• Have the radiologist review the film before it is called negative,
especially if the item is not found.
While the surgeons are doing that, the nurses should be contributing
as well with these steps:
• Tell the surgeon what type of sponge is missing.
• Ask the surgeon to repeat a methodical wound exam.
• Repeat the count; check holders to make sure there is only one
sponge per pocket; search the trash and linens.
• Call for additional personnel to search and call the nurse manager.
• Have the scrub tech search the field and drapes.
• Check sponge "departure" opportunities, such as around speci-
mens, the anesthesia trash and around the GI scope.
• Contact visitors who may have left the room.
4. Utilize radiological expertise
Radiology technologists and radiologists are the content experts in all
aspects of radiology. When the surgical item count is incorrect, you
should ask for X-rays to help find the missing item.
Usually, everybody knows what they're looking for. For example, if
an X-ray is obtained to look for a kidney stone in the urinary tract, the
radiology tech knows to center the image to see the kidneys, ureters
and bladder. But when a surgical item is missing in the abdomen, even
though the surgeon knows it's somewhere in the abdomen, they don't
know exactly where it is. The radiology tech can't just take an X-ray
of the upper abdomen or lower abdomen, sometimes they have to
take multiple X-rays of the entire abdomen.
So, when radiology techs come into the OR, they are members of
the OR team and should share their imaging expertise to find the
missing surgical item. If they need further help, they should call radi-
ologists who are content experts in how to optimize an image or they
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