b. The information recorded on the label on the blood container is to be checked
against the Standard Form 518, "Medical Record--Blood or Blood Component
Transfusion," to be sure the blood is that which is intended for the patient. The
container and SF 518 should be checked by a medical officer (usually the
anesthesiologist) as well as the circulating specialist before the transfusion is started.
c. Unfiltered blood is never to be given. A blood recipient set, which is equipped
with a filter is to be used.
d. The unit of blood is to be rotated gently to disperse the cells evenly. The
blood is not to be shaken, as this would damage the red cells.
e. When pressure is being applied to a container of blood to speed the rate of
transfusion, the container must be kept under constant observation. As soon as the
container has less than a quarter of its total contents remaining, the pressure must be
released. These precautions are taken to prevent the occurrence of air embolism,
which could prove fatal to the patient.
3-14. SPONGE COUNT
a. Discussion. In order to account for all sponges, thus ensuring that none
have been accidentally left in the patient, a sponge count is taken at least three times:
By the personnel who wrap sponges or place them in a surgical pack for
(2) By the circulator, scrub, and registered nurse (RN) immediately before
surgery begins. The circulator then records the sponge count.
(3) By the circulator, the scrub, and RN, and again when the surgeon begins
the skin closure. A sponge count may be taken three times during an operation, as in a
cesarean section when the sponge count is made before the uterus is closed and again
before the abdominal incision is closed, and again as the surgeon is closing the skin. A
registered nurse always witnesses the count of sponges in the OR.
b. Repeating the Count. There should be no interruptions while the sponge
count is being made. If there is any doubt about the count, it must be repeated.
c. Measures Taken During Surgery. During surgery, loss of sponges may be
prevented by various methods. Measures to be taken by the scrub and the circulator
include those listed in ((1)-(2), below). Additional measures may be used depending
upon local policy or the preference of the surgeon.
(1) Sponges used for the patient's skin preparation are not radiopaque. The
circulator is to remove those sponges from the immediate operative area and to secure
them in a conductive bag.