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A retained surgical instrument is an item that has been accidentally left inside a patient’s body from an operation. During a typical surgical operation, it is estimated that 250 to 300 tools are used. In more complicated operations, upwards of 600 tools are used. The more instruments used during an operation, the greater the likelihood that a surgical instrument can be inadvertently forgotten and retained. The number of retained surgical instrument cases is believed to be underreported as many nurses are discouraged from reporting due to malpractice and liability issues.

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Types of Retained Surgical Instruments

One of the most common types of retained surgical instruments is gossypiboma, or a retained sponge or towel. Gossypiboma is difficult to diagnose and can be easily mistaken for an abscess, especially after an extended amount of time has passed. Both abscesses and retained surgical sponges and towels show air bubbles on test results such as a CT scan. Furthermore, X-rays often fail to provide clear results or solid evidence. Symptoms can be so vague and inconsistent that the condition is not diagnosed for several years.

Other types of retained surgical instruments include:

  • Gauze
  • Clamps
  • Tweezers
  • Forceps
  • Scopes
  • Needles
  • Safety pins
  • Knife blades
  • Scalpels
  • Scissors
  • Measuring devices

 

Complications of Retained Surgical Instruments

Complications of retained surgical instruments can range from harmless to fatal. In some cases, symptoms and manifestations of a retained surgical instrument can be mild without causing related health complications. However, serious complications can develop. Retained surgical sponges can rot, collect pus and bacteria, and cause ulceration that grows increasingly life-threatening. Sharp objects such as a blade or scalpel can lead to organ and blood vessel punctures that cause internal bleeding.

One of the main complications noted is the excessive costs associated with removing a retained surgical instrument. Once a retained surgical instrument is detected, additional surgery is typically needed. Occasionally, misdiagnosis of a retained object can lead to unnecessary extreme surgery that uses excessive money, time, and resources of both the patient and the medical facility. Additionally, time spent removing a retained surgical instrument subtracts from time that can be used to treat other patients with potentially more urgent conditions.

Methods for Prevention

While retained surgical instruments are classified as a preventable medical error that should never occur, it is estimated to occur in roughly 1,000 to 1,500 abdominal surgeries. One of the most common methods used to prevent retained surgical instrument occurrences is counting. Counting requires that all objects involved in an operation are counted before and after the surgery has taken place. However, this prevention method is not 100% effective as it is prone to human error.

While metal tools such as scissors and tweezers can be seen in an X-ray, new technologies are being developed to reduce the occurrence of retained surgical instruments such as sponges and towels. In radiopaque marking, sponges are soaked with“radiopaque marker” before the surgery. The radiopaque markerallows them to be easily seen on a radiograph. Barcode scanning systems became available in 2006 to take inventory of sponges. Radiofrequency systems use a tag inside sponges that can be detected from wands held against the patient’s body.

 

Sources:

Allen, George. “Preventing retained surgical instruments.” AORN Journal Apr. 2008: 833+. Academic OneFile.Web. 29 Nov. 2012.
Feldman, David L. “Prevention of Retained Surgical Items.” The Mount Sinai Journal of Medicine, New York.78.6 (2011): 865-871. MEDLINE with Full Text.Web. 29 Nov. 2012.
Gibbs, Verna C. “Retained Surgical Items and Minimally Invasive Surgery.” World Journal of Surgery. 35.7 (2011): 1532-1539. MEDLINE with Full Text.Web. 29 Nov. 2012.