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Title: Keeping The Operating Patient Safe By Accounting For All Items Used During Surge ry Word Count:

537 Summary: Most surgical patients don t know that before their operation begins, a laborious process called an instrument count is down. This procedure includes counting eac h piece of sterile equipment that will be used during the procedure. The count m ust 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 technic ian.) As each tray of instruments is opened unto the sterile field, the two... Keywords: medical equipment, medical supplies Article Body: Most surgical patients don t know that before their operation begins, a laborious process called an instrument count is down. This procedure includes counting eac h piece of sterile equipment that will be used during the procedure. The count m ust 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 technic ian.) As each tray of instruments is opened unto the sterile field, the two nurses wil l compare the contents with a paper sheet which comes with the tray. Each and ev ery piece within the tray will be counted. All sterile supplies are counted. This includes sponges, which are usually wrapp ed 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 pe anut shape and called peanuts are counted. Larger balls of cotton stuffed gauze pillows are counted. Sutures are counted and divided by types. Needles without s utures, or free needles, are counted separately. All of these supplies are possi ble 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 st ates, the standard is to count instruments, sponges and sutures when a body cavi ty 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 ins erted into the uterus. So sponges and needles are counted for those surgeries. Major, but minimally invasive surgeries, such as laparoscopic gastric bypass, la paroscopic nissen fundalpication, laparoscopic nephrectomy, or laparoscopic assi sted vaginal hysterectomy are surgeries in which multiple, small puncture wounds are made in which specially designed sheaths are inserted and then the scope an d instruments access the cavity through the sheaths. Except for thoracic endosco pic 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 surger y done with a scope. However, small screws, jaws to graspers, and parts of stapl

e guns have all been left behind in patients, require additional surgeries and t ime and money lost. Ultimately it is the responsibility of the surgeon to know i f the instrument he pulls out of a patient is complete, but part of the team men tality is that the nurses must also know the construction of an instrument so th at if something is missing, it can be accounted for. An example of this is something that I experienced; I was scrubbed on a back sur gery and one of the bone instruments I gave the doctor was missing a screw. It d idn t affect it s operation, but I didn t know if it was missing before I gave it to t he 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. The web sites below, have much more information on these subjects...

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