Counting?

There should be a policy created in your facility to count instruments during a lady partsl case for EXACTLY the situation you found. My facility does not mandate that instruments be counted for total joint or neuro cases, but does have one in place for lady partsl cases.

In the past policy states not necessary to count inst on lady partsl cases. Now the manager wants counts on d & cs. This is overboard.I am more concerned with the small items on the table. Disposable inst tips,indicators,marker lids,needle caps,ect the list can go on and on. I scrub and am concerned about those things, not losing a vag retractor or a lap inst on a lap hernia.

I read an article about lady partsl retractors being left in. Not good! We had an issue with packing being accidently left in. It wasn't discovered until the patient's post op appointment.

How in the heck could anyone leave a lady partsl rectractor in. You could not close the legs with a retractor in,I mean Heaneys,sides etc. Now I Am worried.I just read a article from ARON,some hosp not counting inst. They say it is a waste of time and the surgeons agree. I dont know about that!

How in the heck could anyone leave a lady partsl rectractor in. You could not close the legs with a retractor in,I mean Heaneys,sides etc. Now I Am worried.I just read a article from ARON,some hosp not counting inst. They say it is a waste of time and the surgeons agree. I dont know about that!

I thought the same thing. One of our first assists brought me the article. Certain retractors come in pieces. I've never seen one because I don't usually work GYN.

How in the heck could anyone leave a lady partsl rectractor in. You could not close the legs with a retractor in,I mean Heaneys,sides etc. Now I Am worried.I just read a article from ARON,some hosp not counting inst. They say it is a waste of time and the surgeons agree. I dont know about that!

I am pretty sure he lady partsl retractor being referred to here is not your "traditional" type retractor. Its more of an instrument used to manipulate the uterus during a laparoscopic hysterectomy. It has a few pieces, one of which is a cup that sits around the cervix to help the surgeon find the plane while working laparoscopically and doing the colpotomy (incision at the base of the uterus/cervix into the lady parts). I have heard of this cup being left in at the very top of the lady parts (which is where it is placed---around the cervix). I have not seen it happen on my watch, but can see it happening....when I have used this type of device, it gets written on the count sheet/board as part of the "miscellaneous" items we count. Its not a large item, but it does need to be counted and retrieved at the end of the ase.

I thing you are referring to that rumi thing right? Same freakin thing happened to me. Scrub noticed the ring was missing when she was cleaning up her instruments. We were fixin to move the lady to the stretcher. The RNFA went in the lady parts and there the little devil was. I always count and check now. As far as D&C's we don't count, but we do for lady partsl hysterectomies, and of course laparoscopic after that happened...

No we don't count instruments on joints. What about inguinal hernias where they just make a small incision. Do y'all count? Just curious...

We count on open Hernias,some do on lap Hernias.Just the first count incase we open. Basicly I feel it is up to the Tech to make sure nothing is left,know your sets. When we first started Joints years ago,we were told to count the inst. Ha that lasted 10 minutes.Impossible and then there were only a few trays.Of course there is always a post op xray. I understand there is a wand of some kind that can be waved over pt to detect metal. Is this true or is someone messin with me?

Yeah, we are trying it in our OR. But the wand is only for laps/ray that have an additional little peice of metal that is detectable by the wand or the gel pad under the patient. The company that is making the wand is making big bucks because if you get their wand you also have to buy their laps/ray's!

I read an article about lady partsl retractors being left in. Not good! We had an issue with packing being accidently left in. It wasn't discovered until the patient's post op appointment.

Where was this packing? just curious....

Do you guys count for lap tubal cases?

Policy schmolicy. That is why you were given a professional nursing license...because you are smart enough to make a professional decision about what needs to be counted and what doesn't. I say, do what you think is safest for the patient. If that means following your hospital policy, then do it. It's your license. All your supervisor cares about is that the hospital's butt is covered. Hence the ridiculous policy that inst. should be counted on pretty much every case.

i think it is very important to count all d and c instruments because we had an untoward incident at our hospital. surgeon was using dilator for holding the uterus antevert/retrovert for a lap case and whilst he was doing the procedure laproscopically, he did not remove the dilator and the intruments were not counted. the woman became very ill and intrument was removed at another facility. not a good experience for the patient, surgeon or the scrub involved. so i think that no matter what, all intruments need to be accounted for and double check with the surgeon if surgeon is performing the procedure on his/her own.