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