The answer to whether you can have painted nails for surgery is generally no, due to sound medical reasons related to patient safety. Removing nail coverings is one of the most consistently required pre-operative instructions. This requirement is not about aesthetics or hygiene, but rather the need for the surgical team to accurately monitor your body’s physiological status during anesthesia and the operation itself.
Why Nail Coverings Interfere with Monitoring
The primary reason for removing nail polish is the need for accurate readings from the pulse oximeter, a device that monitors your body’s oxygen saturation level (SpO2). This small clip-like device is typically placed on a fingertip and works by shining two wavelengths of light—red and infrared—through the finger. The pulse oximeter measures how much of this light is absorbed by the hemoglobin in your blood to calculate the percentage of oxygen being carried.
Pigmented or opaque substances on the nail, such as polish or artificial coverings, act as a physical barrier that blocks or scatters the light signals. Darker colors, like black, blue, or deep purple, cause the most significant interference by absorbing the light wavelengths the sensor needs. This can lead to an inaccurate reading, which may falsely show a higher or lower oxygen level than is actually present.
An inaccurate reading can mask a rapid drop in blood oxygen, known as hypoxemia, potentially delaying a necessary medical intervention. The natural appearance of the nail bed is also a reliable indicator of circulation and oxygenation; a bluish tinge, or cyanosis, is difficult to detect through colored polish. Both the pulse oximeter and the visual check of the nail bed are crucial for continuous assessment of a patient under anesthesia.
Types of Nail Products That Must Be Removed
The restriction applies to virtually all forms of nail covering, as they interfere with monitoring devices. This includes standard nail polish, particularly dark or highly pigmented shades. Gel polish, shellac, and dip powder manicures must also be removed because their opaque, cured composition is often thicker and more resistant to light transmission than traditional polish.
Artificial nails, such as acrylics, press-ons, and nail tips, present a dual problem because they are opaque and add significant thickness to the fingertip. While some facilities may allow for a single nail to be cleared, the safest protocol is to remove the enhancement entirely from at least one finger. Even clear polish is often included in the removal requirement, as it can still cause light reflection or because many hospitals adopt a universal “no polish” policy for simplicity and safety.
The general rule extends primarily to fingernails, as the hands are the most common placement site for the pulse oximeter. Toenail polish is less frequently required, but the surgical team may use a toe as an alternative monitoring site if the fingers are unavailable. It is always safest to check the specific pre-operative instructions provided by the facility.
Pre-Surgical Preparation and Protocols
To ensure a smooth surgical day, remove all nail products from at least one finger on one hand, typically the index or middle finger, before arriving at the hospital. If you have any type of artificial nail enhancement, such as acrylics, the entire structure must be removed, not just the colored coating. The removal should be completed the night before or the morning of the procedure to prevent last-minute delays.
If you arrive with nails that violate the protocol, the surgical team will need to remove the covering before the procedure can begin. This may involve staff using acetone wipes to quickly clear one nail, or using specialized tools for artificial nails, which can cause delays and stress. Failure to comply with these instructions can lead to the postponement of the surgery until the monitoring requirement is met.
While the primary monitoring site is the finger, the team can sometimes use alternative placement sites for the pulse oximeter, such as the earlobe or a toe, if the fingers cannot be cleared. These are often considered secondary options, and the finger remains the preferred location for reliability and speed of access. Preparing your nails ahead of time contributes significantly to the safety and efficiency of your surgical experience.