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Sponge, Needle, Instrument Counts,
Operating Room Resources

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The Retained Surgical Sponge, Agency for Healthcare Research and Quality:"Although less likely to garner public notoriety, errors relating to the failure to remove surgical instruments at the end of a procedure, (ie, needles, knife blades, electrosurgical adapters and safety pins) or sponges (known as gossypiboma; gossypium: Latin, cotton; boma: Swahili, place of concealment) are no less egregious than the better known mishaps such as "wrong-site surgery" (see Subchapter 43.2). Retained materials may cause an acute foreign body reaction with local or systemic signs that prompt investigation and reoperation. Alternatively, a fibrinous response may be elicited, and the retained instrument or sponge may become apparent some time after the original surgical procedure either serendipitously, or via fistulization into local structures.1"
http://www.ahrq.gov/clinic/ptsafety/chap22.htm

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Gossypiboma - Retained Lap Sponge, Imaging Cases of the Week:"This 59 y/o male was seven days post op cystectomy and ileal conduit formation. A KUB was performed because of decreasing urinary output and persistent left flank pain. Retraction of the left ureteral stent is apparent. The more important finding, while not likely accounting for the symptoms, is the retained lap sponge in the right mid abdomen. The patient's wound was reopened and the lap sponge removed without incident. At this time the retracted ureteral stent was also repositioned. Radiologists must always remind themselves to look at the whole film and observe ALL the findings. A familiarity with the x-ray appearance of sponges and other instruments and accessories used in the operating room is a helpful adjunct to interpeting post op films. While retained surgical implements can be diagnosed in a variety of ways(6-12), I recommend you spend some time x-raying or fluoroscoping them. It can be an interesting and rewarding way to spend a rainy day!"
http://home.earthlink.net/~radiologist/tf/050800.htm

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case report: Retained surgical sponges, a denied neurosurgical reality? Cautionary note, Neurosurgical Review:"Surgically acquired foreign bodies are well known but not widely reported. Only seven articles pertaining to this subject were found in the current neurosurgical literature. Are they a denied neurosurgical reality? In this report with a concededly provoking title, the authors elucidate clinical and medicolegal aspects of retained surgical sponges, with emphasis on spinal procedures."
http://www.unboundmedicine.com/medline/citation/11339468/Retained_surgical_sponges_a_denied_neurosurgical_reality_Cautionary_note_

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Gossypiboma revisited: a case report and review of the literature, The Royal College of Surgeons of Edinburgh:"Gossypiboma (retained surgical sponge) is a rare but preventable occurrence. In this case it presented as a chronic abdominal mass which simulated a primary small bowel tumour. The findings on pelvic ultrasonography were typical for this condition and the role of plain abdominal radiology in the gynaecological patient are highlighted."
http://www.rcsed.ac.uk/journal/vol43_6/4360016.htm

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Imaging of Retained Surgical Objects in the Abdomen and Pelvis, UCSF School of Medicine:"Retention of surgical objects in the abdomen or pelvis occurs with a frequency of 1 in 100 to 5,000 operations, and accounts for 50% of malpractice claims for retained foreign bodies [1, 2]. A retained surgical sponge or swab is also known as a gossypiboma, derived from gossypium (Latin; cotton) and boma (Swahili; place of concealment). Clinically, retained sponges may be asymptomatic or result in a granulomatous response with abscess development, intestinal obstruction, or fistula formation. Radiologically, gossypibomas may be confused with post-operative collections or tumors, particularly with the increasing surgical use of absorbable haemostatic sponges to control hemorrhage. In order to provide accurate interpretation, radiologists need to be familiar with the imaging findings of both inadvertent and intentional postoperative surgical objects."
http://www.radiology.ucsf.edu/patient-care/patient-safety/retained-surgical-objects

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The Stowaway Sponge, American Scientist:"A surgical sponge is an item named for its function, not its appearance. A gauze pad, typically four inches by four inches but sometimes larger, it's used to soak up blood during operations, and then removed from the patient before the wound is closed up. Usually, that is--but not always."
http://www.americanscientist.org/issues/sciobs97/sciobs97-09sponge.html

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Nursing Malpractice Cases:

May 23, 1999: Sponge Count Off, Patient Develops Sepsis, Surgeon Blames Nurse.
Sponge Counts are a basic and critical safety measure during a surgical operation.  In this case, the standard three counts were not performed.  A sponge was left in the patient that would later lead to infection.  When the issue went to court, the surgeon claimed "it was not his responsibility" to keep track of the sponges. Johnston v. Southwest Louisiana Assn. 693 So. 2d 1195 –LA (1997)

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InspirationalNursing.com:"InspirationalNursing.com. Touching Poems, and Inspiring stories that touch the heart and occasionally bring a tear to your eye. Affection, Ambition, Angels In Our Lives, Animals, Babies, Bereavement, Caring, Caring, Children, Christian Stories, Christmas, Computers & The Internet, Death, Dependability, Determination, Dying, Easter, Emergency Medical Services (EMS), End of Life, Etc., Friendship, God's Creatures, Grief, Holiday Thoughts, Honesty, Hospice Poems, etc."
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Jocularity.com (Former home to the Journal of Nursing Jocularity (JNJ)):"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."
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Legalnursingconsultant.com:"This website is intended to be a resource for Legal Nurse Consultants, Attorneys looking to use their services, and nurses looking to enter the field of Legal Nurse Consulting. On our site you'll find a directory of LNCs by state and specialty."
http://www.legalnursingconsultant.com

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Nursinga2z.com:"It is our intent for this Alphabetical, A to Z index to be a comprehensive listing (In Progress) of Nursing-related resources on the Internet. It is indexed by Google and fully searchable."
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Nursingdiabetics.com:"Welcome to NursingDiabetics.com. Here you will find information on all aspects of Diabetes, a disease that afflicts millions of people world wide. I'll be adding pages as fast as I can research the information so remember to bookmark this page and return."
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Nursingdiscussions.com:"This website will be a portal to Nursing Discussion boards throughout the Web. If your site has a discussion board we don't have listed here, please contact us."
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Nursingentrepreneurs.com:"Nationwide Nursing resource to nurse entrepreneurs looking to nework and start home based businesses. On it you will find links to small and large business related resources."
http://www.nursingentrepreneurs.com

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Nursinghumor.com:"Nursing & Medical Humor. Find hundreds of jokes and links to sites that will make you smile. Therapeutic Humor Associations, Battle of the Sexes, Bedside Nursing Humor, Brain Teasers, Clowning, Clowns, Therapeutic Humor & Comedy Links, Dental Humor, Emergency Department Humor, General Nursing Humor, Geriatrics, Senior Citizen, etc."
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Send comments and mail to Andrew Lopez, RN

Created on Saturday, May 22, 1999

Send comments and mail to Andrew Lopez, RN
Last updated by Andrew Lopez, RN on Wednesday, January 30, 2013


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