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Body piercing: Old traditions creating new challenges
Pediatric Update Body piercing: Old traditions creating new challenges Author: Diana Meyer, RN, MSN, CCNS, CCRN, CEN, Orange, Calif Section Editors: Deborah Parkman Henderson, RN, PhD, and Donna Ojanen Thomas, RN, MSN
A
dolescents, who are the fastest growing group of pierced individuals, have always searched for ways to identify with their peers and break away from their parents. The renaissance of body piercing has provided adolescents with an opportunity to accomplish this rite of passage. Patients with body piercing may seek care for reasons directly related to the piercing, such as infection, bleeding, nerve damage, or allergic reactions. In addition, body jewelry may create potential hazards or interference with diagnostic or treatment needs.1,2 Awareness of these hazards and of the precautions one must take when treating a patient with body piercings is essential to providing high-quality patient care.
havior could be identified by their love of ornamentation.6 Because of belief in this theory, combined with Western religious attitudes condemning the practice of marking the flesh, distaste toward the practice of body piercing remains prevalent. However, this longpracticed form of body adornment is gaining popularity in our community. Historically, piercing was an accepted practice, a way of being safe and secure by identifying with the cultural norm, and was not considered social rebellion. However, given society’s current perspective of disgust and nonacceptance of the practice of body piercing, the significance of this practice has switched from a way of being compliant with the requirements of traditional society to a manifestation of rebellion against traditional society.
History For thousands of years, the decorative alteration of the human body has been invested with profound cultural and social meaning. Each culture has attached its own significance, whether religious or magical, to these adornments. Egyptian pharaohs and Mayans were some of the first people to pierce their bodies, often for spiritual and virility rituals.3 Roman centurions pierced their nipples as a sign of bravery and functionally as a means of attaching cloaks.4 England’s royalty practiced body piercing during the Victorian era.5 Modern attitudes toward persons with body piercings can be traced to the writings of Cesare Lombroso, a criminal anthropologist living in 1896. He proposed the theory that persons with criminal be-
The why of piercing
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: meyerrn@ socal.rr.com. J Emerg Nurs 2000;26:612-4. Copyright © 2000 by the Emergency Nurses Association. 0099-1767/2000 $12.00 + 0 18/9/111218 doi:10.1067/men.2000.111218
Throughout history, the reasons individuals have chosen to pierce their bodies have changed very little. The reasons most often cited for piercing are as follows: (1) to indicate one’s affiliation with a clan or tribe; (2) to indicate one’s age group or social ranking; (3) to attain magical powers; (4) to appear fierce and frightening to one’s enemies; (5) to be attractive to others and/or oneself; and (6) to enhance sexual stimulation for oneself and/or one’s partner(s).7
612 Volume 26, Number 6
One of the most hazardous places for piercing is the uvula. Fortunately piercing the uvula is very rare, but if you see jewelry there, leave it in. The risk for dropping the jewelry into the airway during removal is very high.
Meyer/JOURNAL OF EMERGENCY NURSING
Figure 2
Figure 1
A stud can be removed by unscrewing the ball at the end of the bar.
The captive bead ring should be removed with a pair of pliers, not a ring cutter.
you see jewelry there, leave it in. The risk for dropping the jewelry into the airway during removal is very high. Although piercing can be an expression of uniqueness, it is erroneous to assume that it is just a rebellious act. The prominent motivation for piercing is the desire to be accepted into a group that one wants to belong to and, consequently, disassociate oneself from a group one does not want to be controlled by. It is also evident that an addiction to piercing develops among devotees. In 1977, Fakir Musafar coined the term “modern primitive” to describe the spiritual concepts and primal urges that drive persons to explore and experience their body through the piercing ritual.5 It is the spiritual dimensions of the pain that is experienced and reaching an altered state of consciousness (probably because of an endorphin release) during the act of piercing that create the passion to repeat the process again and again.5 As varied and interesting as a person’s motivation for body piercing may be, understanding this desire is not required to incorporate issues relating to body piercing into our patient care practices. Patient care usually begins with obtaining a history. Exploring the circumstances around the piercing(s) provides important information about potential problems. Patients whose piercings were not done by professionals (and often without parental permission) are at risk for infectious complications. Using a nonjudgmental approach helps establish a caring relationship and meet the patients’ needs. Body piercings are found just about anywhere on the 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 the uvula. Fortunately piercing the uvula is very rare, but if
Clinical implications Body piercing and its effects on health are not well documented. Complications reflected in the literature range in severity from benign superficial infection and keloids to life-threatening staphylococcal sepsis and hepatitis.8,9 What is an astonished nurse (who hides her astonishment well) supposed to do when faced with an array of interesting body jewelry? The answer depends on clinical assessment and location of the piercing. Hazards/complications caused by piercings include the following: • Any piercings in or around the oral cavity may present a hazard during airway control.
Complications reflected in the literature range in severity from benign superficial infection and keloids to life-threatening staphylococcal sepsis and hepatitis. • Cheek, chin, and throat piercings may interfere with our ability to stabilize the c-spine, and jewelry at these sites may need to be removed. • Genital piercings may interfere with urethral catheterization or childbirth.
December 2000 613
JOURNAL OF EMERGENCY NURSING/Meyer
• Naval or genitalia piercings become hazardous if military antishock trousers are inflated. • Some types of genitalia piercings can interfere with the placement of a Sager splint. • Chest and nipple piercings do not necessarily interfere with electrical therapy; their presence is benign unless the paddles are placed directly over the jewelry. • Chest piercing that is superficial, with long thin metal strips running under the skin, may cause problems with electrical therapy. Obviously the presence of any metal on the body can wreak havoc with our ability to get clear radiographic studies. Complications The risk for piercing-related complications is greater when a nonprofessional or “gypsy piercer” is used. Piercings performed with a spring-loaded “gun,” which is frequently used in mall shops, place the person being pierced at risk for infectious disease. The guns are not easily cleaned and are infrequently sterilized.9 Professional piercers follow an aseptic surgical technique that begins with detailed education of the client about the procedure, risk, consent, and aftercare. When there is evidence of infection, a decision will have to be made about removal of the jewelry. This decision will be based on the extent of the infection. If the site has a minor local infection, it may be advisable to remove the jewelry. When the infection is more extensive, the jewelry should not be removed. Removal of the jewelry will cause the skin to close while promoting abscess development in deeper skin structures. In such cases, it would be better to leave the jewelry in and allow drainage of purulent material to continue.1 Unfortunately, many patients remove the jewelry before seeking medical care and therefore present with an abscess requiring treatment. General rules on removal of body jewelry First, if jewelry is not in the way, and does not interfere with treatment or diagnostic needs, leave it alone. If the jewelry must be removed, the ideal first choice is to ask the patient to remove it. Body jewelry is not constructed in the same way as earrings, and the process of removal can be quite frustrating for the uninitiated. If the patient is unable to remove the jewelry himself or herself, here are some helpful hints for removal 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 continuous with a bead on it. Actually, the bead is held in place by the tension from both sides of the ring. To remove this jewelry, take a pair of pliers
614 Volume 26, Number 6
and spread the ring apart. The bead will drop, and you will be able to pull the ring through the opening. Do not use a ring cutter to cut through the ring. Cutting the ring creates very rough edges that will damage the soft tissue as you pull the ring through. 2. The second common type of jewelry is a stud, called either a barbell or a labret. This type of jewelry is removed by unscrewing one of the balls at the end of the bar and then pulling the bar through the soft tissue. The proliferation of body piercing into the mainstream of society challenges us to adapt our patient care practices. In addition to addressing the physical needs of these patients, we must acknowledge that body art is a meaningful part of human behavior. Regardless of whether we would make the same choices, recognizing the artistic potency, both mysterious and commonplace, of body piercing is a way to begin to develop an attitude of acceptance of patients with body piercings. References 1. Armstrong ML. Body piercing: a clinical look. Office Nurse 1998;11:26-9. 2. Wright J. Modifying the body: piercing and tattoos. Nurs Stand 1995;10:27. 3. Armstrong ML. You pierced what? Pediatr Nurs 1996;22: 236-8. 4. Armstrong ML, Ekmark E, Brooks B. Body piercing: promoting 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 guide to tattoos, piercings and other body modifications. New York: Berkeley Publishing Group; 1971. 8. Simplot TC, Hoffman HT. Comparison between cartilage and soft tissue ear piercing complications. Am J Otolaryngol 1998;19:305-10. 9. Tweeten SM, Rickman LS. Infectious complications of body piercing. Clin Infect Dis 1998;26:735-40.
Submissions to this column are welcomed and encouraged. Contributions can be sent to Deborah Parkman Henderson, RN, PhD, 1255 Linda Ridge Rd, Pasadena, CA 91103; phone (310) 3280720; E-mail: [email protected] or Donna Ojanen Thomas, RN, MSN, 2822 E Canyon View Dr, Salt Lake City, UT 84109; phone (801) 5882240; E-mail: [email protected].
A
dolescents, who are the fastest growing group of pierced individuals, have always searched for ways to identify with their peers and break away from their parents. The renaissance of body piercing has provided adolescents with an opportunity to accomplish this rite of passage. Patients with body piercing may seek care for reasons directly related to the piercing, such as infection, bleeding, nerve damage, or allergic reactions. In addition, body jewelry may create potential hazards or interference with diagnostic or treatment needs.1,2 Awareness of these hazards and of the precautions one must take when treating a patient with body piercings is essential to providing high-quality patient care.
havior could be identified by their love of ornamentation.6 Because of belief in this theory, combined with Western religious attitudes condemning the practice of marking the flesh, distaste toward the practice of body piercing remains prevalent. However, this longpracticed form of body adornment is gaining popularity in our community. Historically, piercing was an accepted practice, a way of being safe and secure by identifying with the cultural norm, and was not considered social rebellion. However, given society’s current perspective of disgust and nonacceptance of the practice of body piercing, the significance of this practice has switched from a way of being compliant with the requirements of traditional society to a manifestation of rebellion against traditional society.
History For thousands of years, the decorative alteration of the human body has been invested with profound cultural and social meaning. Each culture has attached its own significance, whether religious or magical, to these adornments. Egyptian pharaohs and Mayans were some of the first people to pierce their bodies, often for spiritual and virility rituals.3 Roman centurions pierced their nipples as a sign of bravery and functionally as a means of attaching cloaks.4 England’s royalty practiced body piercing during the Victorian era.5 Modern attitudes toward persons with body piercings can be traced to the writings of Cesare Lombroso, a criminal anthropologist living in 1896. He proposed the theory that persons with criminal be-
The why of piercing
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: meyerrn@ socal.rr.com. J Emerg Nurs 2000;26:612-4. Copyright © 2000 by the Emergency Nurses Association. 0099-1767/2000 $12.00 + 0 18/9/111218 doi:10.1067/men.2000.111218
Throughout history, the reasons individuals have chosen to pierce their bodies have changed very little. The reasons most often cited for piercing are as follows: (1) to indicate one’s affiliation with a clan or tribe; (2) to indicate one’s age group or social ranking; (3) to attain magical powers; (4) to appear fierce and frightening to one’s enemies; (5) to be attractive to others and/or oneself; and (6) to enhance sexual stimulation for oneself and/or one’s partner(s).7
612 Volume 26, Number 6
One of the most hazardous places for piercing is the uvula. Fortunately piercing the uvula is very rare, but if you see jewelry there, leave it in. The risk for dropping the jewelry into the airway during removal is very high.
Meyer/JOURNAL OF EMERGENCY NURSING
Figure 2
Figure 1
A stud can be removed by unscrewing the ball at the end of the bar.
The captive bead ring should be removed with a pair of pliers, not a ring cutter.
you see jewelry there, leave it in. The risk for dropping the jewelry into the airway during removal is very high. Although piercing can be an expression of uniqueness, it is erroneous to assume that it is just a rebellious act. The prominent motivation for piercing is the desire to be accepted into a group that one wants to belong to and, consequently, disassociate oneself from a group one does not want to be controlled by. It is also evident that an addiction to piercing develops among devotees. In 1977, Fakir Musafar coined the term “modern primitive” to describe the spiritual concepts and primal urges that drive persons to explore and experience their body through the piercing ritual.5 It is the spiritual dimensions of the pain that is experienced and reaching an altered state of consciousness (probably because of an endorphin release) during the act of piercing that create the passion to repeat the process again and again.5 As varied and interesting as a person’s motivation for body piercing may be, understanding this desire is not required to incorporate issues relating to body piercing into our patient care practices. Patient care usually begins with obtaining a history. Exploring the circumstances around the piercing(s) provides important information about potential problems. Patients whose piercings were not done by professionals (and often without parental permission) are at risk for infectious complications. Using a nonjudgmental approach helps establish a caring relationship and meet the patients’ needs. Body piercings are found just about anywhere on the 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 the uvula. Fortunately piercing the uvula is very rare, but if
Clinical implications Body piercing and its effects on health are not well documented. Complications reflected in the literature range in severity from benign superficial infection and keloids to life-threatening staphylococcal sepsis and hepatitis.8,9 What is an astonished nurse (who hides her astonishment well) supposed to do when faced with an array of interesting body jewelry? The answer depends on clinical assessment and location of the piercing. Hazards/complications caused by piercings include the following: • Any piercings in or around the oral cavity may present a hazard during airway control.
Complications reflected in the literature range in severity from benign superficial infection and keloids to life-threatening staphylococcal sepsis and hepatitis. • Cheek, chin, and throat piercings may interfere with our ability to stabilize the c-spine, and jewelry at these sites may need to be removed. • Genital piercings may interfere with urethral catheterization or childbirth.
December 2000 613
JOURNAL OF EMERGENCY NURSING/Meyer
• Naval or genitalia piercings become hazardous if military antishock trousers are inflated. • Some types of genitalia piercings can interfere with the placement of a Sager splint. • Chest and nipple piercings do not necessarily interfere with electrical therapy; their presence is benign unless the paddles are placed directly over the jewelry. • Chest piercing that is superficial, with long thin metal strips running under the skin, may cause problems with electrical therapy. Obviously the presence of any metal on the body can wreak havoc with our ability to get clear radiographic studies. Complications The risk for piercing-related complications is greater when a nonprofessional or “gypsy piercer” is used. Piercings performed with a spring-loaded “gun,” which is frequently used in mall shops, place the person being pierced at risk for infectious disease. The guns are not easily cleaned and are infrequently sterilized.9 Professional piercers follow an aseptic surgical technique that begins with detailed education of the client about the procedure, risk, consent, and aftercare. When there is evidence of infection, a decision will have to be made about removal of the jewelry. This decision will be based on the extent of the infection. If the site has a minor local infection, it may be advisable to remove the jewelry. When the infection is more extensive, the jewelry should not be removed. Removal of the jewelry will cause the skin to close while promoting abscess development in deeper skin structures. In such cases, it would be better to leave the jewelry in and allow drainage of purulent material to continue.1 Unfortunately, many patients remove the jewelry before seeking medical care and therefore present with an abscess requiring treatment. General rules on removal of body jewelry First, if jewelry is not in the way, and does not interfere with treatment or diagnostic needs, leave it alone. If the jewelry must be removed, the ideal first choice is to ask the patient to remove it. Body jewelry is not constructed in the same way as earrings, and the process of removal can be quite frustrating for the uninitiated. If the patient is unable to remove the jewelry himself or herself, here are some helpful hints for removal 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 continuous with a bead on it. Actually, the bead is held in place by the tension from both sides of the ring. To remove this jewelry, take a pair of pliers
614 Volume 26, Number 6
and spread the ring apart. The bead will drop, and you will be able to pull the ring through the opening. Do not use a ring cutter to cut through the ring. Cutting the ring creates very rough edges that will damage the soft tissue as you pull the ring through. 2. The second common type of jewelry is a stud, called either a barbell or a labret. This type of jewelry is removed by unscrewing one of the balls at the end of the bar and then pulling the bar through the soft tissue. The proliferation of body piercing into the mainstream of society challenges us to adapt our patient care practices. In addition to addressing the physical needs of these patients, we must acknowledge that body art is a meaningful part of human behavior. Regardless of whether we would make the same choices, recognizing the artistic potency, both mysterious and commonplace, of body piercing is a way to begin to develop an attitude of acceptance of patients with body piercings. References 1. Armstrong ML. Body piercing: a clinical look. Office Nurse 1998;11:26-9. 2. Wright J. Modifying the body: piercing and tattoos. Nurs Stand 1995;10:27. 3. Armstrong ML. You pierced what? Pediatr Nurs 1996;22: 236-8. 4. Armstrong ML, Ekmark E, Brooks B. Body piercing: promoting 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 guide to tattoos, piercings and other body modifications. New York: Berkeley Publishing Group; 1971. 8. Simplot TC, Hoffman HT. Comparison between cartilage and soft tissue ear piercing complications. Am J Otolaryngol 1998;19:305-10. 9. Tweeten SM, Rickman LS. Infectious complications of body piercing. Clin Infect Dis 1998;26:735-40.
Submissions to this column are welcomed and encouraged. Contributions can be sent to Deborah Parkman Henderson, RN, PhD, 1255 Linda Ridge Rd, Pasadena, CA 91103; phone (310) 3280720; E-mail: [email protected] or Donna Ojanen Thomas, RN, MSN, 2822 E Canyon View Dr, Salt Lake City, UT 84109; phone (801) 5882240; E-mail: [email protected].