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The Whole Story
Hospital and clinical settings have long provided nurses with valuable skills that contribute to successful endeavors outside the medical field. Nurses have brought their unique experiences into new careers in law, information technology, entrepreneur businesses, and sales. Oh, and body piercing. Micheal Desplaines, RN, BSN, is the only nurse-body piercer in New England. He opened his Boston piercing shop, Tribal Ways, in 1991 to a crowd of people lined along the hall and down the stairs. As word spread of his outstanding ability and strict emphasis on cleanliness, safety, and use of aseptic technique, clients from Texas, California, and even Australia have come to Boston solely to have Desplaines pierce their bodies. Desplaines has been an RN since 1975, working in cardiovascular surgery, emergency care, and pediatric oncology. After receiving his intravenous therapy care nurse certification while working at the University of California, San Francisco Medical Center, he wanted to get a body piercing. “I walked into a couple of [body-piercing] places, and I was scared to death,” Desplaines says. “I asked them about HIV and hepatitis. They had no idea.” He finally found an adequately clean shop to pierce him. “I had a spiritual experience,” he says, which led him to learn more. He found that most body piercers have had five to 15 days of training. He then trained for three months with one of the most recognized piercers in the field, Raelyn Gallina. Desplaines moved back to his native New England, where he continued to work as a nurse, attended classes for a master’s degree in family counseling, and occasionally pierced his friends’ bodies as a favor. After Care Not an Afterthought In Boulder, CO, Gwynn “Wolf” Wolfstar, RN, BSN, BA, incorporates her 18 years of nursing experience into her current professional endeavor. After leaving an administrative position four years ago, she became the master piercer and co-owner of Enchanted Ink. (Tara Wolfstar, RN, is the tattoo artist and other owner.) Her body-piercing career
started on accident. “Sometimes, nurses and EMTs
would get bored during the night shift,” she says,
“and we’d pierce each other’s ears.”
Five years later, Gwynn Wolfstar pursued organized
training in San Francisco. Improper handing and cleaning of body jewelry is the leading cause of infection, rejection, slow healing, or scar tissue. Wolfstar’s after-care instructions begin with nursing’s most familiar chorus: “Wash your hands!” Wolfstar teaches her clients not to clean a new piercing with alcohol; povodine; hydrogen peroxide; Bactine; or any antibiotic ointments, such as Neosporin. “Soak it twice a day in sea salt water and use castile soap only,” she says. Her piercing studio provides both, including their own label of Enchanted Ink castile soap and mouth rinses. She recommends mixing one-quarter to one-half teaspoon sea salt into 8 ounces of water. Wolfstar says alcohol and povodine dry out skin cells that are trying to grow and hydrogen peroxide destroys protein. Petroleum-based ointments can harbor bacteria or viruses when used on any puncture wound, including body piercings. The clinical nursing situation most similar to body piercing is pin care in orthopedics devices, such as external fixators. “Remember when the orders for pin care were, ‘paint with Betadine,’ and a space between the skin and the pin would develop over time?” Desplaines says. “Same idea. Now they use saline.” He points out that the Betadine bottle is labeled “For External Use Only.” Infections a Main Concern More and more, patients are turning up in EDs with piercings that appear to be, or are, infected. “Some are keloids, which are red and have some discharge, but aren’t infected,” Desplaines says. Hypertrophic tissue can also develop at the site. Often, handling the jewelry too much, cleaning it with an irritating substance, or inappropriate jewelry shape or material cause these conditions. Should a piercing be infected, many physicians recommend removing the jewelry to remove the source of infection. However, Desplaines says removal can trap a bacterial infection in the skin. Keflex is the antibiotic most often used to treat an infected piercing. In all cases, both nurse piercers say an immediate follow-up visit to your piercer is essential. At Wolfstar’s studio, a full-time piercing assessor is on site to evaluate their clients’ piercings on a walk-in basis. Another common problem is irritation or trauma to a piercing when a patient has tried to force a piece of jewelry that is too large through a piercing. “It’s like pulling a glove inside out,” Wolfstar says. The healed “tunnel of flesh” is literally pulled or pushed through. She recommends a sea salt soak three to four times a day, and to follow up with the piercer. Healed piercings that suddenly start showing signs of irritation or infection should be a signal to a nurse to investigate further. While Desplaines was on vacation in France, two 15-year-old body piercings began to show signs of irritation. “I had other signs, too,” he says, suspecting he had developed diabetes. When he returned to the US, a visit to a physician revealed his blood sugar to be 450 ms/dL. A Piercing Primer In some medical situations, such as defibrillation or surgery, body jewelry greatly increases the risk of an electrical arc and should be removed. Straight and curved barbells usually have balls that screw on to or into a bar, and are quickly removed with a counter-clockwise turn. Gloves or dry gauze provide a firm grip. Hoops with beads may appear to unscrew in a similar way, but usually do not. The captive beads have a dimple on opposing sides of the bead, holding them in place. The hoop must be opened for the bead to be released and the jewelry removed. Placing the nose of a pair of opening pliers or hemostats into the center of the hoop and then gently spreading the handles will open the hoop and release the bead. The jewelry can then be removed. Large-gauge hoops may be more difficult to remove, and are often cut in emergency cases. Use care when removing jewelry that has sharp edges from a cutting tool, and do not reinsert into the piercing. If a piercing is healed (at least a year old), undamaged jewelry can be easily reinserted after the procedure with a sterile, water-based lubricant. (Some piercings, such as through the tongue, will probably not require lubricant.) Body jewelry may be worn in CT scans, as long as it does not interfere with the imaging. However, an MRI requires more attention. Quality metals, such as 316-grade stainless steel, 14- or 18-karat gold, titanium, or niobium are not likely to become hot during an MRI. Grade 302 or 304 stainless steel contains more nickel and poses potential problems. Wolfstar recommends that body jewelry be removed from patients who require long-term care, such as those in the ICU. These patients may not be able to care for their piercings or inform their caregivers of piercings that are not obvious. Desplaines advises nurses to undress their patients and check the whole body. “I’ve pierced a priest, and you’re not usually going to go looking for body jewelry on a priest in the emergency room,” he says. His advice: Don’t make assumptions; check everyone thoroughly. In the event of a health crisis, both piercers recommend that the piercing should be surrendered and the jewelry removed. “It probably won’t get infected if someone is sick and already on IV antibiotics,” Wolfstar says. “But being sick is a stressor on the body, as is a body piercing, and the jewelry should be removed.” Pregnancy is another common stressor, and body piercing is strongly discouraged during pregnancy. If a piercing is less than a year old, the piercers say remove it for the pregnancy. If it is a healed piercing, there can be adaptations. “A soft tissue piercing over a year old is usually permanent,” Wolfstar says. A navel hoop or barbell may need to be removed during the last three to four months of pregnancy as the abdomen changes shape. Genital piercings should be addressed before delivery. Jewelry that does not interfere with the delivery, such as clitoral hood piercings, can probably be left alone, Desplaines says. Labial piercings and piercings of other areas of the vagina that stretch during delivery should be removed. Wolfstar strongly recommends removing all genital body piercings before delivery. That way, in case of an emergency procedure, the jewelry isn’t inadvertently overlooked. The risk of arcing is greatly increased. “Also, the peri area becomes pretty edematous after birth,” which may compromise the piercing, Wolfstar says. Women with nipple piercings are commonly able to breast feed, as long as the piercings are a year old and fully healed. Otherwise, they should be removed during pregnancy. The jewelry should be removed before breastfeeding to avoid choking the infant. “There’s a small chance that a nipple piercing might interfere with lactation in the future,” Wolfstar says. However, she notes that in the 18th century, nipple piercings were a common treatment for women with inverted nipples who wanted to breastfeed. “Fortunately, we have other ways to deal with that problem now,” she says. Individual Reasons, Individual Care Although body piercing is relatively new to American culture, other cultures have practiced it for centuries. Samoans believed that tongue piercings ensured “better communication with the creator,” Gwynn Wolfstar says. “Male genital piercings were a rite of passage in Egypt, Pakistan, Iran, and Iraq.” She notes that many of the piercings she performs today have a common significance to her clients. “For some reason, a nose piercing often marks independence, or breathing easily. I’ll say, ‘Are you going through a big transition?’ And more often than not, they’ll say: ‘Yeah, I’m getting a divorce. How did you know?’” Desplaines says many of his clients are “reclaiming their body” after a traumatic illness or event. “The whole thing can be extremely therapeutic,” he says. “These are wounded souls. They come here and face their fear and their pain. They leave with control of it. It does my heart great to empower people by something so simple.” Desplaines is now a frequent public speaker for nursing and medical classes and conventions. His piercing career still allows him to make a difference in the individual lives of his clients. It also has put him in front of the camera on PBS, CNN, and Discovery, but it is the one-on-one time he really enjoys. “I can really talk to my clients [and] empower them,” he says. Editor’s Note: For more information, read our self-study CE module, “To the Point: The Contemporary Body Piercing and Tattooing Renaissance” at http://nsweb.nursingspectrum.com/ ce/ce194.htm. Melanie Boock, RN, BSN, has seven years of nursing experience and is an ED staff nurse and nursing/house supervisor. |
