Module 4: B. Types of Sponges – Perioperative Equipment and Instruments for Registered Nurses

Types of Sponges

Sponges are used for several reasons during a surgical procedure such as absorbing fluid and blood, for the blunt dissection of tissue, for applying pressure or traction, and for protecting tissue. Sponges come in varied sizes and shapes.

Gauze
Gauze is also referred to as Raytec, and in other countries is known as swabs. Gauze comes packed in groups of five or ten, bound with a paper band.

Laparotomy Sponges
These sponges are also referred to as lap pads, tapes, or packs. They all have the same radiopaque (X-ray detectable) thread in addition to a blue tag or tape sewn to the corner of each sponge. They are grouped into packs of five.

Dissecting sponges
Dissecting sponges have an X-ray detectable element incorporated into the weave and are self-contained.

Peanuts
Peanuts are small oval soft gauze sponges used for blunt dissection or for absorption in delicate procedures. They must be attached to a clamp instrument when in use. They come in packs of five.

Kidner dissectors
Kidner dissectors are tight woven cotton dental tape that forms a firm cylindrical roll. They also must attach to an instrument when in use and come in packs of five or ten.

Tonsil sponges
Tonsil sponges are soft, cotton-filled, gauze, ball-shaped sponges attached to a cotton string. They are packed in groups of five and come in varying sizes.

Compressed absorbent cottonoids (also known as patties)
These are small, square, and rectangular shaped, varying in size. They are made from compressed rayon or cotton. They are used to absorb fluid/blood in delicate spaces or to apply a hemostatic agent on delicate structures. To locate them easily, t each has a radiopaque thread and a string attached. They typically come on a card in packs of ten.

Towels
Towels may be used for protecting viscera, but not universally. Towels become part of the count when they are placed inside the patient for packing or protecting viscera.

(Phillips, 2020 & ORNAC, 2021)

Counting Sponges

Sponge Counting Requirements

Sponges to be used during the procedure must be radiopaque. This is accomplished by a barium thread woven through them. Some insertions use an RFID tag in their sponges and towels.
Sponges cannot be cut during the procedure as this increases the potential of losing a piece.
Sponges must be counted in the increment they came in as packaged.
Sponges must be counted twice before moving on to the next package to ensure there are no manufacturing errors.
Sponges must be opened and counted separately.
Laparotomy Sponges with a tape or tag need to be pull-tested to ensure they are secure.

Removing Sponges from the Sterile Field

Soiled sponges should be placed in a designated container off the sterile field for retrieval by the circulating nurse.
The perioperative RN counts and bag sponges in the same increment they were initially counted in.
The bagged sponges must remain visible and in the OR until the end of the procedure, in case there is an incorrect count, and they need to be verified.

Small Dissecting Sponges (peanuts, kidners, etc.)

When used within a body cavity, these must be attached to an instrument, to reduce the chances of loss in the surgical wound.

Radiopaque Gauze vs Dressing Gauze

Radiopaque Gauze	Dressing Gauze
Comes in various sizes, 4×8 is most common	Comes in various sizes, 4×8, 2×2
Has X-ray detectable thread woven into the sponge	No X-ray detectable thread
Used throughout a surgical procedure	Only to be opened when the surgical wound is closed
Not used for post-op dressing	Only to be used for post-op dressing
Sterile supply	Sterile supply

Therapeutic Packing

In some events, a sponge may be left in the wound intentionally. This is known as therapeutic packaging.
Sponges used for therapeutic packing must be radiopaque.
For therapeutic packing, the count is documented as incorrect with the number and type of sponge left in the wound. Personnel then follow their facility’s policy/procedure for further documentation.

Returning to the OR for removal of therapeutic packing

Once the packing is removed, it should be taken from the sterile field.
The number and type of sponges should be reconciled from the previous case documentation to ensure all sponges are removed from the patient.
The count is documented as incorrect with the type and number of sponges removed from the surgical site identified clearly.
For permanent wound closure, a thorough sweep of the wound must be completed followed by an X-ray to verify there are no retained sponges.

(ORNAC, 2021, Cromb, 2019 & AORN, 2022)