14

PerioperotiveConsiderotions

proiection of the potient in Surgery

(e.9., electrosurgical unit or tourniquets) is invaluable. An example of the suggested format for the Operative

thetics administered by or at the direition of the

surgeon and records all pertinent times. COUNTING PROCEDURE
Each institution qhould have its own written policy and. procedure regarding the counting of sponges, sharps,

In addition, the JCAHO requires an anesthesia record for each operative procedure, completed by the anesthetist. According to hospital policy, when an an-esthetist is not present during the procedrrre, the cir_ culator documents the patient's vitaLsigns, blood pressure, and the names and amounts of diugs and anes-

Record is shown on pp. 8-9.

If the count remalns rncorrect, the circulator alerts the surseon who wilt i".p;;;lh;-puii!rrt,. wound for the missing item. If-the lt"* i. iro.pitut policy must be followed (usually t" i;.I"d";mediate "oTfl""i!i, x-ray examination), and an incident must
ately.
filed.

befote wound closure begi;s, ;il; skin ctosure is initiated. ";d 9. An additional count is taken prior to the closure of - an organ within a cavity (e.g., uterus o" bhdJe"j. Incorrect closure counts ,"".t"u" ;;il;r"d immedi_

8. Counts are taken before beginning the procedure,

""po"i

be

Sponge Counts

observed when counting all objecis potentially subject to inadvertent seclusion in a wound: 1. All items are counted initially by the circulator and the scrub person together (aioud) as the scrub person touches eath item. 2. The number (count) of each type of item is immediately recorded by the circulator.

and instruments. The following guideiinei should be

3.

If

count,

there is any uncertainty regarding the initial

it is repeated.

4. As additional items (e.g., sponges or needles) are

scrub person counts the item(s) with the circulator, who adds the count to the record and initials
added to the sterile field during the procedure, the

it. 5. Nothing (including laundry, trash, instruments, final count is acknowledged to be cbrrect. 6. Whenever there is a change of'team members,

size sponge is kepr separate. Ail ,p;;;";;;"0 *itt i. the wound must be x_ray detectabi". i-;;;"tectable sponges are never used,for dressings, and dressing sponges are never used to dry the surgical fieldl Sponges are discarded following L;l; ;;i;il ii;;; receptacle. Soiled sponges are counted by the scrub person and the circulator together and thei b"es"a i" i__ pervious. plastic.bags according to -p""j6t""*in"a u numDer_(usually rn sets of 5 or 10). When the counts take,n, the scrub nurse,counts the .p";;;;;;rding are to type, beginning with the s_ponges th" fi;ki and pro_ c99{ins to luli" lhe sponges on tire bick "; off the field. The ciicularor i"f;";. th; ""Jifr"., tt o*" !.,ig;o., of thu results of the counts. Shorp Counts

All sponges. neurological sponges (cottonoids), and soft goods (e.g.. umbilicaftap"r) u.i.o,rrrt"i. euf,f, typ" u.ro

and sponges) ma5r be removed from an operating room while a procedure is in progress until the
a

All

count is taken7. When an incorrectly numbered package of items is dispensed, the items should be Uaggea, hbeled a'ccordingly, set aside, and not in the "e"oided count.

:"ty"" packs may be counted according toine nrmUe, some hospitals require f :::::,.ulC.";each needle_counted each package to oe opened and
a.needle magnet or counter pad to facitiiate countlng. All parts of any needle broken a""i"gl p""^""a"Ie must
needles, btades, and other sharps

needles, knife blades, electrosurgical blades, and any other sharps are counted. N""[i"r- i" Lultiple-

,il;ki il;;ined

individually. lised

on