counting instruments laparoscopic assisted mini laparotomy

[scrubs12]

i recently took over in a laparoscopic assisted mini laparotomy case. colon was brought out via mini laparotomy opening to create the stoma.

only laparoscopic instruments were used inside the patient. no other instruments were placed inside the pt.

instruments were not counted.

i've received conflicting opinions from fellow nurses, some say instruments need to be counted for any and all laparotomy cases, including mini laparotomy.

others say instruments do not need to be counted b/c it was a laparoscopic case and the bowel was brought out, nothing went inside the patient from the mini laparotomy opening.

should surgical instruments of been counted for the mini laparotomy case?

[daVinciNurse]

two rules of the OR: 1.) if you think its contaminated, it is. 2.)if you are unsure about doing an instrument count, just do the count!! always better to count if in doubt...

[Rose_Queen, BSN, MSN, RN]

I follow the rule of if there's a body cavity large enough to hide an instrument in, they need to be counted. In fact, at my facility it's policy to count all instruments at the beginning of every laparoscopic case. At the end, if there was any kind of an incision larger than the trocar insertion site, all instruments had to be counted. We even count the long laparoscopic instruments, even though I've yet to see an abdominal cavity large enough to conceal one of those.

[lockheart678]

I do those laparoscopic assisted bowel cases all the time and we always count all of our instruments. If they can stick their hand in that gel port, then they can get an instrument in there as well. Plus, you never know when the case will need to go completely open.

[Mr. & Mrs. RN]

Yes, I count when the abdominal cavity is opened at all. A superficial hernia I don't, but I do for a mini-laparotomy. However there's not much that can be done if you're taking over a case. I would tell the surgeon that instruments were not counted, and if he/she would like an x-ray, and document the conversation. Also, refer to your hospital's policy.

[canesdukegirl, BSN, RN]

YES! You should always count instruments in a laparoscopy case or even a mini-lap case. The possibility of any incision being extended to allow for a more extensive procedure than anticipated supports the practice of performing an initial count for all procedures.This policy is usually instituted in every hospital. Look up the policy at your facility and then you can quell any doubts.

[JamieJCST]

We always count on laparoscopic assisted bowels. Rule of thumb, whenever a cavity is opened, no matter how big the incision, instruments are counted.