Counting basics #1-sponges

New series alert: Counting Basics.

I go on and on and on about counting. I thought I would take this time and this platform to introduce people to what exactly I mean.

No. Not one, two. Buckle my shoe.

That is a nursery rhyme to teach toddlers how to count.

Prior to the start of a surgical case the circulator (that’s me!) and the scrub tech count.

What do we count, you ask?

Well, that depends on the kind of case and how many body cavities will be entered into.

Yes, there are more than one.

Basically, as the odds go up for leaving something behind, the count gets more layers. And by that, I mean more counts.

And the something that could get left behind gets its own category.

At the most very basic, we count sponges and sharps.

This is for every case that has an incision.

Yes. Every case.

No matter what the surgeon or the staff say.

Once upon a time, there was a patient who was coming in to have an incision and irrigation of what was thought to be a localized abscess that had developed after surgery. This was on a forearm, just below the AC, a bit laterally. And the lump that was on the patient’s arm?

A sponge that had been balled up very small, to about the size of a grape, and shoved in for whatever purpose at the time. And then forgotten. And missed on the count. Did the previous surgical team even count? No idea. Oh, they might have documented that they counted.

But did they really?

No way of knowing.

Much of the OR is built around the honor system. If an action is charted, then it had been done. Right?


There are several types of sponges. These can vary from the very little, the appendix tapes which are skinny enough to go into an appendix incision but long enough to be able to pull them back out again. There are ray-tecs sponges. These are thin sponges that are folded and open up to 4-inch by 18-inch single-ply sponge. They are called ray-tecs because they are x-RAY deTECtable. There is a seam of material that is visible on x-ray. And then there is a large lap sponge at 18 inch x 18 inch. These get their name from the type of surgery they were designed for, the LAParotomy surgery. Or a large incision into an abdomen, the laparotomy incision. They also have an x-ray detectable tail.

This is a run down of the basic sponge that must be counted.

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