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Surgical Tools to Include RFID 272

Posted by ScuttleMonkey
from the now-just-remember-to-use-the-wand dept.
andrewman327 writes "Reuters is reporting that hospitals are considering embedding RFID tags in surgical tools to prevent leaving them in patients. After closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside. The biggest current stumbling block is the chip's size, though scientists hope they will continue shrinking as the state of the art advances."
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Surgical Tools to Include RFID

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  • by KingSkippus (799657) * on Wednesday July 19, 2006 @02:17PM (#15744932) Homepage Journal
    After closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside.

    I have a better idea.

    Before closing a patient, doctors would wave a receiver over the body to look for the chips which would indicate that something was left inside.

    The timing would be a little better, don't you think?

    • Why not just implant the receiver wand inside the patient? Then you can wave the scalpels over it. Or something.
      • Why use RFID at all, since it doesn't matter which particular surgical implement was left behind. How about a simple metal detector? It wouldn't catch some things, like sponges, but if they can put an RFID chip on there, why not a (cheaper) stainless steel bb embedded in the sponge?
        • Because of the very logic you impose. Besides, this also allows for:

          1. Inventory before surgery, to be sure that all necessary parts for surgery are present
          2. Inventory after surgery, to be sure that nothing is left in patient, and that all objects are accounted for
          3. Generic inventory tracking of materials.
          4. Alerts when inventory "walks" out of the hospital

          RFID does have some potentially good uses. This is one of them - a brilliant one at that, because it saves lives - unlike putting them in IDs and pas
    • by 955301 (209856)
      You'd think; however, the doctor needs tools to close you back up. If one of these tools is lost during the process and after the check, we're back to the same problem.

      • Good point!

        Perhaps a check at both points would be in order.

        Cotton! Cotton!
        • The first check would be redundant then, and the process probably already includes a visual check.

          • The first check would not be redundant because it still provides a chance to find an instrument without having to reopen the patient. Of course you have a visual check, but it can miss things--obviously, since instruments are left in patients. However, it's possibly not practical because you'll pick up the RFID chips on the instruments used in closing. Maybe if you had an RFID scan that differentiated between instruments that stayed in while closing and those that don't...

            CHris Mattern
            • Maybe if you had an RFID scan that differentiated between instruments that stayed in while closing and those that don't...

              I envision a fairly narrow reader pattern that only encloses the area being worked on. Combine this with an LCD "scoreboard" on the wall listing each and every tool that's still within the surgical area. The scanner runs continuously, like once a second, updating a "live" list on the LCD of all the tools a such still within the surgical area.
              • Re:A better idea... (Score:3, Interesting)

                by hob42 (41735)
                This sounds like a fantastic idea, but it's likely it'd never be anything but fantasy.

                My hospital just got around to putting computers in the operating rooms, and it'll be another couple years before we're acutally using them for charting and get rid of all the dead trees.

                Something this flashy (read: expensive) for a (supposedly) rare occurance isn't gonna fly in today's hospital. Actually, I don't see anywhere but grant-funded specialty hospitals using RFID for counts. Now, I can see RFIDs in instruments b
          • Actually, two checks is the current standard for surgical counts - a first one before you close, and a final count after you close. It's better to find out before you close, but as he said, you might loose something during closing too.

            The two issues I'd see with doing it *before* closing are:

            1) all the other instruments are still near the patient, so the wand would need to have a pretty narrow field of reception, and

            2) if it needs to be that close, the receiver itself will need to be a sterile instrument. W
    • Before closing a patient, doctors would

      Only before is not suficient, because during various stages of "closing the patient" process, additional surgical tools are often placed inside, especialy during more complex surgeries. Also, often you cannot remove all tools from open patient - e.g. the ones that hold veins and/or arteries closed
    • My thought exactly -- bet it would have made for a great patent for the portfolio.
    • Hopefully, the RFID is not cracked or hacked to become a controlling access point.

      Imagine the rib-cage expander turning into a rib-cracker, or a circular saw becoming a hacker.

      Hmmm, slash image word/word image: concept....
    • Just keep a checklist, a real, live checklist on paper, and check off every tool as you locate it before closing. That way, no chips will malfunction and not be detected, resulting in an instrument left in the body.
      • by Wudbaer (48473)
        Which is exacly how it is (or should be) done, and yes, I am a MD by training. The OR nurse assisting the docs during the operation opens a certain amount of surgical instrument etc. kits with a clearly defined number of items in it. It is one of her responsibilities to keep track of the number of instruments she gives to the doctors as well as the number she is getting back and ones that get "lost" outside the patient (dropped to the floor, given to a third party outside the operating team, e.g. to pass ti
    • I am the poster of the article. TFA says that there will be many safeguards taken to help prevent this kind of accident, but I wrote after because the testing they have done so far has been done after closing.
  • Or do what prisons do and have them outlined so they are put back in the spot they need to be in.
    • I don't think doctors would want to work in the PMITA Surgical Suite.
    • Because you can't manufacture and sell "common sense."

      Seriously: take any application or tool that you manufacture or market, re-paint it (or re-style the GUI) in red, white, and shades of chrome, stick a friggin' caduceus [american.edu] in the upper right hand corner, then sell it into the Medical Industry as being "expressly configured for Doctors," jack up the price by a factor of SEVEN, and watch 'em fly outta your warehouse.
    • You're trusting the counting ability of the same industry that spawned health insurance and HMOs, and tacks an extre $30 to your bill if you ask for a Tylenol?
    • They do count them. Usually multiple times by different people. However, eventually someone will screw up (especially during a marathon operation lasting many hours).

      One of the very first issues I had to deal with as a new attorney working in-house for a hospital were the hysterical parents of a patient who was going to have a "retained sponge" removed a few weeks after a C-section. Don't get me started on how screwed up that term is ("that crafty patient tried to steal a sponge by retaining it in her ute
    • Not a chance: you cannot mix the bloodied, used instruments with the sterile new ones on the shelf, they have to be discarded or autoclaved, and many of them are single use or packed in sterile containers which have no tool-secific shape.
    • ...because after the scalpels been in your gut for the duration of the surgery I assume they dump them in a tin of some sort of strong disinfectant. You want them to neatly lay out there nice gorey used gut digging, spooning and screwing tools back on the tray?

      If they did that, we'd end up with surgeons refusing to set the dinner table at home because it reminds them of work. Think of the consequences!
      • If they did that, we'd end up with surgeons refusing to set the dinner table at home because it reminds them of work. Think of the consequences!
        I was in the hospital over Thanksgiving one year, recovering from surgery. On Thanksgiving Day, my surgeon came in to check on her patients. I asked her if it was her job to carve the turkey for dinner. She said, "No, I'm too picky. I only use German instruments."
  • How about checking before you sew them up - you know - just in case you left something that you WON'T be using for that. Then you can do it agains afterwards of course.
  • by dduardo (592868) on Wednesday July 19, 2006 @02:20PM (#15744961)
    What happens if they forget the reciever inside the person?

    Doctor: Nurse, hand me the wand.
    Nurse: Don't know where it is.
    Doctor: Oh well, I'm sure I didn't leave anything inside.
    • What worries me is the guy [flickr.com] who already has an RFID tag in his left hand.

      Doctor: Oh shit!, we let something in his hand!
      Assistant: But Doctor! We didn't operate on his left hand, this was only a vasectomy.
      Doctor: ... This was a vasectomy?
  • Yea but... (Score:4, Informative)

    by gasmonso (929871) on Wednesday July 19, 2006 @02:21PM (#15744968) Homepage

    What if the hospital forgets to put the RFID chip in the instrument in the first place. It all comes down to accountability. Just count the damn tools before and after surgery. Seems simple to me. If there was a pliers before you started, then there should probably be one after you're done.

    http://religiousfreaks.com/ [religiousfreaks.com]
    • And of course it's totally impossible for the nurse who does the counting to miscount, especially after a 6-hour operation.
      • Write the number down, have 2 nurses do a count and keep counting until the numbers match, there are a million ways to prevent this sort of human error. RFID: the solution to EVERYTHING!!!
  • Or maybe? (Score:2, Insightful)

    by elzurawka (671029)
    they should use this [slashdot.org]
    if size matter, u cant been the size of Tomato Seed. All the tools could be put down on a sensor pad, and it could tell if everything has been returned, or have a running list of what is not on the pad ATM.
  • My Dog (Score:3, Funny)

    by lbmouse (473316) on Wednesday July 19, 2006 @02:24PM (#15744990) Homepage
    My dog has a very small RFID that I had the Vet intentional leave in him (name, address & phone number)... now my dog is suing me for violating his rights for privacy.
  • by dudeX (78272) on Wednesday July 19, 2006 @02:24PM (#15744994)
    that we have to have use technology to prevent this from happening?
    Why would surgeons (or assistants) think it's okay to leave a foreign object lying on top of an organ or tissue in the first place?! Also why is the surgeon in such a rush that s/he would be so sloppy?

    Maybe this would be more appropiate for battlefield sitautions where things can get hairy, but then again, it's pretty rare to do open surgery in the battlefield!
    • With "health maintainance organizations" ( insurance companies )
      in the driver's seat, doctors feel rushed to churn out as many
      patients as possible. So, I suppose they ( insurance companies
      and doctors ) see this as a way to reduce costs by reducing the
      time the doc spends at the table.
    • it's about lowering insurance premiums.
    • Around 1 in every 10,000 http://www.theregister.co.uk/2006/07/19/rfid_surge ry_debris/ [theregister.co.uk].
    • by LunaticTippy (872397) on Wednesday July 19, 2006 @02:49PM (#15745219)
      It sounds as if you're unaware that US hospitals are in a state of absolute crisis. It isn't the surgeon's fault, and it isn't their choice. They are forced to work back-to-back 14 hour shifts. Emergency rooms are having their budgets slashed, having increased business from uninsured patients who can't afford routine care, and have trouble keeping staff from the abysmal working conditions and low pay.

      Here [washingtonpost.com] is a good article on the subject. It claims the ER system is on the verge of collapse.

      Hardly thinking it's okay to make mistakes, these poor people are in a constant state of sleep deprived chaotic panic.

    • Tell that to my late father-in-law, who died from EXACTLY this problem.

      I'm sure that several members of his biological family would be happy to provide directions...

      All snarkiness aside, this happens far more often than the general public would like to believe. ONCE is too often and, with some tools, like sponges, X-ray scans are unrevealing. In surgery, certain items are thrown away during the procedures and that's where problems can arise, especially during long and involved processes. This is why the
    • by Wudbaer (48473) on Wednesday July 19, 2006 @05:29PM (#15746390) Homepage
      You have to be aware that the inside of the human abdomen is a very crowded and puzzling place. Lots of nooks and crannies small items can slip into, also the whole thing is constantly on the move due to the contractions of the digestive organs, beathing and certainly due to the doctors operating and mocing things around. Add a certain amount of blood and bloody water (you flush surfaces both to keep them from drying out (bad for the tissue) and to keep a clear field of vision. Add several hours of operating time for large operations and there is a clear risk to lose things inside the patient. A professional operating team will take several security measures to keep this from happening (see my other post in this thread), but there still is a considerable riskm even without haste and neglect (yes, I am a MD by training).
  • sterilization? (Score:5, Interesting)

    by Yonder Way (603108) on Wednesday July 19, 2006 @02:27PM (#15745014)
    How rugged are RFID chips? How are they going to hold up to being heated in an autoclave for sterilization?
    • I'm glad to see that I'm not the only who thought that surviving the autoclave would be a much bigger challenge.
    • They already have surgically implantable RFID chips. Vets implant them all the time. The same could be used for humans, but the reasons for doing so aren't as benign as with pets.

      My concern would be (not yet having read the FA ... yeah, I know this is /.) how well the chips can be detected on/in metal equipment. The chips lose their ability to communicate in a short distance and metal seems to really cut down the ability to detect them at all.
  • If the scientists want to continue shrinking as the summary mentions, they should camp out on the space-station for a few years.
  • by the darn (624240) on Wednesday July 19, 2006 @02:29PM (#15745048) Homepage
    Don't they use an autoclave or some such to sterilize the instruments? Can the RFID chips take the heat, moisture and pressue invloved in that procedure?
  • That you are paying a doctor quite a bit of money for an operation due to their expertice and yet they do not know how to remove their tools? Auto mechanics seem to know how to keep from leaving a wrench inside the engine that they had in pieces.

    Maybe I would be better off going to the auto mechanic for major surgery.
    • Ah, but the difference is that an auto mechanic usually has to buy his or her own tools.
    • How do you know auto mechanics don't leave tools inside? I'd imagine often it either wouldn't matter, or they would fall out in time. Even if someone did catch one, I doubt "Mechanic left rench in engine" would make the newspaper, whereas "Doctor leaves scapel in person" does everytime it happens.
      • How do you know auto mechanics don't leave tools inside?

        Long ago, I found one sitting on top of the engine of my airplane.

        I was selling the plane, and flew it to this particular place for an inspection. Typical pre-purchase inspection of an airplane includes a compression check of each cylinder in the engine. The wrench in question was one used to tighten the reinstalled spark plugs to a specific torque.

        I called and asked how they wanted me to ship it back. They wouldn't provide me a UPS/FedEx ac

    • by Dun Malg (230075) on Wednesday July 19, 2006 @03:31PM (#15745570) Homepage
      Auto mechanics seem to know how to keep from leaving a wrench inside the engine that they had in pieces.
      I have a really nice 3/8" drive Snap-On ratchet, extension, and 13mm socket that say otherwise.
  • Okay. But... (Score:3, Insightful)

    by Khaed (544779) on Wednesday July 19, 2006 @02:33PM (#15745080)
    Just count the damn instruments.

    Really. Car mechanics count screws.

    I count the screws when putting a computer together or doing work in it. I keep up with where each one goes.

    It didn't take me over eight years of college to figure this kind of thing out.

    "Okay, doctor, we used five clamps, but we only have four. We must have left one..."

    Duh? I mean, hello? You're a doctor. You're getting paid more than ninety percent of the population.

    Learn to count.
    • You can count instruments but a pile of bloody sponges is much harder to count. Besides, this solution is way geekier.
      • Bloody sponges shouldn't be hard either. They use things like the shoe holders that go on the back of doors. Each sponge gets it's own pocket and you count them that way. The few times I've observed surgeries everyone was meticulous about counting and recounting all the instruments and guass that were used.
      • I'm not saying "don't put RFID chips on them" or anything of the sort.

        Just, y'know, surgeons should learn to count. Or at least the nurse handing them their instruments.

      • Re:Okay. But... (Score:4, Insightful)

        by lazlo (15906) on Wednesday July 19, 2006 @03:37PM (#15745624) Homepage
        a pile of bloody sponges is much harder to count

        Maybe, but it's done. The last surgery I watched (my wife's C-section) they were extremely meticulous about sponges in versus sponges out. They double-checked the count of the number of packs-of-10 sponges in the room at the start, there was one person who it appeard had the sole duty of counting used sponges and putting them in little plastic strips with 10 sponge-sized pouches per strip. Then someone else double-checked that count. Then before they closed, they counted the number of unopened packs and added the number of plastic strips, and made sure it was the same as the number they started out with. It seemed like a very well-thought-out way of avoiding that exact problem.

        Actually, as far as uses of RFID go, this seems like a fairly good one. The incremental cost of adding RFID to surgical instruments is trivial, you aren't working against a dedicated attacker trying to subvert your system, and although the number of instances of instruments left in patients is fairly low, this system, I would think, would probably cost-justify itself given the cost-per-incident-avoided.

    • Re:Okay. But... (Score:4, Insightful)

      by elzurawka (671029) on Wednesday July 19, 2006 @02:43PM (#15745164)
      If your in a emergency room, you might have hundreds of tools that you need quick access to. You dont have time to count, or probobly the mental dextarity to remember to count, the number of tools your using when your trying to save someones life.
      You need to concentrate on what your doing, not on how many clamps you've used.
      • Considering the side effects of leaving a clamp in a person: surgeons sure as hell better know how many clamps.

        Generally, as far as my knowledge of this goes, the doctor isn't reaching out and grabbing the tools himself -- a nurse stands nearby. I'm not a surgeon. I'm just giving my opinion.

        but I don't want to be operated on by someone who, with the aid of other surgeons and nurses, can't count.
      • Re:Okay. But... (Score:3, Insightful)

        by Shadowlore (10860)

        If your in a emergency room, you might have hundreds of tools that you need quick access to. You dont have time to count, or probobly the mental dextarity to remember to count, the number of tools your using when your trying to save someones life.
        You need to concentrate on what your doing, not on how many clamps you've used.

        That is why there are assistants! Seriously dude, you've got people, even in ER, who handle the tools and are not operating. Doctors don't just say "scalpel" and they magically appear

    • Re:Okay. But... (Score:4, Insightful)

      by gstoddart (321705) on Wednesday July 19, 2006 @03:06PM (#15745362) Homepage
      Just count the damn instruments.

      Really. Car mechanics count screws.

      Well, I suspect in the case of surgeries, if something starts going wrong, they're probably more busy trying to keep you from dying than remembering if that was the 5th or 6th hemostat of the day.

      When all goes perfectly normal, this might be easy. But when it starts going all to poo, I suspect that's a context in which careful counting can go by the wayside. Things probably get a little frantic when the patient is about to die.

      (Admittedly, on a 'routine' procedure where everything goes as expected, I would think your solution would be effective and obvious. ;-)

      Cheers
    • Here is the problem with "learn to count":

      Nurse: 127, 128, 129...
      Doctor: Nurse! The patient needs suction over here, now!
      Nurse: Yes doctor. [begins suction]
      Doctor: Thanks, that's good for now.
      Nurse: 12.. uh.. what number was I on? Oh.. 129, 130...

      When she should have started at 130.

      Operating rooms are not an ideal environment for the attention to detail required to remember counts for potentially thousands of operating tools, not to mention sponges, etc. It usually is not the doctors counting the tools,
      • Simple solution.

        A small device the nurse clicks a button on for each tool. Or have someone who *does* just count if it's that big of a surgey.
        • A small device the nurse clicks a button on for each tool.

          I saw a documentary once on this problem, and that was one of the solutions they tried. I don't recall how successful it was. They also did a trial of using RFID tagged items, and that proved pretty successful. Of course, it really needs to be trialed over the span of several dozen thousand surgeries to see how successful it'd be in the long run.

          Or have someone who *does* just count if it's that big of a surgey.

          In an age of shrinking personnel

    • Except in some instances I'm guessing that things are a bit rushed, in which case you'll be calling in people, equipment, etc. Generally mechanic-work has all the tools readily available, and in any event they're generally counting that the number of screws that came out also go back in. If the doc forgets to put something back that should have been, it's a bigger problem that RFID isn't going to fix.
  • by digitaldc (879047) * on Wednesday July 19, 2006 @02:38PM (#15745122)
    ...I keep getting an unexplained $248.99 charge at the Target express line!
    • ...I keep getting an unexplained $248.99 charge at the Target express line!
      ... and you wondered why it kept showing up on the receipt as "SURGCL STEEL CHST SPRDR"
  • Turn it around (Score:3, Insightful)

    by Bruce Perens (3872) <bruce@perens.com> on Wednesday July 19, 2006 @02:39PM (#15745138) Homepage Journal
    I'm more worried that they won't forget to put the RFID in the patient before they close the body.

    Bruce

  • by gardyloo (512791) on Wednesday July 19, 2006 @02:45PM (#15745181)
    Warwalking. "Hm... Spidey-sense tingling. w00t! Free wireless!"
  • WTF? Why do they need a superduperwonderfulelectrogadget to solve this problem?
    The easier & cheaper solution involves a pencil and a piece of paper.
    Do you have the scalpel? Check. Do you have the bar of soap? Check.
    • WTF? Why do they need a superduperwonderfulelectrogadget to solve this problem? The easier & cheaper solution involves a pencil and a piece of paper. Do you have the scalpel? Check. Do you have the bar of soap? Check.

      Cripes, is this really that hard to understand? Currently, the way they do it is have people counting the instruments, through all sorts of redundant methods. Still, because it's humans doing the work, the system is subject to occasional human error. Your solution of "pencil & paper,

  • If the chip is literally inside the tool, it seems to me that it would be hard to sense the chip.

    If it's just glued very strongly onto the surface of the tool, then it could come off inside the patient.

    And as for things like sponges... which proverbially (I'm saying "proverbially" because I have no idea whether it's true) are among the commonest things to leave inside, well, they're basically soft, aren't they, so you'd think it might not be that hard for the chip to come loose from the sponge.

    I don
    • Ah. Well, the good news is that TFA says I'm right about sponges being common things to leave in the patient.

      And the bad news is I've made it crystal clear that I didn't read TFA before I wrote my comment.

      But the good news is I think my comment is reasonable, anyway.
  • SO does this mean that items like gauze/cottonballs etc... will now have RFIDs embedded in them?
  • So the scientists are "hoping" they shrink in size? Since when did scientists get all faith based on us? It's time to stop "hoping" and start doing, folks.
  • by TheDarkener (198348) on Wednesday July 19, 2006 @02:57PM (#15745287)
    A computer technician. I know, I know, they are very much different...but they're actually the same, too. ;)

    Tech 1: Ok, just got done replacing the power supply in this bad boy, let's fire it up.

    Tech 2: Hey, where's my screwdriver....

    *ZOT*

    Tech 1: Oh, wait a minute.... oh, ok here's the problem, I left this screwdriver lying on the motherboard and it fried the motherboard!

    Tech 2: Shouldn't you have looked inside the case before you put the cover back on?

    Tech 1: Maybe we should put RFID tags on our tools so I won't do this again...

    Tech 2: .... *SLAP*

    How about, stop smoking the sticky-icky right before you work on very important things (I.E. computers, human bodies)...
  • FTA, "The biggest current stumbling block is the chip's size".

    These folks should talk to HP. According to /., they are making them the size of a grain of rice [slashdot.org] or was it a tomato seed [slashdot.org]?

    I think this is another great example of how the technology can be used for good.
  • Do they really need a precise count?
    The number of things left in the patient should be zero.
    I'd think a normal metal detector could detect most tools without modification,
    and it wouldn't be that hard to add a bit of steel to the sponges.

    The same technology they should be using at the MRI machine.

    -- Should you believe authority without question?
  • by hurfy (735314)
    Is this the new way to force us to read the article...make the headline/summary inaccurate or misleading??

    I guess sponge is a tool in the broadest sense, but they really talk about sponges. I was thinking instruments. Trying to guess how the hospital could imbed anything into stainless steel, hehe.

    Makes more sense as the sponges are the item that needs it most. Needles and blades usually get put on a magnetic card with numbered slots. If you opened 6 there should be 6 used on card/box before you toss it ;)
  • ...should be biodegradable.
  • Inspector: Hmmm...that's odd, the scanner says scapel

    Me: How can it be so precise?
    Inspector: Are you carrying a scapel?

    Me: No - of course not

    Inspector: We have to strip search you - you know...

    Me: Okay...(follows them into the white polstered room)

    Inspector: Now - strip!

    Me: (Doing my strip routine)

    Inspector: Man - you're ugly!

    Me: What was that?

    Inspector: Erhm...I said....man You're lucky! You have no scalpel on you!

    Me: Oh, fine...can I go now?
    Inspector: No...my RFID reader says that y
  • Eliminate the risk of your medical charts getting lost or swapped with other patients. Carry your medical information in an RFID implant.

    Name: Fang
    Colour: Black, White, Tan
    Weight: 27 Ibs 3 Oz
    Height: 23"
    Pulse Rate: 118
    Temperature: 102 deg F
    Condition: Intestinal worms, bad breath.
    Handling notes: May bite if stared at.
  • by kris_lang (466170) on Wednesday July 19, 2006 @05:39PM (#15746454)
    Hey

    Let me give you a quick summary of procedure in an operating room, as regards instruments and instrument counts:

    Every surgeon has a card (usually, literally a 3"x5" index card) with preferences and requirements for each particular operation they perform: for an appendectomy they may need a Saxony brand defrobulator and a #10 blade as the specialized items and they like to close the bowel with 2-0 (aka 00) chromic (made from catgut) and they like to close the skin with 3-0 poly and 6-0 purebread (usually used in cataract / ophthalmic procedures, but hey Underdog spoke out to me.) There might be three each of any particular scalpel blade they need and howsoever much of those stitches threaded on the appropriate types of needles: curved, straight, cutting, non-cutting, etc. There will also be the appropriate number of hemostats, deblooduclips, etc, that are necessary for the procedure. For a different procedure, say a vasectomy,... okay, let's say cranial burr hole or craniotomy for decompression of subdural for all the guys wincing out there, they may want a hand-twist drill, plastic clips for holding the scalp edges, good thick chromic for the fascial closure, etc., so a different set of objects.

    There will be a minimum of two nurses assisting with the procedure, a scrub nurse (scrubbed in to the operation, hence the name) and a circulating nurse. The circulator will make sure that the tray with all of the equipment is already there before the operation starts. Even before the surgeon scrubs in, the scrub nurse will also go over the instruments and objects and de a pre-op count: making sure that there is enough of every item and making a note of the number of objects, including sponges which are actually small pieces of cloth uses to sponge up that red stuff that leaks out humans when they're cut. These cloths usually have a radio-opaque fiber sewn into them so that when they're accidentally left in the human body, something is easily apparent on X-ray or C-T; cotton is not so opaque to x-radiation.

    The nurses know that there are int counts[i] of char* objects[i] for each of the different objects. The preop counts array is usually written on the form the circ nurse fills out. Then all of the really good fun stuff
    happens, and as it is almost all done and the surgeon is getting ready to close, the scrub nurse starts a pre-close count: counts that the number of needles handed back by the surgeon plus the number of unused needles adds up to the number that was in the pre-op count (for each variety of pre-threaded needle). They also check that the number of clean unused sponges (whether 1"x1", 2"x2", 0.5"x0.5", etc) added to the number of blooded sponges handed back by the surgeon off of the surgical field also add up to the number expected. All of the other instruments: retractors, hemostats, bolt-cutters (used to cut the titanium bars in the fun ortho cases), machetes (used in amputations...), are also counted to make sure none are missing. (sometimes, even retractors fall into the morbidly obese and are missed.)

    If the pre-op count is not correct, there is a frenzy as the doc looks inside the patient (or, if the closing is happening real fast, the doc says find it find it and the nurses run around checking the little bits on the floor and mopping up with surgical cloths to see if a needle fell onto the floor or onto the surgeons' or nurses' gowns or even if the needle is stuck onto the bottom of the little blue booties the OR personnel are using to cover their hospital footwear.)

    If the count is correct, then the closing is done, and then the scrub nurse does ANOTHER final post-op count and rewrites it all down to make sure nothing was left behind.

    Amazingly, even in cases where stuff was left behind, the written records usually show that the count was correct: someone takes a shortcut and writes a copy of the list and it often isn't until the patient has an infection or a recurrent problems days, weeks, months, years down the r
  • by Slur (61510) on Wednesday July 19, 2006 @07:06PM (#15746860) Homepage Journal
    And of course, Junior Mints should come with RFIDs just to be safe.

"There is hopeful symbolism in the fact that flags do not wave in a vacuum." --Arthur C. Clarke

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