scrub people who throw off all their raytecs?

Mourkoth · Nov 18, 2007

I think that sometimes it is ok to throw off your raytecs. If I don't plan to use that many rays in a case. I will count them with the circulator and then roll nine of them up real tight with one long unfolded ray. If they are not used in the case (and remain ten) they stay rolled up until the end. The circulator and I agree that they were counted at the beginning of the case and are still rolled. Therefore, at the end of the case, we can throw off the whole ten without counting them (individually). This may not be completely within the guidelines of the AORN standards but, If the case is started and ended with the same scrub and circulator and the rays were counted at the beginning and rolled... they both can agree that the original ten is there without counting.

Scrubby · Nov 18, 2007

It's not done where i work, if we keep the raytecs on the sterile field then they need to be counted regardless on whether they were used or not. If it's not in the ACORN or AORN guidelines then i wouldn't recommend it and I wouldn't sign the count sheet if i were circulating and the scrub tried to do it that way.

ewattsjt · Nov 18, 2007

in my facility, rays are counted regardless of where they are. both the circulator and scrub are to visualize the counted pieces. so no matter where they are, both have to count and see them (time consuming to both parties).

it could always be worse too. we have a couple of docs who want a clean ray for each dap when closing sub-q and skin. to make sure the get a clean one, they throw the old one in the floor (anywhere in the floor).

on small cases i keep them up in a corner of my backtable. on large cases i throw them off (no matter where we are in the case) because of clutter etc... imho an other thing to be considered, it is that anesthesia is supposed to visualize the blood loss. it makes it more difficult for them to estimate the blood loss if the rays are spread on the back table, kick bucket, patient, hanger and wherever else. so it makes more sense to me to keep them together.

perhaps you should speak with the scrub and find out if the action is intentional or they are thinking about it in a way that you don't see.

TakeTwoAspirin, MSN, RN, APRN · Nov 18, 2007

I would much rather work with someone who keeps a clean, uncluttered, backtable (even if that means they throw Rays off) than someone who has stuff everywhere on the table. Like someone else said, everything has to be counted by the nurse and tech anyway, so why would you care whether they are in your bin or on the table - its still got to be accounted for. Really, what difference does it make?

GadgetRN71, ASN, RN · Nov 18, 2007

I've experienced this..and I usually end up cursing them out(In my head!). There's ways around this though..just make a point to ask them to watch you count them-you're supposed to do this anyway. I 've also had the ones who miss the kick bucket on purpose and who try to hit you with the bloody sponges. It can be hard to hit the kick bucket sometimes especially in the heat of the moment, but if the bucket is pretty much right near you and all is quiet, well that's a different story. I was a tech before, so I've been in that position. Some people just feel the need to be difficult, and they like to see you flustered, so try to ignore them and get your revenge another way.(ie pull the neckband of their gown really tightly when you're tying them in! :lol2: )

shodobe · Nov 19, 2007

I always throw off the table so the circ can bag them so we ALL can see them. In my opinion if the scrub keeps them on their back table it makes it easier to lose one. During a case the count is kept up and even when it isn't ready to count the circ, if they know what their doing, will count to themselves and if something seems to be missing can mention this to the scrub and they can look BEFORE the official count begins. Everywhere I have worked sponges, laps or raytecs, are kept on the back table. I don't think this is such a good idea. This is what a kick bucket was invented for so many years ago. Nothing should change just because someone thinks otherwise.

GadgetRN71, ASN, RN · Nov 19, 2007

Also, when I scrubbed a lot, I'd get rid of the small lap sponges if we were to do a big case on the belly or chest. Raytecs should only be on those cases to use as sponges on a stick. I feel that keeping those small sponges on a big case like that is only asking for trouble since some surgeons pitch a hissy fit when you're missing one, and they have to actually look for it! I have no problem with the tech handing off raytecs at the beginning, especially if they won't really be used but I think the OP was referring to people who just dump them off of their table in a lump, so half of them hit the floor, because they don't want to be bothered.

shodobe · Nov 19, 2007

I do make the scrubs take basketball practice because they will hit the bucket more often! I have, luckily yet to have someone who deliberately misses the bucket. In this case they will be there at the end of thecase for them to cleanup because I won't have the cleanup doing extra work just for the sake of a slob! They'll do it once and that will be the end of it.

mikethern · Nov 19, 2007

I think the OP was referring to people who just dump them off of their table in a lump, so half of them hit the floor, because they don't want to be bothered.

Exactly. They think, "why count them when you can get the circulator to count them?"

Scrub people already have gloves on. They also have the extra protection of a gown. To make the circulator put on gloves to count them is a waste and rude.

ewattsjt · Nov 19, 2007

I think the OP was referring to people who just dump them off of their table in a lump, so half of them hit the floor, because they don't want to be bothered.

If that is correct; at my facility the matter can be taken higher up. Our facility believes in being a "team player" for the benefit of the patient. The team part is included in all aspects.

That is inconsiderate!

shodobe · Nov 19, 2007

Exactly. They think, "why count them when you can get the circulator to count them?"
Scrub people already have gloves on. They also have the extra protection of a gown. To make the circulator put on gloves to count them is a waste and rude.

I still think your wrong on this. The whole purpose of counting is to have both the scrub and the circ count them visually, not having the scrub tell you the count is correct. I have been putting gloves to count with the scrub for over 30 years and this statement gives the wrong impression. Who cares if the scrub has gloves on, don't be lazy and put some on and do the count the correct way. Just curious, how are your counts done? Do you use bags to separate the sponges or what? It sounds by your comment the circ really isn't that involved in the counts and if that is your way it is wrong. What is so rude? Do the job the way it is supposed to be done. We have policies in place that dictates the way counts are done and if you would like a copy let me know and I'll get it to you.