For nearly all surgical procedures involving anesthesia, removal of body piercings is mandatory. This requirement is based on standardized patient safety protocols implemented across operating rooms, not preference. Understanding the specific risks associated with leaving metal jewelry in place explains why surgical teams adhere to this strict rule.
The Essential Safety Risks
Electrocautery is a standard instrument used by surgeons to cut tissue and seal blood vessels by passing a high-frequency electrical current through the patient’s body. Metal jewelry is highly conductive and can create an alternate pathway for this current. If the current concentrates where the metal touches the skin, it can result in severe, localized thermal burns.
The body naturally responds to surgical trauma and anesthesia with localized swelling, particularly in the head and neck area. Piercings located in the tongue, lips, or cheeks can quickly become problematic as tissue expands around the jewelry. This swelling can interfere with the insertion or removal of airway management devices, such as laryngeal mask airways (LMAs) or endotracheal tubes. Fixed metal jewelry complicating a swollen airway poses a significant risk of breathing obstruction during recovery.
Even when a piercing site appears healed, the jewelry surface can harbor microorganisms, raising the potential for a surgical site infection if bacteria migrate into the surgical wound. Additionally, during patient positioning or movement while unconscious, external jewelry can snag on drapes or equipment. This mechanical trauma could tear the skin around the piercing site or cause aspiration if a piece breaks off.
Alternatives When Removal is Difficult
If a piercing is new, healing, or too difficult to remove, non-metal alternatives may be used with prior approval. These alternatives are typically non-conductive retainers made from materials like medical-grade plastic, nylon, glass, or Polytetrafluoroethylene (PTFE). PTFE is often preferred because it is biocompatible and can be trimmed to size, allowing the piercing tract to remain open without the electrical conductivity risk.
The use of retainers must be discussed and approved by the surgeon and anesthesiologist well before the procedure date. If a piercing is small or located far from the surgical site and removal is not possible, the team may opt to securely tape over the jewelry. Taping is considered a less secure mitigation strategy, as it does not eliminate the potential for mechanical snagging or the risk of localized pressure necrosis.
Patients are responsible for removing their own jewelry before arriving at the hospital. If specialized tools are needed to remove a stubborn piece, the surgical nursing staff may assist, but this should not be assumed. Since the surgical team focuses on the operation, the responsibility for replacing the jewelry after the procedure falls to the patient or their support person.
Piercings and Non-Surgical Procedures
Requirements for piercings differ significantly when moving from the operating room to diagnostic imaging centers. Magnetic Resonance Imaging (MRI) machines use powerful magnetic fields and require the removal of all metal jewelry. Even small ferrous metals can be pulled from the body, causing tissue tearing or displacement, or the metal can rapidly heat up, leading to severe burns.
Computed Tomography (CT) scans and standard X-rays do not pose the same physical risks as an MRI because they do not use strong magnetic fields. For X-rays, jewelry must only be removed if it directly overlaps the area being imaged, as the metal creates an opaque shadow that obscures diagnostic information. A CT scan allows for metal unless the piercing is within the specific field of view being analyzed.
Minor outpatient procedures, such as receiving stitches or having blood drawn, often have less rigid protocols than general anesthesia surgery. Patients should always confirm the specific policy of the clinic or provider performing the procedure. When in doubt, removing any jewelry near the immediate treatment area remains the safest practice.