Procedure for Removal of Maggots

Exposure to blood and body fluids is a reasonable expectation during the maggot debridement dressing removal; appropriate personal protective equipment is therefore required. Dressings should be removed after about 48 hours; never longer than 72 hours. Patients with fever or changes in mental status should be evaluated for spread of infection (bacteremia or cellulitis) or elevated serum ammonia levels. Maggot dressings may need to be removed immediately to facilitate inspection of the wound.

Step
Illustration
Action
1
Place an infectious waste red bag next to or under the dressing.
2
Inspect the dressing and surrounding skin carefully, noting any problems or abnormalities.
3
Remove the outer gauze dressing and gently loosen (but do not remove) the hydrocolloid pad from the skin.
4
Peel back the hydrocolloid pad and the entire cage dressing with one hand while wiping the larvae in the same direction with a moist 4X4” gauze held in the other hand, sandwiching the maggots between the hydrocolloid pad and the fresh moist gauze pad.  The “wiping” gauze can be moistened with normal saline, irrigation water, or hydrogen peroxide.  If using hydrogen peroxide, make sure it’s all washed out with normal saline.
5
  Place the dressing and sandwiched maggots into the infectious waste bag.  If the bag is below a wounded limb, then the loose maggots will drop into the bag below as they attempt to escape. 
6
Irrigate the wound with normal saline.
7
It may be necessary to use gloved fingers, forceps, or cotton swabs to remove a few immature larvae.  NEVER kill the larvae within the wound if you are unable to extract them.  It’s better to leave live larvae in the wound (they will crawl out on their own and bury themselves in a dry gauze dressing) than to risk leaving dead larvae within a wound.
8
Check the bedding for loose maggots, grasp them firmly and deposit in the infectious waste bag.
9
Secure the waste bag by tying a knot in the plastic bag, and then double-bagging. Be sure that the knots are tied completely, securely, and are air-tight.  A bow tie made of two opposing edges of the bag is NOT adequate to prevent maggots from escaping the bag.  Drop the double-bagged maggots and dressings into the infectious waste bin.
10
Assess the wound for another application of maggots or another appropriate dressing.
11
  Apply dressing as indicated.


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Maggots must be disposed of in airtight double bags to make sure that no maggots escape.
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