Horrible thing happened in O.R yesterday

[Scrubby]

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.

[TazziRN, RN]

The smart ones say, "Shoot an xray and document that it's not in there" to cover themselves.

I'm not saying they don't get grumpy about it, I'm just saying that I've seen a lot more negative on-table xrays than I have left-in needles.

Not to be mean, but I think ebear's 34 years of experience trumps yours........

[ASSEDO]

as an old surgical nurse of many years, i have seen it all. however, the hospital should have a procedure of what to do if a needle or sponge is missing. the surgeon does not have the say-so. you must protect yourself and the hospital. the surgeon does not work for the hospital, he works at the hospital.

if it holds up the next surgical procedure so be it! protect yourself at all cost, call x-ray if your any of your count is off. where was your circulator during that time?

the good news, the object was found and the issue will be taken care of....

you can do surgery on me anytime! i fear the scrub tech and/or circulator that haven't had a near miss on a missing object. they just don't yet understand the fear you are experiencing. don't beat yourself up, and to top it all off, in the future it will not happen to you again because you will be proactive.

god bless!

[TiredMD]

Not to be mean, but I think ebear's 34 years of experience trumps yours........

I was only saying that the "majority" comment was probably an exageration. I will eat my words if she says that, of all the on-table xrays she has seen, more often than not the missing object was left in the patient.

[ebear, BSN, RN]

Because of the expertise of our OR nurses, in my opinion it is indeed the "majority" of the surgeon's fault. After they do multiple counts, look all over the floor with a metallic roller, check the kick bucket, look through the trash, etc., in every occasion, the missing item has been found in the patient. If the staff weren't so "anal" in our O.R. I would never have made the comment "majority"....I know the staff and I trust them and their abilities entirely. They count as each item goes in and as it is returned and keep a running talley (written on the back table with a sterile marker what goes in the belly and as it comes out-the item is checked off and circulator is notified. As a result, not many xrays are required. As for the docs who argue "It's not in there, their buttocks sit on a stool in the OR until radiologist calls into the room with a report. They DO NOT leave the OR, nor is the patient moved to PACU.

[TazziRN, RN]

"I'm not saying they don't get grumpy about it, I'm just saying that I've seen a lot more negative on-table xrays than I have left-in needles."

This is the part I was referring to when I compared Ebear's experience to yours

[CHATSDALE]

i would love to have been a fly on the wall when he explained to patient that repeat surgery would be necessary

'THAT DANG SCRUB NURSE..YOU HAVE TO WATCH THEM EVERY MINUTE!!!'

[shodobe]

Patients are not taken out of the room untill the x-ray is taken and the object is CONFIRMED it is NOT in the patient. Luckily, all of the surgeons I work with know it is in their best interest that this procedure is done. We are not only looking out for their best interest but also the surgical staff. I remember in my early years it was the surgeon's decision on whether to take the patient off of the table or not. Over 30 years I have had no objects left in the patient to require a reopening, knock on wood! I have had though numerous times where I surgeon was told a sponge was not accounted for and he did reach in and, like a rabbit, pull out the offending item! They always thank you profusely for avoiding a disaster. Too many surgeons are too pigheaded to admit they may have "lost" something, luckily I don't work with any of them.

[GadgetRN71, ASN, RN]

The majority of the time, I have not seen things left in patients but.....this is because of the diligence of the circulators and scrubs in my experience. As an example, at my last OR, there was this group of surgeons that were notorious for blowing off the staff when the count was off. We were told "You must have counted wrong to begin with" or "It's on the floor somewhere". I was circulating a case, we were doing a closing count and there were 3 small sponges missing. The scrub and I count them again, I check to make sure they were seperated properly in the counter, we check the field and surrounding area. Nada. No small sponges. I notify the physician and get immediate attitude, eye rolling and questioning on my counting abilities. I stand my ground and keep nagging him to at least check the abdomen. He finally gives in after whining like a child for a good 2 minutes. Guess what was found in the belly-yep, 3 small sponges. I have also seen a vascular surgeon be notified that a large sponge was missing on an elective AAA, and then refuse the X-ray..the 78 year old patient had to be brought back to take it out.

X-rays should be taken in the OR if the count is wrong. Period. If the nurse that was in with Scrubby was smart, she documented the physicians refusal of the x-ray in the OR. That's what I do now. If the doc refuses one I chart the following. "Dr. X notified of incorrect count. Doctor refused x-ray in OR". Or if the x-ray is negative, I chart "Dr X notified of incorrect count. X-ray taken in the OR-this was read by Dr. X and Dr. X stated that the x-ray was negative for retained suture/sponges/instrument".

Also, this is off topic, but I think small sponges have no place in a belly case..An old scrub tech that trained me told me never to "let" the surgeons have them. When I scrubbed, I used to throw them right off my table in the beginning!

[Scrubby]

Thanks for all the support and encouraging comments here....:)

Well today the same patient was brought back into my theatre for a laparoscopic retrieval. I scrubbed for this because i felt that i needed some sort of closure. We spent a good two hours trying to remove it but unfortunately the damned thing was sort of tucked up in a crevice between the spleen and bowel, and the surgeon (the same one who did the previous case) did not want to poke around in there.

He was actually really sorry about the whole thing, blamed himself and i worried about it for nothing. A few anaesthetists who really can't stand the guy stuck there head in the door during the case and made some remarks to me such as 'make sure he doesn't leave anything in there this time!' which i felt was a bit insensitive, (even though he does treat people rather badly at times), it's still not nice to think of the patient with a suture stuck inside them, not a laughing matter.

Last year a very similar thing happened during a lap fundo. The needle somehow broke off and the count was incorrect. The surgeon did an on table x-ray, showed that it was still in there. They decided it was ok to leave it in there, it would just encapsulate. I'm wondering if this a common thing with these types of sutures (we use 2-0 Novafils....)

But the problem is the the senior nurse who told me they had written the incident in the progress notes. I searched her notes today and there was no entry from them! I'm so annoyed at myself for not doing it when i had the chance and for relying on someone else. I wrote an entry and described the incident, probably too late now being two days later but it had to be done. Another important lesson learned, document anything yourself, don't rely on anyone else!

[Marvie]

I am glad to hear that your fears were calmed. Keep up your good work, and thanks for the thanks guys.