This is just one of those nightmares that you never think will happen to you..
I was scrubbed for a lap fundoplication yesterday. Haven't done one in a while, and found it a bit hard to keep up doing the suturing. A suture was missing when i did the final count. The surgeon was convinced it was not left in the patient. At the time i didn't believe it was in the patient either, i believed at the time that i had lost it on my set up, or it flung off the laparoscopic needleholder (which can happen because they release quite violently sometimes). We searched high and low, got the senior RN in and just keep looking for it. I believed it was my incompetence in handling sutures and the surgeon quite readily went along with it.
As per protocol we recommended an on table x-ray. This was suggested several times by myself, the scout nurse, the floor senior. the surgeon said do it out in recovery, the floor senior agreed with this. We all went home believing it was not in the patient.
Found out today at work that the suture WAS detected on the x-ray. They are now waiting to be reopened to have it removed.
At the moment i am so mad for doubting myself. Why should i automatically assume that i lost the damned thing?
I am also disappointed in myself for not keeping a more vigilant track of my sutures. I really should have known if i didn't get one back before handing up another.
I am furious with the floor senior RN for giving in so easily to the surgeons demands to x-ray patient out in recovery.
And i'm mad at the surgeon for assuming it was my incompetence not his that the suture count was incorrect and for not doing an x-ray on the table
I have been told that i'm not to blame for any of this. I still feel so guilty though. Now the poor patient has to have another procedure because of all of this.
And to be honest i'm quite worried here. We are doing the same procedure tomorrow with the same surgeon. He is known for being a nasty piece of work and am concerned about what will happen. I'm still emotional about all of this and don't want to lose it and scream my head off at him.
Under NO circumstances should the patient be taken to the PACU to find the needle,sponge, instrument or anything else that was reported missing on xray. The doc was told by the nurses that the item missing could not be located. None of the docs think that it could ever be their fault, and a majority of time it is! This results in another surgery by the patient, increase medical bills, etc. and this incident should be reported to risk management at once. The hospital should "eat" this extra unnecessary expense and hope that the patient does not file a lawsuit, as this incident falls well below the standard of care for surgeons. A smart NM would have said "Doctor X, this patient is not being extubated or removed from this table until Xray is done and read by a radiologist. If you feel that you must scream and stomp your feet, then be my guest in the doctor's lounge. We'll have the radiologist call you in the doctor's lounge after he calls us!"
Last edit by ebear on Jan 10, '08
Well, in my particular hospital, the staff is so anal about counts and do a damn god job in being thorough about them. It is usually the surgeons who say "WELL, IT'S NOT IN HERE!!" On xray, There it sits--right where he placed it! "Oh! I forgot about putting that there to mark so and so"...
In my hospital, anyway, the surgeon cannot leave the OR until item is found, and the sterile field remains set up and not contaminated. Often the docs are angry about this policy, but it saves a lot of time and expense, as well as subjecting to patient to more apprehension and another induction.
Last edit by ebear on Jan 10, '08