New York State Surgical and Invasive Procedure Protocol (NYSSIPP) - Frequently Asked Questions

If someone other than an attending physician, dentist, or podiatrist is performing a surgery/procedure, such as a physician assistant (PA)/nurse practitioner (NP)/resident/fellow, and they are an active participant in the surgery/procedure and they are present at the start of the surgery/procedure, then they can mark the site using their own initials.

At what point should the site marking occur?

Can the patient receive sedation for the regional block prior to the surgeon initialing the patient's surgical site?

In the case of multiple radiation treatments, does the site have to be marked at each visit?

Do labia and/or ovarian sites need to be marked?

How do you mark internal organs/sites if you do a procedure laproscopically? Example: the left ovary.

For multiple surgical procedures, is it permissible for the surgeon doing the second procedure to mark the site after completion of the first procedure, prior to the re-draping?

Do all surgeons who are performing one of multiple surgical interventions scheduled in one day, have to mark their own sites prior to the first procedure?

Since the intended level for injection is not always possible for intrathecal analgesia and epidural analgesia during labor, must skin marking be done with the intended level?

If a surgical procedure is bilateral, for example, bilateral myringotomy with insertion of tubes or bilateral inguinal hernia repair, does the surgeon need to initial both the right and left side, or does the bilateral nature of the procedure eliminate the question of laterality?

In what circumstance would it be acceptable to sedate and prepare a patient for the operating room prior to the surgeon marking the site?

When there is a remote incision that is not the final surgical site, e.g., a groin incision for an endoscopic carotid endarterectomy, which area should be marked?

If a patient is undergoing a left colon resection or a right hemicolectomy, are the physicians required to mark pre-operatively, reaffirm at the "time out," or both?

Fluoroscopic procedures are particularly challenging to reduce wrong side intervention. Does the state have any recommendations for these challenging cases?

Has any facility shared information about a pen that does not disappear after prepping or that is visible on dark skin?

What is the intent for marking the nerve root? The anesthesiologist does the block at the time they see the patient. The process for doing nerve root blocks is that they are done by the anesthesiologist at the time the patient is seen by the anesthesiologist. They are not marked and then done later. For example, the anesthesiologist would see the patient, mark their initials, then insert the needle.

Can a regional block be performed as in epidural, interscalene, axillary, popliteal or fossa block before the patient has talked to the surgeon?

For carotid angiogram, when an intended site is determined, do you have any solutions or recommendations on how to mark the site/side since access can be obtained from the right or left groin and the carotid area is also draped?

Wrist Band

When is a special purpose alternative wristband appropriate for the patient?

When is marking not required?

What are hospitals using for the Special Purpose wristband? Is there any information available on purchasing?

Time Out

For procedures done outside of the operating room, is it mandated that the "time out" be done with another person?

If the patient is having an upper endoscopy and colonoscopy done by the same physician, what is the criterion for the "time out"?

Is a "time out" required for Computerized Tomagraphy (CT) procedures with contrast?

A patient having a surgical procedure is brought into the operating room with an anesthesiologist, two RNs, and a technician present. The Anesthesiologist performs a spinal anesthetic. The surgeon then comes into the room to perform the surgical procedure. Are two "time out" procedures required, one before the spinal (with the anesthesiologist and staff in the room at that time) and one before the surgery with the entire team?

Does the state consider a Papanicolaou (Pap) test to fall under New York State Surgical and Invasive Procedure Protocol (NYSSIPP)? [Revised December 12, 2008]

Does the surgeon need to be present during the needle localization for a biopsy?

Questions or comments: obs@health.ny.gov

Revised: July 2024

Department of Health

General Information

Current Issues/Info

Help

Language Assistance