i. Pass the peritoneal suture to the surgeon when he is ready to start closure
of the wound. At this point in the procedure, a sponge and sharps count is required.
Again, both the scrub and an R.N. must see each sponge. The sponges in the various
areas are counted separately (those discarded, those on the sterile tables, and those in
the operative field) and then added to obtain the total count. The sequence used in the
sponge count is: start with sponges around the incision; then sponges on the Mayo tray;
then sponges on the back table; and, finally, the discarded sponges. The procedure is
(1) The circulator uses forceps to point to each discarded sponge.
(2) You are to handle the sponges remaining on the back table, separating
each as it is counted so that both you and the circulator see every sponge.
(3) The surgeon may assist in counting the sponges remaining in the
(4) The counts are added and should total the number recorded for the
initial count plus any that were opened during the case.
(5) You are to report the result of the sponge count to the surgeon. If the
count is correct, he will proceed with closure of the wound. If the count is incorrect, all
sponges are to be recounted at once. The circulator is to check the kick bucket and the
floor. He will often need to don rubber gloves to see that all sponges are separated.
The surgeon may assist in recounting sponges in the operative area. You are to check
the instrument tables.
(6) If the count remains incorrect after the recount, the operating room
supervisor is notified and normally assists with another recount. An X-ray of the
operative area may be ordered. If so, it will be taken with portable X-ray equipment
while the patient is still on the operating table.
(7) A sharps count is done at the same time and in the same manner as
the sponge count. An instrument count is done with the first closing sponge count.
j. After the sponge, sharps, and instrument counts are completed, remove the
instruments that are not needed from the Mayo tray and place the material needed for
closing the wound on the tray.
k. Pass the necessary sutures to the surgeon, making sure that you receive
intact each needle used by the surgeon (see paragraph h above). An X-ray may be
necessary to locate a lost needle. While the surgeon is suturing the wound, you are to
begin unclamping the instruments and placing them into solution in one of the basins in
the basin stand.
Prepare the wound dressing during the closure.