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