Types of Instruments Left Behind
Surgical sponges are among the most common instruments left behind. Needles, scissors, clamps, tweezers, suction tubes or tips, forceps, scopes, laser guides and measuring devices are other instruments that may be left in the patient after surgery.
Unretrieved device fragments, or UDFs, are parts of medical devices that break off or disconnect and may be left in the body after the procedure is done.
Frequency of Occurrence
The frequency of incidents in which surgical instruments or parts of medical devices are left behind is not actually known. Some figures suggest it occurs very rarely, but other studies indicate it may be as high as 12% of procedures. Collecting data on the incidents is difficult because the patient may have no effect at all from a retained instrument. It is thought that hospital personnel may be unwilling to report lost instruments because of liability.
Causes of Retained Instruments
It is not always poor management and procedures that can cause the phenomenon of retained instruments in patients. A New England Journal of Medicine study cites hectic emergency conditions and excessive body mass in the patient as the two most common causes for retention of medical instruments. A hectic medical environment increases the risk of a bad count both before and after procedures. High body fat index increases the likelihood that sponges and other instruments can be overlooked before closing wounds. These two circumstances should raise flags for additional care when doing medical procedures.
Consequences of Retained Instruments
Retained instruments and UDFs can cause local tissue reactions, infection, perforation of organs, obstruction of blood flow, blood clots and even death. Sometimes, a retained instrument may not cause any symptoms at all. Discovering the retained instrument occurs in a number of ways. Some patients may experience pain after a surgical procedure that has not have an organic cause. Exploratory surgery may discover the instrument. Other times, a retained instrument is discerned on an x-ray or other diagnostic procedure. At other times, the patient may trigger alarms at airport screenings. The instrument can cause a sudden, medical emergency, during which it is discovered. Whenever a patient has unexplained pain soon after a surgical procedure, a retained instrument should be suspected.
Procedures To Prevent Retained Instruments
To avoid the possibility of retained instruments from surgical procedures, personnel should make roper careful counts of all instruments before the surgery, any time a cavity within a cavity is closed, at the beginning of wound closure and at skin closure at the end of procedures. These counts should be done audibly and in teams of two people to ensure that the count is accurate. Particular care should be taken at the change of shifts to avoid miscounts. Personnel should report discrepancies in the count immediately through the proper channels.
Jonathan Randall writes on legal issues, such as Medical Equipment Fraud, Intellectual Property, International Business Law, Patent Law and other topics as well.