The answer to whether you can have your nails painted for surgery is generally no, as this requirement is based entirely on patient safety. This standard procedure allows the surgical team to accurately monitor your physiological status during anesthesia and the operation. Removing nail coatings ensures that medical devices used to track your well-being function optimally. This preparation step eliminates a variable that could compromise the precise monitoring of your condition.
Why Nail Coatings Are a Concern
The primary reason for removing nail coatings involves a small device called a pulse oximeter, which is typically clipped onto a finger or toe. This non-invasive monitor is used constantly during surgery to measure the percentage of oxygen saturation in your blood (SpO2). The device works by emitting two different wavelengths of light through the fingertip tissue. Hemoglobin, the oxygen-carrying protein in red blood cells, absorbs these wavelengths differently depending on oxygen binding. The pulse oximeter calculates the SpO2 reading by measuring the ratio of light absorption. Any opaque material, such as nail polish, gel, or acrylic, interferes with the light path, causing signal obstruction. This blockage results in inaccurate readings or a complete inability for the device to register a measurement.
Darker colors, specifically black, dark blue, or deep green, absorb light most effectively, leading to the greatest interference with the sensor. Inaccurate readings can falsely suggest a patient has sufficient oxygen or complicate the anesthesiologist’s ability to manage breathing and circulation. Furthermore, the natural color of the nail bed is a direct visual indicator of peripheral circulation. Nail coatings obscure the care team’s ability to check for visual signs of cyanosis, a bluish discoloration that signals low oxygen levels.
Polish, Gel, and Acrylics: What Must Go
All forms of coverage on the fingernails must be completely removed, as any layer can impede the pulse oximeter’s function. Traditional nail polish is the easiest to manage, requiring only standard acetone or non-acetone remover for quick removal. It is advisable to remove all layers, including any base or top coat, to ensure the nail bed is fully exposed.
Gel polish presents a greater challenge, as it is cured under a UV or LED light to create a hard, durable layer. Complete removal requires soaking in pure acetone, often involving saturated cotton balls wrapped in foil for 10 to 15 minutes to break down the material.
Artificial enhancements like acrylic, dip powder, or hard gel nails are even more demanding because they are significantly thicker and more rigid. Removing these materials requires filing down the top layers before a prolonged soak in pure acetone, which can take 20 to 30 minutes or longer. The removal of artificial nails is also recommended due to hygiene concerns, as lifted areas can harbor bacteria that increase the risk of infection.
Alternatives and Exceptions
In situations where a patient cannot remove a nail coating, such as an emergency procedure or due to a specific medical condition, the care team has alternative monitoring options. A pulse oximeter can sometimes be placed on an alternative site, such as the earlobe or the side of the finger, which may provide a clearer reading. However, these sites are considered less accurate than the standard fingertip placement.
If you have polish on your toenails, it is typically acceptable to leave it on, as the pulse oximeter is almost always placed on a finger for proximity and ease of monitoring. Clear nail polish is generally discouraged, as some formulations can still interfere with the sensor’s light transmission, though it is less problematic than opaque colors. If a patient arrives for surgery with a nail coating intact, the surgical staff will often remove it themselves from one or two fingers to ensure reliable monitoring can be established before the procedure begins.