We in the OR count 2 kinds of things. There are the instruments. And then there are the soft goods. By soft we mean anything that is not an instrument.
In this series, I have covered sponges, the real soft of “soft goods” and needles, a not-so-soft part. Today I will be discussing other things that are included in the soft goods that are not sharp.
I considered adding this next one to the sponge count post but it doesn’t count, not really.
There are things that are soft that are not sponges.
These encompass things that have different uses.
There is the KD, aka the Kittner, aka the peanut. It is essentially a wad of sponge that is used clamped into a tonsil clamp, aka the Schnidt clamp. Well, was is a misnomer. If you take it apart, it is an itty bitty half-inch strip of sponge material that is rolled up very tight. It is used for blunt dissection or teasing away the layers of fascia. The reason they are called peanuts is because they are the size of peanuts.
There is the pattie sponge aka the cottonoid. These are strips of material that is not a sponge that is used to blot blood and other fluid away from a surgical site, not always an incision. They come in a variety of lengths, 1/4 inch to 6 inches, and a variety of widths 1/4 inch to 2 inches. And they come on cards in a predetermined number. 2, 5, or 10. This is dependent on the size and what is ordered for the department
Sometimes, especially in cardiac surgery, it is necessary to sew in a bolster along a suture line aka the retention bolster. These are little tubes that the suture is sometimes fed through and then secured. They are designed to distribute the tension along a suture line. Think of it like belt AND suspenders. These are can be little- 3/16th of an inch in diameter and up to 2 inches in length. But they are on the table and must be counted.
Sometimes in surgery, you need a strip of soft rubber. This is also known as the Penrose and can be used to hold important things, like veins or the inguinal cord during an inguinal hernia. This can and has been left behind inside a body cavity and therefore must be counted.
There are soft silicone rubber strips that are used to hold vessels such as arteries and veins, much like the way the above gently distracts and holds away the inguinal cord. These are called vessel loops and are 18 inches long. They come in a package of 2 and mostly come in 2 widths, maxi or mini. Again, they go on the back table and must be counted. If they are cut because they are too long. Surprise, each piece is countable. In a package of 2, and one is cut, this becomes a count of 3.
All or some or none of these can be on the back table. Both the scrub and circulator have to be aware of what is on the table. Yes, all of it. In many ORs, there is a large whiteboard that is visible from the field that is used for counting. Yes, yes, people will say that the whiteboard is too far from their seats and they’d rather keep the count on a clipboard.
Yeah, no. Don’t do that. The entire room needs to be able to see the count in real-time.