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Discussion

Out of OR procedure count question

Hope that thread title makes any sense. I'm a little concerned about something that happened in my ICU today. When our open-hearts come back with their chest still open, a few days later the CT fellow will come up to the unit and close it right there at the bedside, by him/herself. No scrub, no circulator, he sets it all up and the ICU nurse (i.e., me) just monitors vitals and pushes meds as needed. So today was the first time I'm doing this, and I realize halfway through that... he never counted anything. Now, obviously a pair of scissors isn't going missing inside an infant's chest, but... needles? He certainly used several packs of suture. I sort of mentioned it, like I was just curious, and he just told me no, he doesn't count. Needless to say I watched the field like an absolute hawk, and of course they get an XRay afterwards, but am I totally out of line being uncomfortable with this?

Yeah, I can't stay out of your forum, apparently, even though I decided not to take the job. Thanks for indulging me!

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The CT Tech is allowed to close an open chest wound? This, IMHO, is totally unacceptable! Why? I think this goes beyond his scope of practice, and if his licensing agency was questioned about this I think he would be in alot of trouble. So, what makes the difference if you operate the CT machine? Same difference, your not qualified so he shouldn't be qualified to close a wound. Most states won't even allow a seasones OR nurse to do the same without a RNFA course to back them up. Also, what competent Vascular surgeon would allow this? I question his training and judgment.Find out who license him and question them about this. I would have no problem reporting this because this drags you down with him if you new and allowed this to occur. Remember, CYA!

  • Author

Holy cow, noes! I meant the Cardiothoracic surgery fellow!

At the last place I worked, the OR staff would go to the NICU for similar procedures. A scrub and circulator from the OR would go with the surgeon or fellow, and we would set up a field similar to the one we'd set up in the OR, within the limitations of the space we had of course. We would count just like we would for any other operative procedure.

I can't imagine that it would be within your hospital's policies to do such procedures without counts. I think you are right to be concerned, and I would suggest discussing the situation with your supervisor.

Holy cow, noes! I meant the Cardiothoracic surgery fellow!

That makes more sense now. Sorry, I misunderstood you but from where I come from CT usually means a x-ray tech. I would think since this is a vascular fellow, it's his responsibility to make sure everything is there. Now, if I was to help him I would want to make sure he doesn't leave anything. That would be for my own well being.

At the last place I worked, the OR staff would go to the NICU for similar procedures. A scrub and circulator from the OR would go with the surgeon or fellow, and we would set up a field similar to the one we'd set up in the OR, within the limitations of the space we had of course. We would count just like we would for any other operative procedure.

This is exactly how my hospital does it as well.

Just an FYI... we had an article floating around our OR some time ago in regards to needle/lab/instrument visibility on Xrays when attempting to "clear" an opsite after unresolved counts... I can't remember exactly where the end of the range was on needle size, but a fair number of the common suture needle sizes appeared nearly invisible to us. Now if that was due to the poor copy of the article or that we're not trained Radiologists, I leave that to you to decide...

And I don't care WHO you are, that's poor practice to not account for sharps/sponges/instruments Before and Following non-emergency procedures... and I'd be scared if that's what the facility policy allows... I know I don't want to end up on 20-20 for being involved in a "retained foreign object" scandal...:no:

  • Author

Thanks for all the input, guys, glad to know I'm not crazy! Now, if I can just figure out how to get this taken care of without it turning into "elizabells is a troublemaker, and the CT fellow doesn't want her taking care of his open-chest kids" I'll be all set.

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