Our Universal Protocol states that diagnostic/interventional catheter insertion sites (groins,IJ,SC) do not need to be marked prior to percutaneous procedures. The protocol states that the number and size of sheaths/catheters inserted, and their placement, varies from patient to patient and physician to physician. It is my understanding that this satisfies TJC requirements.

For device procedures (implants, revisions, lead repos/additions, etc) we do mark the intended incision site. We use a sterile surgical marker (not a regular "magic marker"). The mark frequently washes off during the surgical prep, but can be reapplied by qualified personnel using a new sterile marker (the hospital has trialed numerous markers and so far we have not found any that does not wash off). The site markinig is done by the implanting physician prior to the patient entering the procedure room and is to be visible after draping the patient for the procedure.

TJC guidelines further state that the site mark must be removed following the procedure (to avoid confusion if further interventions are needed), so that complicates the issue further("sharpie" markers do not wash off with the prep, but are also difficult to remove after the procedure).

Interestingly, a recent study showed that the only marker that did not encourage bacterial growth was "sharpie" markers. However, experts fear that permanent markers could "tattoo" the skin, especially in infants/young children or the elderly.