Urgent Csection

[Tink1987]

Hi all! I was an IMC nurse for three years and transferred to L&D in January. Overall I'm loving it but my major weakness is csection. I'm just so out of my element in the OR. My patient needed an urgent section. I always feel pulled in a million directions and my scrub tech was calling for a count while I was trying to get FHR which was Brady. In the rush I recorded the suture count wrong. I didn't realize until final count and said something. My scrub tech insisted she knows what she pulled. The surgeons told me to "fix" my count. I just felt uncomfortable and so we called for an X-ray. Nothing in patient so clearly my mistake in counting. There was a delay in the next case as we only have two OR and can't open one without the second being ready to go. Everyone was upset and I just feel like an idiot. I just don't know how seriously ill be taken in the future. Part of me thinks I did the right thing for my patient but part of me just thinks I uselessly called for an X-ray and delayed the next case (also urgent although not STAT). Can someone more experienced offer their opinion? And how do I face people when I come back in for my next shift :/! Please help! Feeling disheartened.

[2008CaliRN]

I used to work at a facility that required an xray if a proper count could not be done prior to the start of a stat case. It would be wise to search your policy and procedure reference and see if something like this is in place. It also would be wise to institute a policy if you don't find one. A minimal suture count (one or two needed to close the uterus) could be opened for a stat and then add the additional sutures with the view of a witness as the case progressed. Same thing for the laps. One package of 5 opened for the start of the stat, then add the additional laps after the urgency is relieved. I hope that this was helpful. We all learn from these situations. It will get better.

[xoxJanexoxDoexox]

I scrub and circulate for c-sections so I've been on both sides. I would have made the same call you did..if there is ANY doubt an x-ray is the only solution. I wish you would have had more help in the OR. Another nurse could have found heart tones while you did the count or the other way around. Sometimes if I'm in a hurry the 1st assist will do the first count with the scrub. When I'm scrubbing I also leave all the suture casings on the table..that way I know what suture I've used and how many.

[RiskManager]

As the risk manager, it gives me all sorts of warm fuzzies that you stopped the line and called for imaging to rule in/rule out an incorrect count prior to closure. This is exactly what I want my staff to do, and if the attending or other staff have a problem with this, they can discuss it with me. I am a big fan of staff advocacy for patient safety. Kudos to you.