I am guessing that if you tag all surgical equipment with at least a bit of metal, you could use electromagnetic devices to determine if any such equipment happens to be still inside the patient when you begin sewing him up. Is this approach used? Or are there alternative better ways to deal with the problem? Or is this simply a non-problem since very few such mistakes happen?
I’ve never heard of this practice, though I’m only MS2. The most common method I’ve heard of is a check list. Every piece of equipment gets written down and accounted for at the end of the procedure.
I know in veterinary medicine, at least, some gauzes have metallic threads. If radiographs are used (common in orthopedic surgeries) and the gauzes are there, they can be recognized and removed (if they haven’t been removed already.
Even with checklists I still don’t get why things still get left inside…
My father once worked a case involving a woman who had several sterile gauze rags left in her abdominal cavity, only to discover the problem weeks later when she nearly died of sepsis.
All operating room equipment, including rags, is tagged to display brightly on an X-ray after everything’s been sewn back up. So, even though these rags quickly become soaked in blood, are diaphanous, and quickly turn the same color as the underlying viscera, they should still show up on the radiographs, if not the extensive post-op equipment checklists.
So, how does this kind of thing still happen?
The rags weren’t from the OR. No tags, no checklist.
There are at least two nurses in the OR. There’s the scrub nurse, who is sterile and is in charge of handing sterile instruments to the surgeon and assisting her with surgical stuff. Then there’s the circulating nurse, who is not sterile, but can fetch sterile items (wrapped in nonsterile wrapping, obviously), and is generally in charge of patient safety, making sure they’re grounded if electronic instruments are used, taking vital signs, transporting samples to the lab, etc. The circulating nurse is the person ultimately responsible for the “sponge count”, as well as the instrument count. Theoretically, the patient isn’t sewn back up until the count is performed twice with everything accounted for.
In reality, mistakes happen. Sometimes a sponge is accidentally severed, and one half counted as “one”. Sometimes the patient starts to crash and the surgeon is more interested in getting them closed and stable than waiting for the second count. Sometimes, people just mess up the count.
A very good friend of mine got a house and her son’s college tuition paid from a hospital in a settlement for leaving a sponge in her and then refusing to acknowledge it for almost three months of agony and infection. Ironically enough (or maybe not), she’s an OR nurse now.
When my wife went in for her last C-section, the doctor had a bit of a bitch fit until they found the missing sponge (it turned out it wasn’t inside my wife). They do try to account for everything. Mistakes can still happen though.
There are some drawbacks to using xray to detect surgical items left behind.
For this to be most useful, the patient needs to be x-rayed before they’re closed, so you need yet another thing in the OR that needs to be kept sterile and out of the way when not needed. Good luck on finding space - most ORs are fairly compact.
Otherwise, you need to button them up, clean them up and roll on down to Radiology. Take a couple shots, and if you find anything that doesn’t belong, it’s back to the OR to open them up again.
Work is being done with RFID. There’s a new system called SmartSponge from someone called ClearCountthat uses RFID-tagged sponges.
I have taken plenty of in-OR w/ patient still-on-the-table X-rays whenever there was suspicion of foreign objects being within patient (miscount at end of procedure or whatever). Most gauze has a radiopaque thread in it so it is visible with a decent film, and of course instruments stand out clearly. I have used both portable X-ray units and C-arms when needed, plenty of room for either one, IME.
In my twenty+ years of it, only once was anything found when I was involved, and that was a month after this patient’s surgery; non-healing wound (incision) and guy had five gauze '4x4’s still in his abdomen from three procedures from three different surgeons. There was quite the argument over who left the stuff in there, and patient sued for a few million, iirc (no idea of outcome) 
Its not all that common, IME - quite rare actually with all the safeguards used. I have rarely known a patient to come to X-ray for a post-op film as that is almost always done in recovery room with a portable unit such as this one (GE’s AMX’s are my preferred machines). I have been called to OR for FB (foreign body) films when the checklist is not 100% but almost always by the time I got there the missing needle or gauze is located.
