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Does the type of skin marker prevent marking erasure of surgical-site markings?

Mears SC, Davani AB, Belkoff SM - Eplasty (2009)

Bottom Line: We then subjected one row of markings on each flap to a chlorhexidine-based solution and the other row to an iodine-based solution.No marker was significantly better than another.The development of a better skin marker or a chlorhexidine-based skin preparation solution that does not erase site markings is essential to prevent wrong-site surgeries and promote patient safety.

View Article: PubMed Central - PubMed

Affiliation: International Center for Orthopaedic Advancement, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

ABSTRACT

Objective: Site marking is essential to prevent wrong-site surgery, and there are many skin markers commercially available. However, preoperative skin preparation can erase the site mark, especially when a chlorhexidine skin preparation solution that requires skin scrubbing is used. The purpose of our study was to test the hypothesis that some markers can withstand skin preparation with a chlorhexidine-based skin preparation solution in a manner similar to that of an iodine-based solution.

Methods: On each of 5 cadaveric skin flaps, we made 2 rows of site markings with 9 types of markers. We then subjected one row of markings on each flap to a chlorhexidine-based solution and the other row to an iodine-based solution. A digital photograph was taken before and after each skin preparation. Using imaging software, the contrast in grayscale between the skin and skin marking was measured on each photograph. The effect of the type of marker and skin preparation solution on the difference in grayscale contrast was evaluated by multiple linear regression analysis and significant differences were determined (P < .05).

Results: In all cases, the chlorhexidine-based skin preparation solution significantly decreased the contrast measured. No marker was significantly better than another.

Conclusions: We conclude that all 9 skin markers are significantly erased with the chlorhexidine-based skin preparation solution. The development of a better skin marker or a chlorhexidine-based skin preparation solution that does not erase site markings is essential to prevent wrong-site surgeries and promote patient safety.

No MeSH data available.


Related in: MedlinePlus

Photographs of skin markings before (left) and after (right) the application of a chlorhexidine-based (top) or iodine-based (bottom) skin preparation solution. Marks made with each of the pens from left to right are as follows: Sandel 4-in-1 marker, Waterproof Permanent Marker-Mini, OP-marks mini markers, OP-marks mini max, Accu-line wide body, Sharpie super permanent marker, Securline surgical skin marker no. 1000, HMS Twin-Tip broad, and HMS Twin-Tip fine.
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Figure 1: Photographs of skin markings before (left) and after (right) the application of a chlorhexidine-based (top) or iodine-based (bottom) skin preparation solution. Marks made with each of the pens from left to right are as follows: Sandel 4-in-1 marker, Waterproof Permanent Marker-Mini, OP-marks mini markers, OP-marks mini max, Accu-line wide body, Sharpie super permanent marker, Securline surgical skin marker no. 1000, HMS Twin-Tip broad, and HMS Twin-Tip fine.

Mentions: Five flaps of skin from male white cadavers were obtained from the State Anatomy Board. The skin flaps were warmed to 20°C, and the temperature was measured with a thermocouple (K-type; Omega Engineering, Inc, Stamford, Conn). Nine commercially available pens specifically marketed for skin marking were identified through an Internet search. On each flap of skin, 2 separate rows of marks were made with each of the 9 types of pens: (1) Sandel 4-in-1 marker (skin, wide) (Sandel Medical Industries, LLC, Chatsworth, Calif); (2) Waterproof Permanent Marker-Mini, Fine Tip (Viscot Medical LLC, East Hanover, NJ); (3) OP-marks mini markers (OP-marks, Inc, Bogart, Ga); (4) OP-marks mini max (OP-marks, Inc); (5) Accu-line wide body (Accu-line Products, Inc, Hyannis, Mass); (6) Sharpie super permanent marker (Sanford Corporation, Oak Brook, Ill); (7) Securline surgical skin marker no. 1000 (Precision Dynamics Corporation, San Fernando, Calif); (8) HMS Twin-Tip broad (Hospital Marketing Services Co, Inc, Naugatuck, Conn); and (9) HMS Twin-Tip fine (Hospital Marketing Services Co, Inc). Each mark was a single vertical line that was approximately 50 mm long. Digital photographs (Fig 1) were obtained with a 10.1-megapixel camera (Digital Rebel XTi; Canon USA, Inc, Lake Success, NY), equipped with a 100-mm macro lens (EF 100-mm ƒ/2.8 USM Macro Lens; Canon USA, Inc) and a ring flash (MR-14EX TTL; Canon USA, Inc). Camera settings included a shutter speed of 1/60 seconds and an F-stop value of 4.0.


Does the type of skin marker prevent marking erasure of surgical-site markings?

Mears SC, Davani AB, Belkoff SM - Eplasty (2009)

Photographs of skin markings before (left) and after (right) the application of a chlorhexidine-based (top) or iodine-based (bottom) skin preparation solution. Marks made with each of the pens from left to right are as follows: Sandel 4-in-1 marker, Waterproof Permanent Marker-Mini, OP-marks mini markers, OP-marks mini max, Accu-line wide body, Sharpie super permanent marker, Securline surgical skin marker no. 1000, HMS Twin-Tip broad, and HMS Twin-Tip fine.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2743516&req=5

Figure 1: Photographs of skin markings before (left) and after (right) the application of a chlorhexidine-based (top) or iodine-based (bottom) skin preparation solution. Marks made with each of the pens from left to right are as follows: Sandel 4-in-1 marker, Waterproof Permanent Marker-Mini, OP-marks mini markers, OP-marks mini max, Accu-line wide body, Sharpie super permanent marker, Securline surgical skin marker no. 1000, HMS Twin-Tip broad, and HMS Twin-Tip fine.
Mentions: Five flaps of skin from male white cadavers were obtained from the State Anatomy Board. The skin flaps were warmed to 20°C, and the temperature was measured with a thermocouple (K-type; Omega Engineering, Inc, Stamford, Conn). Nine commercially available pens specifically marketed for skin marking were identified through an Internet search. On each flap of skin, 2 separate rows of marks were made with each of the 9 types of pens: (1) Sandel 4-in-1 marker (skin, wide) (Sandel Medical Industries, LLC, Chatsworth, Calif); (2) Waterproof Permanent Marker-Mini, Fine Tip (Viscot Medical LLC, East Hanover, NJ); (3) OP-marks mini markers (OP-marks, Inc, Bogart, Ga); (4) OP-marks mini max (OP-marks, Inc); (5) Accu-line wide body (Accu-line Products, Inc, Hyannis, Mass); (6) Sharpie super permanent marker (Sanford Corporation, Oak Brook, Ill); (7) Securline surgical skin marker no. 1000 (Precision Dynamics Corporation, San Fernando, Calif); (8) HMS Twin-Tip broad (Hospital Marketing Services Co, Inc, Naugatuck, Conn); and (9) HMS Twin-Tip fine (Hospital Marketing Services Co, Inc). Each mark was a single vertical line that was approximately 50 mm long. Digital photographs (Fig 1) were obtained with a 10.1-megapixel camera (Digital Rebel XTi; Canon USA, Inc, Lake Success, NY), equipped with a 100-mm macro lens (EF 100-mm ƒ/2.8 USM Macro Lens; Canon USA, Inc) and a ring flash (MR-14EX TTL; Canon USA, Inc). Camera settings included a shutter speed of 1/60 seconds and an F-stop value of 4.0.

Bottom Line: We then subjected one row of markings on each flap to a chlorhexidine-based solution and the other row to an iodine-based solution.No marker was significantly better than another.The development of a better skin marker or a chlorhexidine-based skin preparation solution that does not erase site markings is essential to prevent wrong-site surgeries and promote patient safety.

View Article: PubMed Central - PubMed

Affiliation: International Center for Orthopaedic Advancement, The Johns Hopkins University/Johns Hopkins Bayview Medical Center, Baltimore, MD, USA.

ABSTRACT

Objective: Site marking is essential to prevent wrong-site surgery, and there are many skin markers commercially available. However, preoperative skin preparation can erase the site mark, especially when a chlorhexidine skin preparation solution that requires skin scrubbing is used. The purpose of our study was to test the hypothesis that some markers can withstand skin preparation with a chlorhexidine-based skin preparation solution in a manner similar to that of an iodine-based solution.

Methods: On each of 5 cadaveric skin flaps, we made 2 rows of site markings with 9 types of markers. We then subjected one row of markings on each flap to a chlorhexidine-based solution and the other row to an iodine-based solution. A digital photograph was taken before and after each skin preparation. Using imaging software, the contrast in grayscale between the skin and skin marking was measured on each photograph. The effect of the type of marker and skin preparation solution on the difference in grayscale contrast was evaluated by multiple linear regression analysis and significant differences were determined (P < .05).

Results: In all cases, the chlorhexidine-based skin preparation solution significantly decreased the contrast measured. No marker was significantly better than another.

Conclusions: We conclude that all 9 skin markers are significantly erased with the chlorhexidine-based skin preparation solution. The development of a better skin marker or a chlorhexidine-based skin preparation solution that does not erase site markings is essential to prevent wrong-site surgeries and promote patient safety.

No MeSH data available.


Related in: MedlinePlus