Counting Sharps
Sharps are either pointed or cutting items, typically made of metallic material. For the count to be correct, all segments must be accounted for if a sharp breaks. This reduces the risk of a retained piece.
The following objects are included as sharps:
Suture Needles
Disposable sutures are prepackaged and sterilized by the manufacturer. The label will specify the number of suture needles contained in the package.
Reusable eyed needles will come in a sterilized needle rack or book, which are sterilized separately from instruments. These reusable suture needles are much less common than other types.
- Suture needles are counted and recorded based on the number on the outer package. This needs to be verified by the scrub nurse when the package is opened.
- The scrub nurse should not open all the packages for the initial count as this creates a greater risk for retained items.
- Surgical gut suture packages also need to remain closed until the time of use, to prevent the alcohol from evaporating and making it less pliable.
- Disposable sutures are prepackaged and sterilized by the manufacturer. The label will specify the number of suture needles contained in the package.
Note: Counting empty suture packages is not appropriate for recalling a count at the end of the procedure.
Suture needles on the sterile field need to remain:
– In their sterile package
– Mounted on a needle driver
– In the needle counter/sharps pad
During the procedure, when multiple sutures are being used, the scrub nurse is responsible for keeping track of suture needles and retrieving them as soon as possible.
When all the sharps are returned to the scrub nurse after wound closure, a final count can be considered complete.
Several small-sized suture needles are difficult to visualize on an X-ray. Healthcare institutions may include a specific size range in which an X-ray may not be used, as they do not have the technology to pick up the small suture needles. These small suture needles are still required to be accounted for.
If a suture falls off the sterile field, it must be retained for count reconciliation. A magnetic stick or roller can be used to search for sutures on the ground or a piece of tape may be used to pick up suture needles.
Other Sharps
- Hypodermic needles that come with a cap need to be counted to ensure there is no retained portion.
- Scalpel blades come in individual packages. In some cases, they come pre-sterilized in a custom pack. They are opened by a circulating nurse who retrieves the blade with a needle driver and places it in a needle counter/sharps container for counting.
- If they come pre-sterilized, the scrub nurse should always verify the blade is present after opening the package.
- Cautery pencils come with a stock tip. Additional tips in varying sizes, come packaged individually.
- Counted sharps should not be taken off the sterile field or leave the OR.
- If counted sharps fall off the sterile field or puncture a glove, they need to be retained and secured to reconcile the count at the end of the procedure. An empty specimen container may be used for a lost sharp.
- Personnel must be mindful when retrieving sharps off the ground. As stated above, using a magnetic stick or a piece of tape is helpful in finding the items.
(Phillips, 2020, ORNAC 2021)
Counting Miscellaneous Items
Opened miscellaneous items are to be included in the surgical count. These items can be retained as foreign bodies. Each healthcare institution will have its own policy/procedure as to which miscellaneous items must be included in the count.
Examples of surgical miscellaneous items include:
- Syringes
- Clip cartridges
- Vessel loops
- Hernia and umbilical tapes
- Defogger solution bottles, caps, wipe sponges
- Small endoscope parts such as trocar caps, springs, washers, valves
- Screws
- Wing nuts
- Elastic bands
- Suture reels
These items can come packed or counted as individuals or as multiples, depending on the item. For example, vessel loops come in a pack of two; therefore, the circulating nurse will record two on the count.
(Phillips, 2020 & ORNAC, 2021)
