Storage and use of nail varnish removal products in theatres
Through its regular review of recorded patient safety incidents, the NHS England National Patient Safety Team identified an issue related to administration of acetone instead of the intended sodium citrate to a patient being prepared for caesarean section.
Acetone has been required in anaesthetic rooms/theatres for the removal of nail varnish/gel to ensure accurate oxygen saturation readings. Sodium citrate is often given before caesarean section as a prophylaxis against acid aspiration during general anaesthesia.
The error was identified as a ‘look alike sound alike’ (LASA) type error as both solutions were contained in glass amber bottles of similar size, and the sodium citrate solution was required quickly.
The issue was discussed with the Safe Anaesthesia Liaison Group (SALG). Following consideration, SALG’s opinion was that the presence of nail varnish or gel does not affect oxygen readings during anaesthesia and sedation to a clinically significant degree. Presence of nail gels has been shown to have a small effect on pulse oximetry readings, which is within the accuracy range of pulse oximeters of +/- 2%.1 In theatres, arterial blood gas tests are readily available and used if there is a need for more accurate assessment of a patient’s oxygen status than can be provided by pulse oximetry. On a risk versus benefit assessment, the recommendation from SALG is that acetone and other nail varnish removal products should be removed from anaesthetic rooms, to eliminate the possibility of this error occurring again.
Reference
- Aggarwal, AN et al. Impact of Fingernail Polish on Pulse Oximetry Measurements: A Systematic Review. Respir. Care. 68(9). Pp. 1271-80
July, 2025