You should remove all nail polish and artificial nails before any surgical procedure. The primary reason is to ensure the surgical team can accurately monitor your oxygen levels and circulation throughout the operation. While policies vary across different surgical centers, the general rule is to have bare nails, and you should always confirm specific requirements with your surgical facility beforehand.
Monitoring Oxygen Saturation During Surgery
The restriction on nail coverings is directly related to the use of a device called a pulse oximeter, which is the standard method for measuring oxygen saturation in your blood. This small clip-like device is typically placed on a finger or a toe. It works by shining two wavelengths of light, usually red and infrared, through the tissue of your fingertip or toe.
The light passes through the nail bed and is absorbed differently by oxygenated and deoxygenated hemoglobin. By measuring the ratio of light absorption, the pulse oximeter calculates the percentage of hemoglobin saturated with oxygen. This reading provides a continuous measure of how effectively your body is being oxygenated during anesthesia and surgery.
Colored nail polish can significantly interfere with this process by absorbing or blocking the light signals the sensor needs to read. This interference can lead to an inaccurate measurement, often causing the device to show a falsely low or inconsistent reading. A distorted reading can delay the surgical team’s detection of a true drop in oxygen levels, which could compromise patient safety.
The color of your nail bed also provides a visual indicator of your circulatory health. A bluish discoloration, known as cyanosis, signals low oxygen levels or poor circulation. This change is difficult or impossible for medical staff to see if the nail is covered, making bare nails necessary for safe monitoring.
General Guidelines for Nail Preparation
You should plan to remove all nail coverings well in advance of your scheduled procedure. This includes any type of colored lacquer, as even a thin coating can sometimes affect the pulse oximeter’s accuracy. The standard practice is to have all fingernails completely bare, clean, and dry before arriving at the hospital.
While the finger is the most common site for the pulse oximeter, some facilities may also use the toe, the earlobe, or other areas. Therefore, it is often recommended to remove all polish from your toenails as well, unless your surgical center explicitly tells you otherwise. Removing all polish ensures the surgical team can place the monitoring device on any convenient and reliable site.
If you are concerned about your nail health or the removal process, take care of it at least a day or two before your surgery. Doing so avoids rushing and ensures that any residue from the polish or remover is completely gone. This preparation ensures that the monitoring equipment can function without interference when you are under anesthesia.
Specific Concerns with Artificial Nails and Gels
Artificial nail enhancements present a greater challenge than standard nail polish. These materials are thicker and more opaque, which further blocks the light transmission required by the pulse oximeter and makes it nearly impossible to get an accurate reading. This inaccuracy is a significant safety risk because it can mask a real drop in oxygen levels.
Due to the difficulties in getting reliable readings, most surgical facilities require the complete removal of all artificial nails from at least one finger on each hand, typically the index finger. If you cannot remove all of them, you must confirm with your provider if removing just one nail per hand is acceptable for monitoring. However, the safest and most common instruction is to have all artificial nails removed entirely.
Artificial nails often require professional removal that cannot be done quickly in the pre-operative area, and arriving with them may lead to delays or cancellation. Beyond monitoring, artificial nails are a concern for infection control, as they can harbor bacteria even after thorough hand washing. Planning for professional removal a few days before your surgery is the best way to comply with safety protocols.