Removing nail polish, gel, or acrylic overlays before surgery is a strict safety requirement because nail coverings compromise both the appearance of the nail and the accuracy of monitoring devices. Anesthesia and surgical teams must have an unobstructed view and reliable electronic data to continuously monitor a patient’s well-being throughout the procedure.
The Primary Monitoring Tool: Pulse Oximetry
The pulse oximeter is a small, clip-like device typically placed on a patient’s fingertip, and it is the most important non-invasive tool for monitoring during anesthesia. It works by shining light through the finger to measure the percentage of oxygen-carrying hemoglobin in the blood. The resulting reading, peripheral oxygen saturation (SpO2), provides real-time data on oxygen delivery.
Maintaining a stable oxygen saturation level is paramount when a patient is under sedation or general anesthesia, as breathing can be affected. A drop in SpO2 signals a significant complication, such as breathing difficulty or a circulation problem, requiring immediate intervention. The pulse oximeter acts as an early warning system, alerting staff to changes in oxygenation before they become major issues. The accuracy and continuity of this measurement are necessary for the anesthesia provider.
How Nail Coverings Interfere with Vitals
Nail polish, and especially thicker coverings like gels and acrylics, directly interfere with the pulse oximeter. The device uses two specific wavelengths of light—red and infrared—to distinguish between oxygenated and deoxygenated hemoglobin. The color or opacity of the nail covering can absorb or scatter these light wavelengths, preventing a clear reading.
Darker colors, such as black, blue, and green, are the most problematic, often causing the oximeter to give a falsely low reading, known as “artifactual desaturation.” Thicker coverings like gels or opaque acrylics can impede light transmission entirely, resulting in a non-existent or erratic reading. This inaccuracy can mask a genuine drop in blood oxygen or prompt unnecessary medical interventions based on a false alarm.
Visual Assessment and Infection Control
Beyond electronic monitoring, the appearance of the nail bed offers crucial, traditional signs about a patient’s circulation and oxygenation. Healthcare providers perform a quick, non-electronic check called the capillary refill test, where pressure is applied to the nail to momentarily push the blood out. The time it takes for the color to return to the nail bed should be two seconds or less, indicating healthy peripheral blood flow.
Nail coverings prevent this visual assessment, making it impossible to check the capillary refill time or visually detect cyanosis, a bluish discoloration that occurs when blood oxygen levels are low. Furthermore, artificial nails, including gels and acrylics, pose a risk for harboring bacteria, even after rigorous hand scrubbing. These enhancements can harbor pathogenic organisms, increasing the risk of surgical site infections or contamination, especially if intravenous lines or arterial monitoring are needed near the hands.