Which part of the inguinal region should be clipped before a groin arterial or venous access procedure?

Hair Clipping for Groin Surgical Access

If hair removal is necessary for groin procedures, clip (do not shave) the hair over the entire inguinal region extending from the anterior superior iliac spine superiorly, 15-20 cm inferiorly along the thigh, and medially from the pubic tubercle—but clipping should be performed only if needed for surgical field visualization, as routine hair removal does not reduce infection rates. 1

Evidence-Based Approach to Hair Removal

Primary Recommendation: Avoid Routine Hair Removal

• Routine removal of pubic/groin hair does not decrease surgical site infection (SSI) rates and should be avoided unless necessary for surgical field visualization 1
• A Cochrane review demonstrated lack of evidence supporting hair removal for infection prevention 1
• Small studies comparing perineal shaving with no hair removal showed no difference in infection rates 1

When Hair Removal Is Necessary

Method: Clipping Over Shaving

• If hair must be removed, clipping should be used instead of shaving to reduce SSI rates 1, 2
• Clipping is associated with lower infection rates compared to razors 2
• This is a high-quality recommendation despite the overall evidence being of lower quality 1

Anatomical Boundaries for Groin Access

The clipping field should encompass the standard inguinal lymph node dissection boundaries, which define the surgical field for groin procedures 3:

• Superior border: From the external inguinal ring extending laterally to the anterior superior iliac spine 3
• Lateral border: Vertical line from the anterior superior iliac spine extending 20 cm inferiorly 3
• Medial border: Line drawn from the pubic tubercle extending 15 cm downward 3
• Inferior border: Should extend to at least the intertrochanteric line of the femur or 1.5-2 cm distal to the saphenofemoral junction 4

Critical Anatomical Considerations

Avoid Contaminated Sites

• Select insertion sites that are not contaminated or potentially contaminated (e.g., burned or infected skin, areas adjacent to tracheostomy or open surgical wounds) 5, 6
• The inguinal area is considered a potentially contaminated site for central venous access, though this can be mitigated with proper technique and tunneling 5, 6, 7

Vascular Anatomy Implications

• The main cutaneous vascularization of the femoral triangle comes from three arteries: superficial circumflex iliac, superficial epigastric, and external pudendal 8
• These vessels typically originate approximately 1.5 cm below the inguinal ligament 8
• Proper hair clipping boundaries help ensure adequate visualization while minimizing trauma to these structures 8

Common Pitfalls to Avoid

• Do not shave: Shaving creates microabrasions that increase SSI risk compared to clipping 1, 2
• Do not clip unnecessarily: Only remove hair when it genuinely interferes with surgical field visualization 1
• Do not use inadequate field preparation: If clipping is performed, ensure the entire surgical field as defined above is addressed to avoid intraoperative extension of the prep area 3