Keeping The Operating Patient Safe By Accounting For All Items Used During Surgery
Picture: Accounting for All Illustration |
Keeping The Operating Patient Safe By Accounting For All Items Used During Surgery. Most surgical patients don’t know that before their operation begins, a laborious process called an instrument count is down.
This procedure includes counting each piece of sterile
equipment that will be used during the procedure.
The count must be done by a registered nurse and the sterile
nurse or scrub nurse. (In some jurisdictions, a scrub nurse can be unlicensed
personnel called a scrub technician.)
As each tray of instruments is opened unto the sterile
field, the two nurses will compare the contents with a paper sheet which comes
with the tray. Each and every piece within the tray will be counted.
All sterile supplies are counted. This includes sponges,
which are usually wrapped together in groups of five or ten. Sponges can be
large gauze bundles, or 4”X 8” rectangles of gauze.
Also, small gauze pieces which are bound together into a
peanut shape and called peanuts are counted. Larger balls of cotton stuffed
gauze pillows are counted.
Sutures are counted and divided by types. Needles without
sutures, or free needles, are counted separately. All of these supplies are
possible foreign objects that can be left behind in a body cavity.
There is a debate about which surgeries are at risk for lost
objects. In most states, the standard is to count instruments, sponges and
sutures when a body cavity is opened.
A cavity would be the head, abdomen or chest. There is also
a risk for left behind sponges in some gynecological surgery where instruments
are inserted into the uterus. So sponges and needles are counted for those
surgeries.
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Keeping The Operating Patient Safe By Accounting For All Items Used During Surgery Nex
Major, but minimally invasive surgeries, such as
laparoscopic gastric bypass, laparoscopic nissen fundalpication, laparoscopic
nephrectomy, or laparoscopic assisted vaginal hysterectomy are surgeries in
which multiple, small puncture wounds are made in which specially designed
sheaths are inserted and then the scope and instruments access the cavity
through the sheaths.
Except for thoracic endoscopic surgeries, utilizing a scope
requires the body cavity to be expanded in some way.
Laparoscopic surgeries use carbon dioxide gas, arthroscopic,
genitourinary and gynecological surgeries use fluid. The sheaths prevent the gases or fluids from escaping from the
cavity.
Technically, it is hard to imagine how anything could be
left behind in a surgery done with a scope. However, small screws, jaws to
graspers, and parts of staple guns have all been left behind in patients,
require additional surgeries and time and money lost.
Ultimately it is the responsibility of the surgeon to know
if the instrument he pulls out of a patient is complete, but part of the team
mentality is that the nurses must also know the construction of an instrument
so that if something is missing, it can be accounted for.
An example of this is something that I experienced; I was
scrubbed on a back surgery and one of the bone instruments I gave the doctor
was missing a screw.
It didn’t affect it’s operation, but I didn’t know if it was missing before I gave it to the doctor or not. It required an xray during the surgery to see if the screw was somewhere within the patient’s back incision. It was not. (*)