2-6-26-Small+&+Large+Counts

Introduction to Surgical Counts

Surgical counts represent a critical aspect of the surgical technician’s role, ensuring that no surgical materials either sharps or sponges are left inside the patient after the procedure. The essential collaborators in this process include the surgical technician (surg tech) and the circulator, who perform the counts together. It is a responsibility shared across all team members involved in the surgery, but the two pivotal figures in the counting process are indeed the surgical tech and circulator. It is imperative that any discrepancies in counts are addressed immediately, as surgical teams cannot proceed to close the patient until clarity on counts is established.

Preparation for Counts

1. Initial Count Setup: Counts typically begin before the patient enters the operating room. The surgical technician’s objective during setup includes preparing for these counts. The count sheet is to be placed on the mayo stand—this ensures it is readily accessible while organizing the surgical instruments. Several additional tasks will need to be completed before conducting the counts, which will be covered during practical lab sessions.

2. Importance of Performing Counts: It's crucial for the surgical tech to recognize that performing counts correctly is fundamental to their job. Accurate counts prevent complications during surgeries, such as leaving instruments or materials inside the patient. Structural organization ensures no mistakes are made throughout various surgical procedures.

Types of Surgical Counts

1. Small and Large Counts: Two different types of counts must be recognized:

   • Small Count: This is primarily comprised of sponges and sharps. Conducting the small count is always the first step and must be completed in every case irrespective of the surgical procedure.

   • Large Count: This count comes into play during procedures involving the abdominal or thoracic cavity, as these are areas where instruments can be unintentionally left behind.

Details of the Small Count

• Components:

  • Sharps: These include hypodermic needles, surgical blades, suture needles, and bovie tips—which are critical because they can detach.

  • Sponges: Key types include laps, Raytecs, latex sponges, and Kittners (or peanuts).

• Counting Method: When conducting small counts, the sponges are counted first, recognized for their likelihood of being left behind. The technician must verbalize each item counted so that the circulator can accurately notate this on the count sheet.

  • Example: For counting laps, one must say, “laps,” and count, "one, two, three, four, five," ensuring that the nurse writes a five on the count sheet. The same methodology applies to the remaining sponges and sharps, requiring individual counts and careful verification.

  • In case of counting errors, the technician must restart counting rather than add to the previous count.

Details of the Large Count

• Initiation of the large count should always start with counting the stringer and then proceed to the instruments laid on it. It is crucial not to remove the stringer until the counts are completely verified.

• Instruments must be recognized and counted carefully, ensuring that both the technician manages to call them out correctly and the circulator