A cesarean section is a major surgical procedure that involves strict safety protocols. The general rule across nearly all medical facilities is that patients must remove all jewelry before entering the operating room (OR). This policy is a necessary safety measure designed to protect the patient from specific risks associated with the surgical environment. This requirement is typically communicated during pre-operative consultations, allowing the patient time to prepare before the day of surgery.
Safety Hazards Requiring Removal
The primary reason for removing all metal jewelry is the widespread use of electrosurgical tools, often called electrocautery, during the procedure. These devices use an electrical current to cut tissue and stop bleeding. If metal jewelry is in contact with the skin, it can act as a conductor, potentially creating an alternate pathway for the electrical current. This misdirection can cause the current to concentrate and result in severe thermal burns where the metal touches the skin.
Metal items also create a physical hazard in the sterile environment. Jewelry can snag on surgical gowns, sterile drapes, or monitoring equipment, which can compromise the sterile field or cause injury, such as tearing the skin around a piercing site. Furthermore, jewelry has many small surfaces and crevices that can harbor bacteria, increasing the risk of introducing infection.
Protocols for Different Jewelry Types
Standard protocols require all rings, bracelets, and watches to be removed before surgery. If a ring is easily removed, it should be taken off well before the procedure, as swelling caused by IV fluids or pregnancy can make removal difficult later. For items with sentimental value, such as a wedding ring, some hospitals may allow a partner or family member to hold it.
Necklaces and earrings, even small studs, must also be removed due to the risk of snagging on equipment or drapes. Jewelry near the surgical site, such as a belly button piercing, is an absolute requirement for removal. The surgical team typically requests the removal of all metal piercings, including those on the ears, face, and body.
Oral piercings, like tongue jewelry, must be removed without exception, especially if general anesthesia is possible. Intubation can cause the tube to strike the piercing, potentially damaging teeth or the airway. For piercings that cannot be left out without closing, some facilities permit the temporary use of non-conductive retainers made of materials like glass, nylon, or plastic.
Managing Non-Removable Items
In situations where an item cannot be removed, such as a ring stuck due to significant swelling, a specific protocol may be followed. The surgical team may allow the jewelry to remain if it is completely covered with medical tape. Taping is used to insulate the item and prevent it from snagging, though it does not guarantee protection from electrical current.
If a ring is so tight that it impedes circulation or cannot be safely taped, the last resort is to use a specialized tool to cut the ring off. This prevents complications from increased post-operative swelling. Patients with permanent jewelry, such as dermal anchors or certain cartilage piercings, should communicate this issue to the pre-operative nurse or anesthesiologist as early as possible. Pre-planning allows the medical team to make arrangements, which could include substitution with a non-conductive alternative.