Sponges/dressing/drains/immobilization

Question 1

Surgical sponges?

Answer 1

Variety of shapes and sizes

Main component is cotton

Radiopaque indicator in each sponge

Type used depends on surgical wound and how it will be used
- packing? Soaking up blood?

All must be accounted for before use and before closing

Question 2

Common surgical sponges?

Answer 2

Lap sponges 
4x4 sponges 
Surgical peanuts 
Surgical cottonoids 
Tonsil sponges

Question 3

Most common item and place for RSI?

Answer 3

Surgical sponge - most common

Abd + pelvis - most common place

Question 4

Count responsibility?

Answer 4

Team responsibilty

Circulator
Scrub
Surgeon + assist
Anesthesiologist

Question 5

Counting key takeaways?

Answer 5

All team memebers responsible
Minimize distractions/noise/Interuptions during counts
Use consistent counting methods
Discrepancy - immediate action to locate item
Systems approach to improve prevention of RSIs

Question 6

When to count?

Answer 6

Before procedure 
When adding new items
Before closing a cavity within a cavity 
When closure begins 
Conclusion of procedure 
Anytime suspected discrepancy 
Whenever nurse is permanently relieved

Question 7

Events of RSI?

Answer 7

Complications - infection, reoperation

The joint comission - #1 top ranking with falls as negative patient safety event

Team training - system/human factors

Question 8

Best counting practices?

Answer 8

Involves all team members
Standardized count process
Seperate all items 
Count audibly
Record counts
Count items according to the # of items its packaged with
Keep allitems in OR until counts completed
- included linen and waste containers

Question 9

What sponges should be counted first?

Answer 9

Sponges on sterile field before sponges in a kick basin

Question 10

What to do if count discrepancy occurs?

Answer 10

All team members help
Recount the items when missing item is found
If not recovered intra op imaging to rule out retained items before closing if pt stable
If pt unstable take xray as soon as possible in necxt phase of care

Question 11

What to document about count discrepancies?

Answer 11

All actions taken to recover item 
Description and location of item if known 
Pt notification and consultation 
Plan for follow up
Who counted 
Where discrepancy was and resolution 
Surgeon notification

Question 12

What do drains do?

Answer 12

Provides exits for:

• air to prevent air accumulation in surgical site
• fluids (blood, bile, pus) to prevent collection in surgical site

Question 13

Simple drains?

Answer 13

Permit free dlow through the drain to a dressing and use gravity to facilitate drainage

Ex. Penrose, T tube

Question 14

Closed drains?

Answer 14

Uses suction to draw to draw fluids

Ex. JP, Hemovac

Question 15

Chest drain?

Answer 15

Drains air, blood, pus or lymph from pleural cavity

• prevent re entering of fluid and air
• allows lungs to re expand
• restores normal negative pressure intrapleural pressure
• one way movement out of pleural cavity from water seal

Question 16

Indications for chest drain?

Answer 16

Pleural effusion
Pneumothorax 
Tension pneumo
Hemothorax
Open heart sx
Multiple rib #
Flail chest

Question 17

What is a dry seal system?

Answer 17

Sutured into place and dressed

Evacuates air + fluid 3 ways

• positive pressure
• gravity
• suction

Question 18

Negative wound therapy?

Answer 18

Wound is filled with one or more drsg specific sterile sponges and sealed with occlusive drsg material

Device is closed, sealed system thst helps remove excess fluid from the wound via suction tubes into a liquid collector

Indicated for complex wounds
- diabetic foot ulcers, open abd wounds

Question 19

Documentation for drains?

Answer 19

Type
Size
Serial #
Location
Description and amount of drainage 
Functionality

Question 20

What do dressings used for?

Answer 20

Absorb drainage
Assist in hemostasis 
Apply medications 
Provide aesthetic appearance 
Support, splint or immobilize

Question 21

Surgical dressings.

Primary vs secondary?

Answer 21

Primary - applied directly over wound site and is a non adherent material

Secondary - cover primary dressing

May be secured with soft gauze rolls, elastic bandages and tape 

Or may be packing
- iodophor or plain gauze

Question 22

Splinting an extremity?

Answer 22

After primary and secondary dressing have been placed
Wrap w/ rolled gauze/padding before splint applied
Variety shapes/sizes
Plaster or fiberglass

Question 23

Are splints circumferential around extremity?

Answer 23

No

Need to be easily removed
Can be tightened or loosened
Allow for observation of wound

Question 24

When mught casts be applied?

Answer 24

When edema decreases

With primary and secondary dressings on

Fiberglass/plaster

Question 25

Examples of immobilization devices?

Answer 25

Shoulder immobilizer Abduction pillow Splint Cast

Question 26

What to document about dressings?

Answer 26

``` Type Ointment/medication Location Immobilization devices Elevation of limb and with what equipment CWMS checks Functionality of device ```

Question 27

Who can perform counts?

Answer 27

``` One always needs to be perioperative RN Scrub nurse Circulator 2 circulators may count if no scrub Surgeon Certified dental assistant ```

Question 28

Full vs partial count?

Answer 28

Full surgical count when body cavities are entered or may be entered during surgery Partial surgical count when a body cavity will not be entered

Question 29

When is a full count done?

Answer 29

Initial count when body cavities are entered or may be entered When closing body cavity Any closure with an incision of 2inch or more

Question 30

When is partial count done?

Answer 30

Initial count when a body cavity will not be enetered Prior to closure of a cavity within a cavity Done at closure of skin Done for each incision