Removing gel nails, acrylics, dip powder, or dark polish before surgery is a common requirement in healthcare settings. This protocol is rooted in fundamental patient safety during the operating and recovery phases. Artificial nail enhancements interfere with the medical team’s ability to monitor a patient’s physiological status, a non-negotiable aspect of modern anesthesia and surgical care.
Monitoring Oxygen Saturation
The primary reason artificial nail products must be removed relates to the function of the pulse oximeter, a device that monitors the amount of oxygen carried by the red blood cells. This non-invasive monitor clips onto a fingertip and works by transmitting two wavelengths of light—red and infrared—through the nail bed tissue. Specialized sensors then measure how much of this light is absorbed by the hemoglobin, allowing for a continuous calculation of the blood’s oxygen saturation level (SpO2).
Opaque materials like gel, acrylic, or dark-colored polishes physically block or distort the passage of this light, preventing the sensor from obtaining a reliable reading. This interference can result in the device displaying an inaccurate number or no reading at all, often referred to as signal dropout. Certain dark shades or thick layers of gel polish can lead to an overestimation of the true SpO2 value, delaying the detection of hypoxemia (dangerously low oxygen levels) in a sedated patient. Preserving a clear site for the pulse oximeter is paramount.
Other Safety Concerns
Beyond interfering with monitoring equipment, artificial nails present safety issues related to hygiene and potential hazards in the operating room. Long or artificial nails, including gels and acrylics, are known to harbor a greater number of pathogenic microorganisms compared to natural nails, even after thorough hand scrubbing. The space between the natural nail and the enhancement can trap moisture and bacteria, including gram-negative microorganisms and fungi. This increased microbial load raises the risk of a surgical site infection (SSI) for the patient.
The composition of artificial nails also introduces a risk during the use of electrosurgical tools, commonly known as cautery, which are used to cut tissue and stop bleeding. These tools generate high heat and can pose a risk of ignition when near flammable materials. Research has demonstrated that acrylic materials are flammable; one study reported a 41.5% rate of ignition when electrocautery was used directly on acrylic nails. While this specific scenario is rare, the presence of flammable material is a recognized hazard that surgical teams seek to eliminate to prevent potential burns.
Necessary Preparation and Alternatives
To ensure a smooth and safe procedure, patients should plan to remove all nail enhancements and polish well in advance of their surgery date. Most hospitals and surgical centers require this to be done before arrival to prevent delays or the need for an emergency removal by staff. If complete removal is not feasible, patients should contact the pre-admission testing (PAT) department or the surgeon’s office immediately.
Policies can differ between facilities, but many will allow a compromise that still prioritizes monitoring capability. This typically involves requiring at least one finger (often the index finger or thumb) to be completely clear of any product, including clear polish. This single clear nail provides the anesthesiologist with a reliable site to place the pulse oximeter probe. By proactively addressing nail preparation, patients contribute directly to their own safety and facilitate the medical team’s ability to provide care.