# Removal of a Ring Without a Ring Cutter

## Overview

This module describes how to remove a ring on a digit when a ring cutter is not available.

## Indications

1. Non-removable ring

## Contraindications

1. Finger fractures or significant soft tissue damage—consult surgery

2. Tissue necrosis distal to the ring—consult surgery

## Patient information & consent

Always verify your patient’s identity and obtain informed consent before proceeding.

### How do I explain this procedure?

“I'm going to try removing your ring using a string and some lubricant.”

### What can my patient expect?

“If necessary, I can give you an injection for pain. I’m going to first squeeze the fluid out of your finger with an elastic cord, then I will wind the string around your finger and under your ring. As I pull the string, your ring will travel over the string and hopefully come off.”

### What is my patient’s role?

“Tell me if this is very painful and you need an injection for pain. Otherwise, try to keep still and calm.”

## Preparation

###

### Documentation

1. Patient notes

### Equipment

1. Alcohol-based hand rub

2. Lubricant gel

3. Penrose drain or a thin, elastic bandage

4. Umbilical cord tie, thick suture material, the strap of an oxygen mask or dental floss

5. Equipment for local anaesthesia if necessary

6. Haemostat

## Site & Positioning

Position the patient with the finger in easy reach.

## Procedure

Follow medical asepsis without gloves.

1. Perform hand hygiene.

2. Perform a

   digital block
   digital block

   Inject lignocaine around the entire circumference of the base of the digit.

   proximal to the ring if required.

3. Lubricate the ring thoroughly and attempt to remove it with a twisting motion.

4. Wrap the Penrose drain or elastic bandage around the finger from tip to base. Leave for 5 minutes.

5. Remove the wrap.

6. Feed the end of the string/tie/floss under the ring with the haemostat.

7. Firmly wrap the distal end around the finger multiple times, from the ring, over the PIP joint, to the middle of the middle phalanx. Each wrap should be adjacent to the other.

8. Pull on the proximal end of the string, pulling towards the fingertip, so that the string unravels and the ring travels down the finger.

9. If this does not remove the ring, obtain a ring cutter or consult surgery.

10. Dispose of medical waste safely.

11. Record the completion of the procedure in patient notes.

## Risks

1. Digital nerve injury

2. Skin abrasions or other wounds

## References

1. Gupta P. How To Remove a Ring Using the String Method. MSD Manual. 2020. Available from: https://www.msdmanuals.com/professional/injuries-poisoning/how-to-do-other-orthopedic-procedures/how-to-remove-a-ring-using-the-string-method

2. Holme TJ, Mohan A. How to remove a ring using an oxygen mask. Ann R Coll Surg Engl. 2017;99(8):663. doi:10.1308/rcsann.2017.0062