Second OpinionsDermal anchors
Recently we have been seeing an increase in the number of young adult patients who have dermal piercings. These are not the traditional type of piercings we have dealt with in the past, however. These are implants under the skin, which would require surgery to remove. Since our policy requires piercings to be removed prior to surgery, this presents us with a difficult situation. Does anyone have experience with these? How are they being handled in your facility?
Started by: Marlene Sapa (Director, Surgical Services/Director of Nursing) at March 5, 2012 (9:20 am)
Comments and Responses
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We have recently addressed the dermal anchors and any jewlery issues because it is ongoing. The Pre-op call prior to surgery explains to the patient that all jewelry must be removed prior to surgery and explains why. We still see patients arrive with jewelry in place and many times say it cannot be removed. We added a waiver on the consent concerning jewelry which includes metal on the body that revealed and not revealed to the nurses and sometimes found on the patient in the OR. Ultimately, it is the surgeons decision to proceed with the surgery with the metal in place or to cancel. If the metal is not within the path of the incision and the electrode most times we proceed. We have enlightened our surgeons about the dermal anchors and they are in agreement that the patient should have these removed prior to the surgery for the safest solution.
Sherry O. (Administrator/Director/Manager/Owner/Executive Officer) at July 11, 2012 (9:02 am)
We ensure that the piercings are not in proximity to the cautery pad or the surgery site. We have had multiple patients and have not had any adverse effects or concerns.
Barb G. (Director, Surgical Services/Director of Nursing) at July 2, 2012 (8:04 am)
We ensure that the piercings are not in close proximity to the cautery pad or the surgery site. Patients are educated by the staff and the surgeons on the possible complications with these piercings. However, we have had multiple patients and have not had any adverse effects or concerns.
Barb G. (Director, Surgical Services/Director of Nursing) at July 2, 2012 (8:02 am) [last edited on July 2, 2012 (8:04 am)]
As all of you have experinced they are not easily to be reinserted , my suggestion to you is to tell the patient that , allow it to heal and have it re done by there piercer or have some one come in do a inservice and teach you how that is the best way . Or just have there piercer re insert after the surgery and have them sign off on that . Your responsiblility is to the saftey of the patient during surgery. The piercers would be to re insert after wards and again we can do inservice for any of you if you would like the web site is hlthedu.com
David A Vidra
David Vidra (Other) at June 25, 2012 (2:53 pm)
I would agree with mr judge as a nurse and someone who has taught infection controll in the body art industry for 17 years this is the best way to handel it , the piericng everyone is speaking of is not defined as a implant there is exposrue to the air and does not totoally live under the skin in the body if any needs any inservice please let us know this is what we do .
David Vidra, owner Health Educators Inc ,www/hlthedu.com, we are in north america and internationally so do not hesitate to contact us.
David Vidra (Other) at April 27, 2012 (8:22 am)
patients are questioned during the preop call and told to remove any body jewelry - it is mandatory for any jewelry in the mouth to be removed and our anesthesiologists have cancelled cases for non compliant patients - others sites - if the patient did not remove are required to sign a waiver - that usually is enough to get them to remove it
Sally R. (Administrator/Director/Manager/Owner/Executive Officer) at March 20, 2012 (9:26 am)
We are a multi specialty center. Last year we had a plastics patient present with a dermal piercing. After speaking to the patient and explaining her options (canceling or removing it) she and the surgeon agreed that he would remove it in the OR prior to starting the case, but we would not re-insert it. We also recently had an ortho patient present with the same thing and once again the surgeon agreed to remove it. We do not charge anything and only make a note of it in the chart. All our patients are advised in advance of removal of piercings, however, they seem to think of these dermal piercings as more like a tattoo than a piercing. They are not happy about the required removal, but explaining burns from cautery seems to change their mind.
Kimberly T. (Administrator/Director/Manager/Owner/Exec. Officer) at March 15, 2012 (2:44 pm)
We too are struggling with this issue on a more recurrent basis. We are documenting the conversation with the patient AND the surgeon prior to proceding with case. This documentation outlines the risks associated that were covered with patient AND surgeon. A definitive, evidence base answer would be so very helpful!
Thanks for starting the conversation!
Marian McCann (Director, Surgical Services/Director of Nursing) at March 15, 2012 (12:22 pm)
As long as the piercings are not in close proximity to the incision site or the return electrode, they should not pose a burn risk. These dermal piercings are actually in-grown over time and can cause other problems if not properly removed, such as an open wound. Dermal piercings usually consist of two parts; the implant and the removable ornamental piece. We request that the ornamental piece be removed and the remaining implant be cover with a telfa dressing, providing they do not interfere with the surgical or return electrode sites. This assists in the reduction in possible removal during transfer or draping. Any piercing that cannot be removed, or the patient refuses to remove,the patient signs a waiver stating so.
If the implants are too close to the surgical site, arrangements must be made to have them removed well enough in advance of the surgery date to allow for healing.
William Judge (OR Manager/Supervisor) at March 15, 2012 (11:25 am)
We do out patient plastic surgery in our office and have begun to see these piercings so I consulted a shop that provides this procedure and was told they should be removed prior to any surgical procedure involving the use of a cautery.
Barbara C. (Director, Surgical Services/Director of Nursing) at March 15, 2012 (11:05 am)
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