Systematic Review of the Literature for Jewelry and Body Piercing in the Operating Room

Background and Objectives: Questions were raised regarding best practice for jewelry and body piercing removal for operating room and procedure room patients in an ambulatory surgery unit. Surgical providers and anesthesia providers did not always agree with jewelry or body piercing removal requirements. The Unit Practice Council was tasked with reviewing best practices for jewelry and body piercing removal before surgery, or to leave jewelry and body piercings in place. Methods: The Unit Practice Council assigned a small task group consisting of two operating room nurses and a perianesthesia care unit nurse. This group conducted a systematic review of the literature for jewelry and body piercing in the operating room. The PICOT question was direct: What is best practice for jewelry or body piercings in the operating room (to require removal or not)? Results: Searches of Joanna Briggs Institute, CINAHL Ultimate, CINAHL Plus, EBSCOhost E-book Complete, and Eric Medline, and known sources including the Association of Perioperative Registered Nurses and perianesthesia nursing publications. There were 38 usable sources; however, with grading the evidence, most articles were “expert opinion”. There were 3 Level 1 results, which are national guidelines based on evidence. Airway’s concerns with jewelry and body piercings are among the themes that have been identified the most in the literature. 32 authors indicated that jewelry or body piercings should be removed. Recommendations within the literature review also included teaching the patients preoperatively not to wear jewelry into the facility, and for staff to know how to remove piercings. Few authors also recommended using a waiver for patients who refused to remove piercings or jewelry, and to proceed with a procedure after the waiver is signed. Conclusion: With these findings the group has recommended that all jewelry and body piercings to be removed prior to arrival to the same day surgery center, to update the preoperative instructions to include removal of body piercings or jewelry prior to arrival for surgery, and to include the statement in the preoperative instructions, that a procedure may be canceled if the patient is unable to remove jewelry or body piercings. Staff will monitor compliance with the removal of jewelry and body piercings prior to arrival, and document cancellations required due to piercings/jewelry.