Underwire bras in surgery

[BridgetJones]

So I had a patient come in today for minor abdominal surgery and she was still wearing her bra. After she was asleep I took it off to be on the safe side (I know metal conducts electricity and we were going to use the Bovie), but I was wondering if any of you know whether it's technically necessary to take it off. In theory, if you put the grounding pad near the incision site, wouldn't the energy flow through that and out of the patient? I think I will continue my no bra policy just to be safe, but I have see anesthesiologists leave facial piercings in....

[Argo]

The issue with the bra is the space between the metal and the skin. The space allows do arching of electricity. With rings piercings that are tight to the skin or taped you will not get the arching.

[sharkdiver]

Electricity can't flow without a return path to ground and will follow the path of least resistance. That's the function of the bovie pad - to provide a return path to ground. The large size of the pad insures a low impedance path with a large surface area to keep the current density to a minimum.

The only way for the underwire to possibly cause an arc would be for the wire itself to come into direct contact with either the scalpel/electrocautery tool or a direct path to earth ground, and in the latter case it would have to be less resistance than the bovie pad to have any effect. Since the wire is contained in and electrically insulated by the cloth material of the bra, and the area is further covered by the surgical drape, there is virtually no possibility of this occurring. It's impossible to have any kind of arcing or current flow without a complete electrical circuit.

[BridgetJones]

Electricity can't flow without a return path to ground and will follow the path of least resistance. That's the function of the bovie pad - to provide a return path to ground. The large size of the pad insures a low impedance path with a large surface area to keep the current density to a minimum.

The only way for the underwire to possibly cause an arc would be for the wire itself to come into direct contact with either the scalpel/electrocautery tool or a direct path to earth ground, and in the latter case it would have to be less resistance than the bovie pad to have any effect. Since the wire is contained in and electrically insulated by the cloth material of the bra, and the area is further covered by the surgical drape, there is virtually no possibility of this occurring. It's impossible to have any kind of arcing or current flow without a complete electrical circuit.

Thanks, that made a lot of sense! I had forgotten about the "path of least resistance" principle. It's been a while since high school physical science. ;-)

[mactheknife]

I would be worried about the electricity aspect and also the possible risk of infection. How do you know the bra is clean?

I would definately remove any item of clothing that a patient is wearing in the OR.

[Argo]

Sharkdiver, the problem is that your leaving everything to theory. Reality and theory are two different things unfortunately. I have seen arching burns in reality that killed the theory stuff for me.