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Preoperative Evaluation/Patient Issues/What kind of jewelry can patients wear?

QUESTION:

What do you do about body jewelry? I've always had patients remove tongue rings and nose rings because they're in our field. But patients frequently object strongly to eyebrow rings and naval rings being removed. Historically, we've always said electrocautery and burns are an issue. But is this really true?

-- From David S. Rapkin, M.D., Richmond Heights, OH

REPLY:

This is an increasingly common problem. Our head of ambulatory anesthesia, Dr. Sivashankaran, does not think that electrocautery-induced burns are an issue. Another colleague, Dr. Mark Boswell, notes that the risk of a burn applies only to electrocautery applied "near" the jewelry. He suggests that the decision about removal be left to the surgeon and that this be documented. Dr. Boswell also says that tongue jewelry should come out.

It appears that there are at least 3 distinct problems here. Firstly, there is the risk of tissue burn. Jewelry may provide an alternate path to ground for electrocautery units. Although newer units have ground-referenced generators that should prevent burns, manufacturers of electrosurgery systems continue to advocate for removal of all jewelry. Certainly, if jewelry is to be retained, electrocautery should not be used in close proximity. Secondly, there is the risk that jewelry may become snagged on bedding or other items, causing damage to tissue or to the jewelry itself. Third, oral jewelry and piercings can impede airway management - there seems to be a consensus that these decorations should be removed before surgery.

It would be interesting to know what the policy is in different institutions.

-- From Gary Kantor, M.D., Cleveland, OH

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