RETAINED FOREIGN BODY
• In this case, a retained foreign body is an
object, typically a surgical instrument, gauze
or sponge, that has been left inside a patient
during the surgery and not accounted for in
the count at the end.
• In 2009, the occurrence rate was “0.0031% or
1 in 32,672 cases” (Shah & Lander, 2009).
RISK FACTORS FOR RETAINED FOREIGN BODIES
• “Risk factors included a change in nursing personnel during
surgery, excessive loss of blood, lack of complete count of
sponges and instruments, fatigue of the surgical team from
the lengthiness or lateness of the procedure and urgency of
the surgery, obesity, unexpected intra-operative
developments, the involvement of multiple surgical teams,
and the performance of more than 1 major procedure at a
time”(McLeod & Bohnen, 2004).
• The 3 most important factors identified were: “emergency
surgery, unplanned change in the operation, and body
mass index” (McLeod & Bohnen, 2004).
COUNTING
During an operation, the
counting of the instruments,
gauze, and sponges is the
duty of the circulating RN.
COUNTING
• The hospital’s Standards of Care as well as the
Association of periOperative Registered
Nurses (AORN) Recommended Standards of
Practice provide an outline for the procedures
involved in counting instruments and other
items for surgery.
COUNTING
• Only sponges detectable with an X-ray can be
used and should be counted once at the
beginning and twice at the end of the surgical
procedure.
• Instrumentation should be counted for open
cavity procedures, once at the beginning and
once at the end of a surgical procedure.
• If a sponge or instrument is unaccounted for in
the final count, a radiological exam and manual
exploration should be performed.
(Erickson, 2003)
COUNTING
• One of the difficulties involved in counting is
that there is no “standard” surgical kit.
• Instruments, sponges, gauze all vary based on
the surgery being conducted.
• They can be of all shapes, sizes, and amounts.
• Like in any setting, small objects or a large
quantity of objects can be difficult to count
without having an error.
THEY CAN BE ANYWHERE
Pie chart was made from figures obtained from a study of thirty cases by Lincourt et. al., 2007.
THEY CAN BE ANYWHERE
• Retained Foreign Bodies seem to appear more
often in the Abdominal and Thoracic cavities
than anywhere else in the body.
• This can possibly be because more items, like
sponges, tend to be used in these areas.
• But, it is possible to be found in any area of
the body that has been operated on.
SYMPTOMS OF A RETAINED FOREIGN BODY
•
•
•
•
•
Infection
Sepsis
Bowel Perforation or Obstruction
Internal Bleeding
Abscesses
• It is possible to have a retained foreign body
and remain asymptomatic.
POSSIBLE SOLUTIONS
• Have at least one other person than just the
circulating nurse count!
– I.E. scrub nurse
POSSIBLE SOLUTIONS
• Formulate a detailed checklist of everything
that will be used!
POSSIBLE SOLUTIONS
• There are specialized trays, but they can be
further advanced.
MY SOLUTION
MY SOLUTION
MY SOLUTION
FEATURES
• Tray has inlays in the shape of the instrument
with notches to pick them out.
• Would have bowls for sponges or gauze.
• Counts the amount of objects present based
on weight that has an adjustable tolerance to
account for soiled materials
• Has an “on/tare” function to set for prior to
surgery.
FEATURES
• LED lights will be lit Green when all are
accounted for, Red when missing something,
Blue when there is more than what originally
was there.
• Digital Liquid Crystal Counter built in as back
up to tell an exact amount present.
• Will be made of materials that allow it to be
autoclavable.
WORKS CITED
• Erickson, S. (2003). O.R. Left behind. Counting surgical
instruments reduces medical errors. Materials
Management In Health Care, 12(7), 32-34.
• Lincourt, A. E., Harrell, A., Cristiano, J., Sechrist, C., Kercher,
K., & Heniford, B. T. (2007). Retained foreign bodies after
surgery. The Journal Of Surgical Research, 138(2), 170-174.
• McLeod, R. S., & Bohnen, J. M. A. (2004). Canadian
Association of General Surgeons Evidence Based Reviews in
Surgery. 9. Risk factors for retained foreign bodies after
surgery. [Article]. Canadian Journal of Surgery, 47(1), 57-59.
• Shah, R. K., & Lander, L. (2009). Retained foreign bodies
during surgery in pediatric patients: a national perspective.
Journal Of Pediatric Surgery, 44(4), 738-742.