1. D'Alesandro, Mary Ann MSN, RN, CNOR, BC

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Body piercings, including subdermal implants, have become more common and can affect intraoperative patient safety. Open communication, a thorough assessment, a plan of care, and awareness of potential complications are essential for safety and positive patient outcomes.


The most common areas pierced are the earlobe, ear cartilage, tragus, nasal septum, nasal edge, distal portion of the nose, eyebrow, tongue, lips, navel, nipples, and genitalia.1 Nontraditional body decorations have recently posed additional challenges to patient safety. Nontraditional body decoration blends traditional body piercing with subdermal, transdermal, and microdermal implants.2 Subdermal implants consist of burrowing and embedding decorative objects (usually made of silicone or metal) under the skin, which results in a three-dimensional effect of the object on the surface of the skin.2 Transdermal and microdermal implants consist of a stainless steel or titanium anchor (also known as a footplate) inserted into the epidermis with a thin piece of the metal protruding from the skin, to which jewelry is attached.2


Preoperative awareness

Removing traditional piercings preoperatively decreases the risk of electrical burns, skin injury (such as skin tearing or displacement of the piercing object during positioning), and anesthesia complications, including possible aspiration of the piercing object or tongue injury resulting in profuse bleeding that may cause airway obstruction.1 Perioperative nurses should ask about the existence and location of body piercings when performing a thorough preoperative assessment.1 Ideally, the patient should remove his or her own piercings, but in an emergency or when the patient is unable to do so, the perioperative nurse should remove the body piercings according to the facility's policy and procedure. The removal of the body piercings and the skin assessment must be documented in the patient's medical record.1,3


Intraoperative concerns

Skin and pressure protection. The location of dermal implants should be included in the time out before surgery to reduce the patient's risk of injury.4 Jewelry should be removed before positioning and transfer activities if the piercing or piercing accessories could cause an injury or interfere with the surgical site.3 When positioning a patient with a dermal implant that cannot be removed, the perioperative nurse must prevent pressure on the nerves and tissue and assess whether additional padding is needed.3 Factors to consider include the site and anticipated length of the procedure and if positioning or the surgical approach will need to be modified.


Burns. When possible, metal jewelry should be removed before surgery, as it can pose a risk for a burn if the patient is not properly grounded when electrosurgery is used.2,3 A burn may occur from contact with an active electrode, from heat conducted from an electrode, or from any leakage of current if metal jewelry or piercing remains in place.3 The risk of a burn can be decreased by removing metal near the electrode activation site.3


Effective communication and a comprehensive preoperative assessment are key to providing an optimal experience for the patient and creating an environment in which the perioperative team can provide safe care for all patient procedures.4




1. Diccini S, Nogueira AM, Sousa VD. Body piercing among Brazilian surgical patients. AORN J. 2009;89(1):161-165. [Context Link]


2. Wanzer LJ, Hicks RW. Identifying and minimizing risks for surgical patients with dermal implants. AORN J. 2012;96(4):C5-C6. [Context Link]


3. Association of periOperative Registered Nurses. Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc.; 2014. [Context Link]


4. Denholm B. Caring for surgical patients who have sub-dermal implants. AORN J. 2013;97(3):372-375. [Context Link]