Surgical Tools to Include RFID

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."

Yea but...

[gasmonso]

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]

Re:How common is this problem...

[Mikeeee84]

Around 1 in every 10,000 http://www.theregister.co.uk/2006/07/19/rfid_surge ry_debris/ [theregister.co.uk].

Re:Why not just count them?

[Antique Geekmeister]

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.

Re:Okay. But...

[mph]

But the sponges won't be getting RFID chips anyway, so you still have the same problem.

Huh? TFA was about sponges with RFID chips!

Re:How common is this problem...

[misterhypno]

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 "layout and count" solution proposed earlier by someone else won't work - some stuff gets thrown out and simply cannot BE counted!

When a surgeon has been on his or her feet for fifteen or twenty hours straight, doing highly technical work, demanding pinpoint precision, under life-or-death circumstances, it is relatively easy, at the end of the job, for the adrenaline to drop off and fatigue errors to happen, even in the best of circumstances and with the best in the business, which is exactly what happened in my father-in-law's case.

Lee Darrow, Chicago, IL

Re:Common occurrence?

[Dun Malg]

Expect it to become more and more common as surgeons become even more painfully overworked. It's not their fault. I blame a bizarre system of high spiralling costs combined with drastic costcutting.

Don't forget the AMA, which tells medical schools how many doctors they're allowed to graduate every year. They've been artificially limiting the doctor supply from the beginning. If too many doctors are allowed, it might end up like (say) Austria, where you can wander in to a doctor's office and have a mole removed without an appointment for forty bucks. Heaven forbid the "noble" profession of doctoring should be reduced to what it really is, that of a "biologcal mechanic". It's the same moronic mindset that continues to allow the practice of hazing in the form of "residency".

Re:An even better idea!

[Wudbaer]

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 tissue samples or excised organs, tumor parts etc.). The same applies for gauze pads, surgical cloth etc. Gauze particles and cloth also have either metallic tags or markings that show up on X-rays on them to be able to locate them either after the fact or, in difficult cases where you know something is missing but can't find it, before clothing the patient using a portable c-beam x-ray machine.

Nevertheless both the nurses and the docs are only human and work often inhuman working hours under extreme pressure, so in spite of all those measure it still can happen that surgical items remain inside the patient.

Re:How common is this problem...

[Wudbaer]

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).

the non-ISO compliant Operating Room

[kris_lang]

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

But what if.....

[ChestyLaRueGal]

say a drill bit breaks off inside? My grandmother has several pieces of drillbit stuck in her wrist from sugeries. Fancy RFID technology isn't helpful there.