The case is winding down and you and the scrub tech start the closing count.
dun, dun, dun!!!
A sponge is missing.
This can be for a variety of reasons. It’s on the floor, it’s held in place against the patient by someone’s abdomen, it’s under the mayo stand, it’s in the mess of the back table because someone, looking at you surgeon, has been impatient and rummaging through the carefully set up table.
Or it’s in the abdomen/cavity/joint where someone, again looking at you surgeon, tucked it to control bleeding, or to get it out of the way, or used it to sop up fluids of some kind and forgot about it.
There are steps to follow
- check the floor
- check the kick bucket
- count again
- if you find it, count again
But you are still missing a sponge. Tell the surgeon to stop closing and announce that a sponge is missing.
9 times out of 10 a surgeon will say immediately when told the count is incorrect, “Well, it’s not in the wound.”
Often without looking.
Stare at them and if they continue to close, ask nicely for them to examine the wound for the missing sponge. If they continue to close, ask not so nicely.
Get anesthesia involved if you have to.
The scrub tech can also be useful here by declining to hand them requested items.
In a huff, the surgeon will search the cavity/incision/abdomen and find the sponge, tucked away safe.
Sheepishly they will announce, “Found it!” And they will continue on closing.
Feel free to raise an eyebrow in disbelief.
And return to counting. Beginning with sponges.
Counting is a process, after all.
Next week I’ll write about if the sponge is truly missing, what then?
Dispatches from the Evening Shift 