Ring Removal


Ring Removal, Tungsten Carbide Ring Removal, Titanium Ring Removal

  • Indications
  1. Ring trapped on a swollen finger
  • Precautions
  1. Neurovascular compromise (e.g. finger ischemia) warrants rapid removal techniques with ring destruction
  1. Elevate the finger
  2. Apply a Skin Lubricant
    1. Apply soap and water
    2. Lubricating Jelly (e.g. surgilube)
  3. Strap compression technique (see below, preferred method)
  4. Glove Technique
    1. Cut off the entire fingertip of a glove
    2. Slide the proximal glove fingertip beneath the ring
    3. Use the glove proximal end, with equal circumferential pressure to slide the ring distally over the glove tip
  5. Hemostat technique
    1. Lubricate finger as above
    2. Use 2 hemostats to grasp ring at points separated at 180 degree
    3. Apply equal pressure at each hemostat and rock the finger back and forth to gently slide it over the finger distally
  6. Ring cutter
  • Technique
  • Strap compression technique (preferred)
  1. Obtain long, narrow strap or string (best if elastic narrow strap)
    1. Oxygen mask strap (or other narrow elastic band)
    2. Penrose drain (1/4 inch)
    3. Phlebotomy tubing
    4. Umbilical tape
    5. Silk ties
    6. Kite string
  2. Wrap the finger tightly
    1. Thread the strap or string under the ring
    2. Apply tight, close loops spiraling with 50% overlap from proximal (adjacent to ring) to distal (towards fingertip)
    3. Continue wrapping until the most swollen parts of finger are compressed
  3. Wait 5 to 15 minutes
    1. Consider immersing finger in cold water bath while waiting
  4. Remove the ring
    1. Unwrap the strap/string from the proximal end (under ring)
    2. As the strap or string is unwound the ring is pulled over the swollen tissue
  5. Resources
    1. Oxygen Mask Strap technique
  • Technique
  • Tungsten Carbide or Titanium Ring Removal using Vice Grip
  1. Precautions
    1. Titanium or Tungsten Carbide rings will not typically respond to standard techniques (e.g. ring cutters)
    2. Wear Eye Protection (titanium parts will disperse widely)
    3. When gradually applied with this technique, the vice grip shatters the ring without finger injury
  2. Apply vice grip
    1. Adjust vice grip so that closes and locks without significant force over ring
  3. Gradually tighten the vice grip
    1. Tighten the vice grip 1/4 turn, reapply and clamp to locking position, then release
    2. Continue to tighten, test and rotate clamp position in stepwise fashion until the ring shatters
  4. Resources
    1. YouTube Video of Technique
  • References
  1. Warrington (2024) Crit Dec Emerg Med 38(1): 26