:30 Then you would want to do manual digital compression to minimize the edema that is present. And you're going to do that by actually using your fingers, and you want to document your response to this conservative therapy.

02:45 To do the string approach, if all that fails, then you could do the string approach again, making sure that the patient's comfortable with their hands supported on a flat surface.

02:55 You want to apply a liberal amount of water-soluble lubricant around the ring and the digit, and then you want to select the appropriate string material which we discussed, which is going to be the dental floss or the Penrose drain.

03:10 Ensure adequate lighting and assistant is available if you need them.

03:15 Let's start with this string approach.

03:18 So you're going to begin wrapping the string tightly from the distal tip of the digit toward the ring. You're going to maintain constant tension.

03:27 This will supply compression of the tissue.

03:31 You're going to thread the string free end under the ring, slowly unwinding the string, moving the ring distally.

03:41 Monitor patient comfort and tissue response throughout.

03:45 So the next procedure we're going to talk about is using the ring cutter.

03:50 You want to ensure proper protective equipment for you and the patient.

03:55 You want to position the ring cutter on the nonvascular side of the digit.

04:01 You want to make a single cut, and then you want to spread the ring apart using two pairs of pliers.

04:08 Protect the underlying skin during the cutting process and consider a digital block if this is significant discomfort.

04:16 Let's talk about post-procedure.

04:19 Reassess neurovascular status and document your findings.

04:23 We want to clean and dress the digit if any skin breaks or present.

04:27 We want to provide wound care instructions if needed.

04:31 We want to schedule a follow-up if complications are noted.

04:34 And then we want to document the procedure details and outcomes.