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Hospitals
face dilemmas treating patients with pierced parts
Tuesday, May 2002 Boney Joe, with his seven earring plugs, a horseshoe nose ring, lower lip barbell, stainless steel implants and intricate tattoos, is a hospital worker's worst nightmare.
While the look of the Zelienople piercing artist might be a tad excessive for the Pittsburgh region, the proliferation of this form of expression is a growing concern among some medical workers. Will navel rings disrupt a CT scan? Will the metal cause burns by conducting electricity from surgical equipment? What do you do when the patient refuses to remove the tongue bob that could pose a choking risk if he receives anesthesia? And many do refuse. Or they won't disclose that they have the jewelry, and after they're under anesthesia and the nurse lifts the drape to put in a urinary catheter....whoops! well, hello! Many patients sporting pierced nipples, navels, tongues and you-know-whats aren't as willing to remove them before surgery as they are to remove ear jewelry. With tongue piercings, in particular, the holes can start closing as soon as the studs are removed. Some patients seeking elective surgery are even shopping around from hospital to hospital to find out which will allow it and which won't -- not all have written policies addressing these issues. "Some of these piercings are very intricate," said Patricia Boyle, director of surgical services at St. Francis Hospital in Cranberry. "We have no instruments to get them out." Several operating room managers related these concerns during a recent brainstorming session at St. Francis, which drew representatives from 14 community hospitals stretching from Greensburg to Meadville to Altoona to Washington, Pa. And Boney Joe, a k a Joe Clark, offered a demonstration on Piercing Removal 101. "It's really simple," he told the nurse managers. "It's complicated because you don't understand it." Some of the resistance to having jewelry removed isn't as much a problem in big city emergency rooms. When a patient is facing life or death, keeping the piercing intact is a minor consideration, said Dr. Fred Harchelroad, director of emergency medicine at Allegheny General Hospital. Staff often can work around the piercings. A pierced nipple generally doesn't interfere with a heart defibrillator because the pads aren't placed over the nipple.
A small piercing on the tongue usually doesn't have to be removed if a breathing tube is inserted. But the staff at Allegheny General has been trained to remove the jewelry if it does interfere. Piercings do present problems with body scans. Metal jewelry can scatter the radiation in CT scans, skewing the results. And magnetic resonance imaging, which essentially uses a large magnet, can yank metal jewelry out of the skin. Years ago, the worst jewelry problem hospital workers faced was with patients who had worn their wedding bands for decades and could no longer get them off. These rings must be removed if there is a chance a procedure could cause swelling in extremities. Hospitals have ring cutters handy for such occasions. At the St. Francis meeting, Jim Balawajder, a medical equipment sales representative for Valleylab in Boulder, Colo., said his company advises patients to leave their jewelry at home. Most modern surgery is done with an electrical cauterizing knife that seals blood vessels to reduce bleeding as tissue is cut. Even though this equipment has tight safeguards, there is still a slight risk of burns because metal conducts electricity, he said. Unintended contact of the deactivated electrode tip with the jewelry could cause burns, or current could leak from the electrode cord. A couple of the community hospitals had written policies banning jewelry in surgery. Patients refusing to remove it must sign release forms. Anesthesiologists, however, often won't administer anesthesia if tongue jewelry is in place because of the choking risk. "There's a lack of education and stubbornness" among patients, Balawajder said. "Their concern isn't about safety, it's about the opening closing." That shouldn't be a problem, said Clark, the Zelienople tattoo artist. Plastic studs, fish line and even toothpicks can serve as temporary plugs to retain the openings. He, for one, urges customers to return to his shop if they need to have their piercings removed. Several types of piercings are not meant to be removed for an extended time. Clark, 35, of Evans City, has been tattooing since 1987 and piercing since 1995. He showed the operating room managers the three main types of piercings, making even these seasoned medical professionals a bit squeamish with his descriptions. There's the captive bead ring, which may be found on the nipple, eyebrow, navel or genitalia. Hospital workers can easily grasp the ring with scissors where the bead and ring meet. Squeeze firmly, and the bead pops right off. With barbells, either one or both balls will screw off. Clark wears a stainless steel cone-shaped labret in his lower lip. He unscrews the cone and the other part comes out. Plugs, which are almost always worn in earlobes, can either pop out of the holes or one end can be unscrewed for removal. More of a problem is his implanted stainless steel barbells, one in the back of his left wrist and the other in his right chest. They can't be seen, but they can be felt through the skin. The implant in his wrist is 1 1/2 inches long. Most newer ones are made of Teflon and generally don't interfere with medical equipment. Most are found in areas where there is not a lot of fatty tissue, such as across the forehead, along the breastbone or on the back of the wrist.
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