Disposal of epinephrine; shellfish and iodine allergies; fires caused by hair gel; patient jewelry; vaginal use of chlorhexidine gluconate

AORN Journal,  Feb, 2006  by Eric Briesemeister,  Byron L. Burlingame

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QUESTION: Recently, when intubating a patient, the anesthesia care provider discovered that the patient had a pierced tongue. I was taught that all jewelry should be removed. Is this stilt applicable?

ANSWER: The best practice is to remove all patient jewelry before the beginning of surgery. Jewelry presents multiple risks to the patient, including

* aspiration,

* burns,

* complications during urinary catheterization,

* increased risk of infection,

* loss of the item,

* pressure sores, and

* tissue injury from tearing or edema.

Body jewelry on or in the tongue should be removed because of the risk of injury during intubation. If tongue jewelry is not removed, it may be dislodged, causing tissue tearing and aspiration of the jewelry item. (18) This risk also should be considered if the patient has nasal piercings, which may become dislodged if nasal intubation becomes necessary.

Burns can occur when jewelry is within the activation range of the active electrode or if the jewelry touches a metal object and becomes the route for current leakage. (19) If a reusable full-body return electrode is being used, all jewelry with potential of touching the return electrode should be removed because of the possibility that small metal objects (eg, jewelry) touching the electrode could cause a burn at the site of contact. (18,19) Jewelry in the genitalia can cause difficulty with successful passage of a urinary catheter. Jewelry has been shown to harbor potential pathogens, therefore increasing the risk for surgical site infection. (20) Removal or accidental dislodging of the jewelry item in the OR may result in the loss of the item. Jewelry may cause pressure on an anatomical area because of the way the patient is positioned. The pressure may be caused by an instrument (eg, retractor) or a piece of equipment (eg, the Mayo stand) or a person leaning against the area containing the piece of jewelry. (18) Jewelry should be secured to prevent potential injury from other sources, such as being caught in the drapes and becoming dislodged during drape removal. An additional injury may result from edema at the location of the jewelry item. Jewelry should be removed if it is of a style that could cause constriction or is in a location where there is potential for edema. (18)

The patient should be asked preoperatively if he or she has any body jewelry. This should be asked of all patients because any person may be wearing jewelry. (19) If body jewelry is present, the patient should be instructed to remove it. If the patient cannot remove the jewelry, he or she should be instructed to go to a piercing shop to have it removed. At that time, the piercing artist can place a nonmetal device into the hole to help keep it open if there is a concern about the hole closing before the jewelry can be replaced. The patient needs to be cautioned that a nonmetal insert cannot remain in place if the jewelry

* is in the surgical prep zone,

* is in an area where the insert will cause increased pressure,