Q for the OR nurses??

[The surgeon allows his surgical assistant to leave prior to closure of the incision and asks the scrub nurse to assist (retract and cut sutures) while she is doing the closure count. As the scrub nurse, you would:

inform the surgeon that you are still counting but will assist as soon as your count is completed

assist the surgeon and count after the closure of the abdomen is complete

assist the surgeon while counting as a scrub nurse is supposed to multitask

inform him that retracting is not your job]

I would go with the first answer. It's bad practice to count after the abdomen closure is complete because if there is something missing and still inside the patient then they would have to reopen which is time consuming and the scrub would probably cop the blame for it anyway.

I would not count and assist at the same time because I want to be focused on my count and not distracted. And to count and retract at the same time would be bad because you'd be twisting your body around a lot which is very bad for your back.

[You are asked to scrub for an emergency cesarian section (C/S). You know that you usually perform this many counts for a C/S (think about how many body cavities are entered to deliver the baby):

2-initial count and skin closure count

3-initial count, abdominal cavity closure count, and skin closure count

4-initial count, uterus closure count, abdominal cavity count, and skin closure count.

5-initial count, uterus closure count, peritoneum closure count, fascia closure count, and skin closure count]

Have never scrubbed for a c-section because we don't do them where i work so i'm going by what i do for a hysterectomy.

I would have to go with number answer 4.

[The patient is rushed into the OR just as you are just beginning to receive supplies from the circulating nurse. You are not yet set up and have not even started your initial count and the surgeon has scrubbed and is beginning to prep. Best practice dictates that you would:

insist that an initial count be done prior to the start of the surgery

notify the appropriate management that an initial count was not done

forget about counting because of the emergency status of the procedure and then follow incorrect count policy at the end of the case

only count items used in the procedure]

This is a tough one. I would have to go with the last one and go with an incorrect count policy as well and have the patient x-rayed afterwards.

Hope this helps :)

I agree with the above posters for the 1st two questions. The third question would depend on the policy of your institution, but I would count my disposables as best I could (as they're opened). You can usually get things counted once the surgeon has a knife and a few retractors. I would inform the surgeon that a complete count was not done, then follow the incorrect count procedure (usually an incident form, and an x-ray for the patient).

There are some individual hospital policy issues to consider, but here's what I think.

The surgeon dropping out during closure. Often times in our hospital, there is only a surgeon and tech working, so the tech does often, multi task, helping close and counting at the same time. Our docs understand that counting will come first, and we will do what we have to do!

On the C-Section count question. Four counts.

Prior to the case (1), as the uterus is being closed (2), as the abdominal cavity is being closed (3) and on skin (4).

Now, I don't do Sections any more, those are done by the Child Birth team, but I believe that it's sponges/needles x4, and instruments x2, prior to case, and as the abdomen is being closed.

On the emergency procedure question. You do the case, care for the pt, and deal with the missing count later.

Sponges and needles can be taken care of quickly enough, counting as the pt is being put to sleep, etc. However, instrument counts are another animal. Our policy is to do a Stat KUB at the end of the procedure, while the pt is still asleep and on the OR table, unless the pt's condition warrents otherwise. The film is read initally, by the surgeon/anesthesia doc and then the radiology doc.

Again, if the pt's condition allows, they will remain asleep and on the OR table until the film is read. We often remove the field drapes, and even put dressings on, but keep the back table/mayo etc, sterile until the films are OK'ed.

Good Questions. Good Luck Hope this helps 'ya!

Mike