Sterile Field Break and Missing Laparotomy Sponge
An 11-month-old, 22 kg Labrador retriever is undergoing an exploratory laparotomy for a suspected intestinal foreign body. The technician has clipped and prepped the ventral abdomen with chlorhexidine scrub followed by 70% isopropanol; the alcohol has not fully dried when the surgeon begins and uses electrocautery. During closure, the surgeon's right glove contacts the drape edge; the surgeon continues. The circulating technician's sponge count records 9 radiopaque laparotomy sponges used but only 8 accounted for in the kick bucket and on the field. The surgeon is preparing to close the linea alba. The dog is stable under sevoflurane, heart rate 95 beats/min, mean arterial pressure 70 mmHg. The clinic has no RFID sponge system. The technician must speak up.
1. What should the technician do about the glove contact and the alcohol prep before the surgeon continues? Explain the reasoning for each action.
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These are two separate breaches. The glove that contacted the drape edge is contaminated; the surgeon must reglove before continuing. If the gown cuff or sleeve also contacted the nonsterile edge, the gown should be changed. Wiping the glove with alcohol is not acceptable. For the prep, 70% isopropanol has not dried and may pool; alcohol vapor can ignite with electrocautery. Stop and allow the prep to dry completely, blot any pools with sterile gauze, and keep drapes away from pooled alcohol. In future, use chlorhexidine scrub with adequate contact time, then remove residual scrub with alcohol only if it can fully dry, or use a nonflammable final prep. The circulating technician should state the concern aloud rather than assume the surgeon noticed.
2. The sponge count is short by one. Describe the step-by-step response, including what must happen before the abdomen is closed.
Read the worked answer
Announce the discrepancy before the linea alba is closed. The surgeon should stop closure, and the team should recount aloud: the surgical field, kick bucket, floor, laparotomy drapes, trash, laundry, and suction canister. Inspect the abdomen. If the sponge is still missing, obtain an intraoperative radiograph while the abdomen is open; radiopaque sponges are visible. Do not close until the count is resolved or a radiograph documents that no sponge is retained. Document the event, the times, the recount, and the radiograph result, and complete an incident report. If the sponge is found, record where it was found. If it is not found, the surgeon documents the negative radiograph and the postoperative monitoring plan.