count sheet

As a matter of fact, just this past Monday, I spent a good long time recounting and carefully looking through 210 Raytecs and then was forced to sift through a bucket with about 1 1/2 gallons of blood, clots, and brains searching for a 1X1 pledgett that the surgeon insisted was not in the patients head and had completely closed the wound. He finally ordered an X-ray. Well, I'm sure you know where the 1X1 was.

No count of instruments? I guess the scrub nurse would be pretty stressed about keeping track of everything? I know I would be.:uhoh21:

Well, I have said this before, but when I was in OR tech school (in the '70s) we were taught to put a minimum of instruments up on our mayo stands, in pairs, and get rid of them (put them in water in a soak pan or your round basin) as they were no longer needed.

We put instruments up AS WE NEEDED THEM--and replaced them with others AS WE NEEDED THEM. As you get deeper, you replace your short clamps, scissors, pick-ups with long ones--you don't keep both sizes up on your mayo.

Even now, I have a bare minimum of instruments on my mayo at any given time, and always in an even number--a pair of tonsils; 4 mayo clamps (never more than 4 of anything.)

It seems like these days there is a tendency for new techs and RNs to practically put their entire back tables up on their mayo stands.

I have seen vascular cases where people drape an extra mayo stand and proceed to put an entire stringer of vascular clamps up on it, at the beginning of the case--why?

Why not wait until the moment, say, that you have to cross clamp the aorta--an hour and a half into the case-- and bring up a single Craaford? Why have medium and large hemoclip appliers, peanuts and sponge sticks up on your mayo stand BEFORE THE INCISION IS EVEN MADE, if at all?

Why not anticipate the actual NEED for 2 DeBakey peripheral vascular clamps, or 2 umbilical tapes or vessel loops on passers, or a medium hemoclip applier, followed by another, followed by long Metz, and have them ready to go at that time--not cluttering up their Mayo an hour before? It's no wonder they cannot keep track of things.

Use your instruments as needed, put them back in a soak pan of water when they are no longer needed, bring up the appropriate replacements as needed, and then by the time you are ready to close skin you should be left with 2 pairs of Adsons and a stapler. Keeping track of instruments should not be stressful if one simply follows those simple techniques.

I agree Stevierae, and dont know if you or others might agree but I have found that the type of Mayo loading you describe is usually due to a mixture of inexperience, lack of confidence and sometimes sheer ignorance of what a Mayo stand is for. Sometimes it just takes a quiet word from an experienced OR nurse to rectify a mistake which could go on a long time.

It sounds like "count sheets" are still being kept as part of the record...is this true. I haven't seen that in awhile. We count, but we do not keep a count record.

We don't keep the count sheets either.

We don't keep the count sheets either.

We keep the count sheets, stays in the patients chart as permanent record.

Interesting story: Reported in the news today of pair of 17cm metz scissors found in a woman's abdo 18 months after surgery:uhoh21: Apparently that hospital dosen't count all instruments, only those that might be used:angryfire :angryfire