Preparing for surgery involves detailed instructions to ensure patient safety, including the complete removal of all personal items, especially jewelry. This directive often confuses patients, but it is rooted in established medical protocols designed to prevent complications and prioritize patient well-being.
Understanding the Risks of Metal Jewelry During Surgery
The primary concern with metal jewelry involves the routine use of electrosurgical units (electrocautery or diathermy devices). These instruments use high-frequency electrical currents to cut tissue and control bleeding. The current travels through the patient’s body and returns to the machine via a grounding pad.
If metal jewelry is worn, it can act as an unintended pathway for this current, causing electrical energy to concentrate. This concentration rapidly generates intense heat where the metal contacts the skin, leading to severe thermal injuries known as radiofrequency burns.
Metal objects also pose risks beyond electrical hazards. Ferromagnetic metals can cause severe image distortion during Magnetic Resonance Imaging (MRI), compromising diagnostic clarity. Furthermore, jewelry surfaces can collect bacteria, raising the risk of surgical site infection by introducing microorganisms into the sterile field.
Specific Considerations for Plastic and Non-Metallic Jewelry
Non-metallic items like plastic, acrylic, or wood do not pose the same direct electrical conductivity risk as metal, but they are still universally discouraged in surgery. These materials present unique thermal and operational risks related to the operating room environment.
Operating rooms use powerful, focused light sources, such as high-intensity LED or halogen lamps, which generate significant localized heat. Plastic materials, like polystyrene, have low melting points and can deform or melt when exposed to these temperatures. This melting can cause direct contact burns or compromise the sterile field.
A significant concern is the risk of jewelry breaking or coming loose during the procedure. A small piece of plastic could become a foreign body, potentially falling into the surgical wound or being aspirated. Hospitals maintain a blanket policy requiring the removal of all jewelry, regardless of material, to standardize safety protocols.
Non-conductive items can also interfere with monitoring devices, such as pulse oximetry or electrocardiogram leads. A bulky plastic item may prevent staff from properly securing these devices, leading to inaccurate readings. Jewelry can also be snagged by surgical gowns or wires, potentially causing trauma.
Preparing for Surgery: What to Do About Difficult-to-Remove Items
If items are genuinely difficult or impossible to remove, such as permanent piercings or rings stuck due to swelling, patients must consult the surgical team well in advance. While complete removal is the preferred option, alternatives can be discussed before the day of surgery.
For permanent body piercings, the surgeon may approve substituting the metal post with a non-conductive retainer. Materials like polytetrafluoroethylene (PTFE) or glass are commonly used because they are heat-resistant and non-ferromagnetic. These specialized retainers keep the piercing channel open without introducing electrical or thermal hazards.
In rare instances, such as a wedding band stuck due to arthritis, the item may be permitted to remain if explicitly approved by the anesthesiologist. If approved, the item must be secured completely with non-conductive tape. This taping prevents snagging and helps isolate the item from the surgical environment, though it does not insulate it from electrical current.