Hospitals and surgical centers typically require the removal of all nail enhancements before a scheduled surgery. This requirement is based on standardized safety measures designed to protect the patient during and immediately following the procedure. The necessity for bare, natural nails stems from medical monitoring needs and infection control practices.
The Primary Medical Reason for Removal
The main reason for removing acrylics, gel polish, or any opaque nail enhancement is to ensure the proper function of the pulse oximeter. This non-invasive device measures oxygen saturation in the blood (SpO2) and is continuously used throughout the surgical experience. Monitoring the body’s oxygen levels is a foundational safety measure during general anesthesia and sedation, where breathing can be affected.
The pulse oximeter works by shining light through the fingertip, emitting two different wavelengths—red and infrared. It measures the amount of light absorbed by oxygenated and deoxygenated hemoglobin to calculate the percentage of oxygen in the blood.
Artificial nails and opaque polishes interfere with this light-based measurement by scattering or blocking the light waves. The presence of a thick, colored layer of acrylic or gel distorts the light transmission, which leads to an inaccurate or unreliable reading of the patient’s oxygen saturation. This interference can cause a delay in detecting a drop in oxygen levels or produce a false reading that misleads the surgical team.
Dark colors can absorb light in a way that causes the pulse oximeter to overestimate the oxygen saturation. Even clear acrylics can interfere due to the thickness of the material, making it difficult for the sensor to obtain a strong signal. Reliable, real-time data is essential for the anesthesiologist to make timely adjustments to the patient’s breathing support and anesthesia delivery.
Additional Safety and Monitoring Concerns
Artificial nails present two secondary safety concerns: the risk of infection and the obstruction of visual assessment. The sterile environment of the operating room is maintained with rigorous protocols to prevent surgical site infections (SSIs). Artificial nails, including acrylics and gels, harbor a significantly higher number of pathogenic organisms compared to natural nails.
Studies have shown that artificial nails retain bacteria even after thorough hand scrubbing, increasing the risk of transmitting pathogens to the surgical site. The gap between the natural nail and the artificial material traps moisture and microorganisms, creating a difficult-to-clean reservoir for bacteria.
Visual Assessment of the Nail Bed
The second concern involves the medical team’s ability to visually check the patient’s physiological status. The color of the nail bed acts as a rapid, non-electronic indicator of blood circulation and oxygenation status. When oxygen levels drop, the nail beds can develop a bluish or purplish tint, a condition known as cyanosis.
This visual assessment is a fundamental part of patient monitoring, especially when the pulse oximeter reading is questionable. The presence of any artificial enhancement or opaque color completely obscures this natural visual sign. Removing the enhancements ensures medical professionals can use this simple, established method to quickly assess for circulatory or respiratory distress.
Pre-Surgical Preparation and Alternatives
The safest approach is to completely remove all artificial nails, gels, and polishes from both fingernails and toenails before arriving at the hospital. This proactive step eliminates the risk of electronic interference and the potential for increased bacterial presence. Patients should aim to have this removal done by a professional salon or use pure acetone at home well in advance of their procedure date.
In some cases, such as an unexpectedly scheduled surgery or an inability to remove all enhancements, a compromise may be necessary. The minimum requirement is usually to have at least one natural nail completely bare and free of any product. This bare nail is typically the index finger or thumb, which is the preferred site for the pulse oximeter probe.
Patients should confirm the specific requirements with their surgical team or hospital well before the date of the procedure, as protocols can vary slightly. While the primary focus is on the hands, many facilities also recommend removing polish from toenails. This allows for the use of a toe as an alternative monitoring site if the fingers are unavailable or if a specific surgical procedure requires it.