What happens if you leave a sponge?

  1. I've been searching the web and can't find the answer. We've all heard of sponges getting left behind. So what would be the s/s of a sponge left behind? I have read it can take years to become apparent but I can't find a single thing on how this type of thing becomes apparent. Anyone seen it in real life?

    Mommy
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  2. 22 Comments

  3. by   UM Review RN
    It's called a gossypiboma. Here's a link describing a case with discussion highlighted below:
    Gossypiboma


    Discussion: Gossypiboma is the technical term for a retained surgical sponge. It is derived from the Latin "gossypium" (cotton) and the Swahili "boma" (place of concealment). The presentation of gossypiboma is variable. The acute presentation typically consists of local inflammatory reaction. If it becomes infected, an abscess forms. The differential diagnosis in such cases includes post-operative collection, hematoma, and non-foreign body abscess. A delayed presentation, however, may develop months or even years after the initial surgery. Adhesions and encapsulation are common, and the lesion may present as a mass or subacute intestinal obstruction. In these cases, the differential diagnosis typically includes tumor.
  4. by   Mommy TeleRN
    Thanks Ang... I didn't know there was a fancy word for it! lol I was able to google that word and learn more. Seems like, if I understood correctly, it can also try to work the sponge out of the body and cause a fistula/tunneling. Yikes!

    I know NOTHING about surgery..hoping to shadow on one in a few weeks just to gain an overall experience. What does a sponge look like? I'm picturing like a gauze sponge but I know it's not like that. How many are used in a typical surgery? I know they have to count and recount.

    Surgery sounds so interesting...yet so does ICU...yet so does ER...yet so does nursery/postpartum/NICU... maybe one of these days I'll figure out what kind of nurse I want to be when I grow up

    Mommy
    Last edit by Mommy TeleRN on Dec 2, '06 : Reason: too groggy to type coherently lol
  5. by   UM Review RN
    Quote from Mommy Nurse2b
    Thanks Ang... I didn't know there was a fancy word for it! lol I was able to google that word and learn more. Seems like, if I understood correctly, it can also try to work the sponge out of the body and cause a fistula/tunneling. Yikes!

    I know NOTHING about surgery..hoping to shadow on one in a few weeks just to gain an overall experience. What does a sponge look like? I'm picturing like a gauze sponge but I know it's not like that. How many are used in a typical surgery? I know they have to count and recount.

    Surgery sounds so interesting...yet so does ICU...yet so does ER...yet so does nursery/postpartum/NICU... maybe one of these days I'll figure out what kind of nurse I want to be when I grow up

    Mommy

    They just look like 4X4 gauze pads. There's a picture of one in the link provided (under Gross Pathology specimen). I won't post the picture as it's kinda gross, but it's the bottom row of pictures. They opened up the thing so you can pretty easily tell what it is.
  6. by   Mommy TeleRN
    I didn't see a link... and I was looking forward to seeing the gross stuff lol.
  7. by   ortess1971
    I have seen a sponge get left in a patient-usually when this happens, the count has been incorrect and the surgeon will have refused an X-ray(they do this when the count is wrong, and you can't find it after looking for it in the sterile field and the floor etc. The sponges have a radiopaque strip running through them). I have also had surgeons keep closing after you've informed them that the count is wrong. This is where you get the higher ups involved and you document that the surgeon was notified of an incorrect count and proceeded anyway. The instance I witnessed was when I was second scrubbed on a AAA, we were missing a large sponge and told the doctor that it was missing. He very quickly ran his hand around the cavity and said "you people must have it somewhere, it's not in the wound" He also refused an X-ray. They ended up having to bring the guy back to retrieve the large sponge that had been tucked up near his spleen.:angryfire . Hopefully, when things like this happen, you have managers and administration that back you up when you are advocating for the PT and following proper procedure! People can get very sick from this(ie sepsis)
    Last edit by ortess1971 on Dec 2, '06
  8. by   UM Review RN
    Here's a link describing a case with discussion highlighted below:
    Gossypiboma.
    Click on the blue underlined word. That's the link.
  9. by   BSNtobe2009
    Oh hey, you don't need to look that up...that's easy.

    You get sued



    Put that on a test and see if you get an A.
  10. by   Marie_LPN, RN
    Quote from Mommy Nurse2b
    Thanks Ang... I didn't know there was a fancy word for it! lol I was able to google that word and learn more. Seems like, if I understood correctly, it can also try to work the sponge out of the body and cause a fistula/tunneling. Yikes!

    I know NOTHING about surgery..hoping to shadow on one in a few weeks just to gain an overall experience. What does a sponge look like? I'm picturing like a gauze sponge but I know it's not like that. How many are used in a typical surgery? I know they have to count and recount.

    Surgery sounds so interesting...yet so does ICU...yet so does ER...yet so does nursery/postpartum/NICU... maybe one of these days I'll figure out what kind of nurse I want to be when I grow up

    Mommy
    Raytecs are the 4 x 4 and 4 x 8 gauze sponges. They look like your typical gauze sponges for dressings, except that they have a blue X-ray detectable stripe woven through them. When a pt. would be X-rayed, only the stripe shows up in the film.

    Lap sponges (4 x 18, 18 x 18, and 18 x 36) have a blue X-ray detectable string on them, and sometimes a plastic X-ray detectable ring.
  11. by   UM Review RN
    You know Marie, I never knew before I read that article that there was a way to detect them via X-ray.

    I also never knew anything about the topic before it was posted. Just goes to show how much you can learn if you're willing to ask questions and do a little poking around, doesn't it!
  12. by   Marie_LPN, RN
    Quote from Angie O'Plasty, RN
    You know Marie, I never knew before I read that article that there was a way to detect them via X-ray.

    I also never knew anything about the topic before it was posted. Just goes to show how much you can learn if you're willing to ask questions and do a little poking around, doesn't it!
    But there are some hospitals in some countries that don't use the X-ray detectable sponges.

    And there are a few cases of a blue cotton OR towel getting left in as well. I've had surgeons get bent out of shape with me because i refused to give them a blue towel to pack with, but too bad, we're going to wait all of 3 seconds for another pack of large laps to get opened instead.
  13. by   ortess1971
    Quote from Marie_LPN
    But there are some hospitals in some countries that don't use the X-ray detectable sponges.

    And there are a few cases of a blue cotton OR towel getting left in as well. I've had surgeons get bent out of shape with me because i refused to give them a blue towel to pack with, but too bad, we're going to wait all of 3 seconds for another pack of large laps to get opened instead.
    We also had a problem with surgeons wanting to use the or towels to pack-we ended up putting it in our policy that they are NOT to be used. LOL..doesn't mean some of them still don't try. As a tech, I actually slapped a doctors hand because he tried to grab it off my back table. This was done in a somewhat humorous manner and I knew the doc fairly well so he didn't flip out. The circulator actually applauded!
  14. by   Mommy TeleRN
    Quote from Angie O'Plasty, RN
    Click on the blue underlined word. That's the link.

    oh doh! Cool pic..very clear. Very scary! Fascinating topic. There are sooo many areas of nursing you can learn forever!

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