Mr. Harry the Excessive Hair Patient

Been there,done that, ASN, RN · May 23, 2016

Surgical consent involves consent for shaving not related to the procedure? They have no recourse if they wake up with their eyebrows gone or a Mr. Clean scalp after a knee replacement?
My toes are kinda fuzzy (being part hobbit and all), so I'll be sure to notify the surgical team if I ever need to go under.

Perhaps you missed this from kalycat:

"Former circulator here who did my share of abdominal prep, as well as lady partsl prep prior to hysterectomies.

Just regarding the abdominal surgery....oftentimes patients are shaved if there is *any chance* that the incision and surgical site will have to be extended emergently. There are specific AORN guidelines regarding how much skin must be prepped around the actual incision. Depending on what surgery and the surgical approach, even if at first glance it appears that the pubic hair is 6 inches out of the way, it still must be trimmed with electric clippers, the loose hair blotted up with an adhesive mit, and then prepped with surgical scrub or paint. Just for reference, an open heart skin prep is from neck to toes down both sides of the body due to high risk of infection. (We don't usually have to shave the entire body first, but it has happened.) Even for robotic or laparoscopic surgeries, our surgeons prefer to prep as if we would need to "go open".... And it pays to do so in terms of patient safety and post op infections.

It is unfortunate that the patient in question didn't have this covered during education and consenting for the procedure. Shaving prior to skin prep in the OR is a major chore due to all the loose hair. In most cases it is not a task to be undertaken lightly, and skin irritation is a definite risk post op. Also, despite the fact that hair is natural and serves a purpose, it is still indeed considered dirty in the context of a surgical field. Not everyone needs to be shaved, but there are guidelines for that too.

Just thought I would throw that out there."

Shaving before a surgical procedure is a necessary part of the prep. It has nothing to do with sexual assault.

kalycat, BSN, RN · May 23, 2016

I was just using open heart as an example since the actual incisions are usually just the sternotomy and a leg site... We still do both legs and the entire torso, up the neck, etc.

I wasn't picturing a Brazilian type hair removal on Calivianya's patient. I figured they shaved the mons pubis and maybe down to where the labia start to divide. That was our usual move for abdominal cases that had the potential to go open. Much depends on the surgeon, preference, density of hair (can the chloroprep fully reach the skin?) etc. so there's variability in the whole shave/not shave algorithm.

It truly is a royal pain in the hair to shave in the OR so I tend to believe that there was a solid reason for the patient's missing pelt.

Definitely tell them about your toes, hobbit, for any orthopedic procedure or open heart. For ortho we even prep *between* all toes and the bottoms of the feet... There's a whole procedure requiring strong muscles for a total joint circumferential prep that involves the entirety of both legs.

For what it's worth yes, the majority of the surgeons I worked with were excellent about educating the patient on the possibility of body hair removal when we did the final consent prior to procedure.

For the record I am a traditional soap and water (or suitable cleanser) girl when providing peri care at the bedside on the floor. I have had to shave many chests for tele leads. One guy asked for a specific pattern in his chest hair. He and his wife had a good laugh about it actually. I would never shave someone on a whim or if it wasn't medically necessary.

Ellie G · May 24, 2016

I feel that is a very personal thing to do. I would never do such a thing without permission from the patient, spouse or POA

Horseshoe, BSN, RN · May 24, 2016

Now that I think about it, I was shaved before my emergent c-sections. I don't remember being asked about it, I don't remember them even doing it (not surprising, since I had an epidural in). But I do remember noticing it afterward. Of course, with a low incision, it was certainly necessary to do that as part of the prep.

roser13, ASN, RN · May 24, 2016

I feel that is a very personal thing to do. I would never do such a thing without permission from the patient, spouse or POA

I'm guessing that you would if it was part of the OR protocol that you were obliged to follow.

jesserpie · May 24, 2016

If that were me, I would feel utterly violated. I would raise heck.

AMEN

Think about this, what if it were someone underage? What if it was your teenage daughter? Would that change your opinion of the matter??

roser13, ASN, RN · May 24, 2016

If that were me, I would feel utterly violated. I would raise heck.
AMEN
Think about this, what if it were someone underage? What if it was your teenage daughter? Would that change your opinion of the matter??

If it was my teenage daughter and it was necessary for her health and safety during her procedure, or even her potential health and safety if the case turned open, then have at it.

chloe8100 · May 25, 2016

Hahaha! Oh dear...I had a pt with chronic diarrhea who had hair about, oh, I don't know, 15 ft long. She was also a quad. REFUSED to have her nether regions groomed in any fashion...brief changes were FUN.

chloe8100 · May 25, 2016

I too, can definitely understand the temptation. I wouldn't do it, but it would be a struggle. I have to fight back rubbing my hands together when asked to assist with I&D of an abscess. It's sick, but I loooove popping stuff. Don't judge me...lol :nailbiting:

Farawyn · May 25, 2016

I too, can definitely understand the temptation. I wouldn't do it, but it would be a struggle. I have to fight back rubbing my hands together when asked to assist with I&D of an abscess. It's sick, but I loooove popping stuff. Don't judge me...lol

Judge you? I want to hang out with you! :blink:

chloe8100 · May 25, 2016

I find this juvenile. OP, honestly. How old are you? Using correct grammar would go far in your credibility as well. Edited to add: It is disturbing that a nurse assistant would find it appropriate to have such discussions. I can understand if one genuinely wanted to learn if it was proper procedure, but this just sounds like mockery of a patient, which is not okay and is unprofessional.

...But it would be okay for nurses to have these discussions? Doctors? I've spent my share of time in the ED, and in the break room, we ALL (READ: EVERYBODY) commiserate. It falls under the heading of "shop talk". It's not so much mocking the patient as it is having a sense of humor about the plethora of absurd and CRAZY things we see day in and day out.

In what other career does one get to experience the joy of having their face farted in, or discuss size, color, consistency, and frequency of bowel movements with people one has just met? In what other career does one have the opportunity to be bitten, kicked, struck, etc., all while trying to save a life? We have to laugh at this stuff, or we will go insane.

NotAllWhoWandeRN, ASN, RN · May 26, 2016

I too, can definitely understand the temptation. I wouldn't do it, but it would be a struggle. I have to fight back rubbing my hands together when asked to assist with I&D of an abscess. It's sick, but I loooove popping stuff. Don't judge me...lol

So let me tell you about this infected stage 4 pressure ulcer on a greater trochanter that opened up during my wound care days...