Raney Clips

TracyB,RN, RN · Jul 28, 2007

not at the moment. We're probably safe until TPTB see this post & decide "heyyyyy, that's a goood idea. We should count those clips. Let's count

the staples while we're at it, too." LOL

GadgetRN71, ASN, RN · Jul 28, 2007

not at the moment. We're probably safe until TPTB see this post & decide "heyyyyy, that's a goood idea. We should count those clips. Let's count
the staples while we're at it, too." LOL

Get this, one of the facilities I worked in as a tech, DID count staples(the cartridges). Also reels, liga clip cartridges, and Raney clips. The place I worked in recently did the same..basically anything that could fall into a big wound and be lost...I think it is because we had some docs that wouldn't take the counts seriously and they had some issues..

ewattsjt · Jul 28, 2007

we don’t do crani type of cases here so raney clips are not on our sheets. we do count liga clip cartridges, reels etc… a proper count should consist of anything that could potentially fall into the wound and become “lost”. did you know that the small anti fog pad for lap procedures have a radiopaque strip in them? it is because it is to be counted too.

staples may not need to be counted but, misfired staples like an endo gia need to be located and removed; otherwise it could perf the organs. even mis-applied hemoclips that may come loose need to be removed.

it has nothing to do with the doctors; it has everything to do with patient safety and ensuring the best possible outcome.

GadgetRN71, ASN, RN · Jul 28, 2007

we don't do crani type of cases here so raney clips are not on our sheets. we do count liga clip cartridges, reels etc... a proper count should consist of anything that could potentially fall into the wound and become "lost". did you know that the small anti fog pad for lap procedures have a radiopaque strip in them? it is because it is to be counted too.

staples may not need to be counted but, misfired staples like an endo gia need to be located and removed; otherwise it could perf the organs. even mis-applied hemoclips that may come loose need to be removed.

it has nothing to do with the doctors; it has everything to do with patient safety and ensuring the best possible outcome.

try telling that to some of these docs..there was one group there that would keep closing after you told them you had a sponge missing. they'd insist there was no possible way it was in the wound and then when they'd finally get around to checking, there it would be in the belly. they then would try to blame it on the tech or circulator. if you were lucky, you had a tech with some backbone that would refuse to hand them any more closing suture until the situation was resolved. thank god not all docs did this, most were happy and grateful that you kept them in the loop and told them immediately about the incorrect count. just as a point of interest, one of my friends once worked in an or that did no counts. everyone just got an xray afterward! part of me doesn't believe him though. how would they get away with that?

Cynthy55 · Jul 28, 2007

Thanks for your replies. We do currently count liga clips, staple cartridges, esu tips etc but seem to have more opposition on counting raney clips. If one becomes dislodged during the procedure and fell in the wound, dont you think it would be seen? It will be a hassle to change surgeon behavior to count them and to not let these things fly off the wound!

The practice of using an xray to confirm every count is a scary one! Not all things are seen on xray, especially small needles. I have also seen a radiologist pick up a foreign body on an xray that had been read as negative by the surgeon.

TracyB,RN, RN · Jul 29, 2007

We also count stuff that could potentially harm by falling into open wound. I was trying to be funny, but it was late & I was sleepy. I was referring to counting each individual staple before use... didn't come out that way... Wooops.

We also have a few docs who will keep closing despite not being able to find something like a raytec. It is sooo aggravating. They are told... we have one raytec missing. Please hold your closure until it's found. They get ticked...blah blah blah.. The biggest culprit... Double gloving & peeling off the top glove, leaving a raytec balled up inside the glove. I LOVE spending my free time unfolding bloody gloves!!!

ewattsjt · Jul 29, 2007

tracy, i assumed your post was because of something like that. you always give good posts.

witchy, we do not use x-ray for place of counts but, i also agree with you on the use of an x-ray at the end for more than one reason. my main reason is that all procedures are to be as minimal a possible. if a doc uses a shortcut like an x-ray over a count, in my opinion, the procedure was not as minimum as possible. i have also seen phantom sponges on total knees where the 2nd x-ray reveled nothing. i could go on but enough said about that practice.

i can’t stand it when docs continue to close when there is a missing item from the count. i refuse to pass anything else (unless something like hemostasis is an issue). if they can’t go any further, they usually help you look. (know your docs and manager before you try this one). our manager was a chapter president of aorn, so she backed me when the doc went to complain about my insubordination. this doc hates me now but we work well together for the patient. he is starting to speak to me now too.