Surgical Counts, Organization of the Human Body, and Prepping & Draping: Week 4 Study Notes

Surgical Counts

Introduction to Surgical Counts

Surgical counts are a critical safety procedure performed before, during, and after surgical operations to ensure that no foreign objects are retained in the patient. These counts are essential for both patient safety and legal documentation.

• Purpose: To prevent retained surgical items (RSIs) such as sponges, sharps, and instruments.

• Timing: Counts are performed at the beginning and end of the surgical procedure, and at key points during surgery.

• Documentation: All counts are documented by the circulator and are part of the patient's surgical record.

• Emergency Situations: If an opening count is not possible due to an emergency, an x-ray should be performed postoperatively to ensure nothing is retained.

When to Count

Counts are performed at specific times to ensure accuracy and patient safety.

• Initial Count: Before the skin incision, all sponges, sharps, and instruments on the sterile back table are counted.

• Cavity-Within-Cavity Count: Required when closing a cavity within another cavity (e.g., closing the uterus during a C-section before closing the abdomen).

• Cavity Closure Count: Before closing any body cavity (e.g., peritoneum), a complete count must be performed, regardless of incision size.

• Final Count: Completed during closure of subcuticular and skin layers.

Counting Technique

Proper technique is essential for accurate counts and involves both the surgical technologist and the circulator.

• Each item is counted one at a time, with both parties able to see the item.

• Items are separated and counted audibly.

• The circulator records the number on the count sheet.

• All items must be visible and organized for counting.

Types of Counts

• Sponges: Packaged in groups (usually 5 or 10), must be separated and counted individually. Each sponge must have a radiopaque strip for identification on x-ray.

• Sharps: Includes needles, scalpel blades, and suture needles. Each sharp must be visible and counted individually. If a package contains multiple needles, each must be counted.

• Instruments: Counted in the sterile processing area and again in the operating room. Each instrument and its parts must be counted and checked against the count sheet.

Intraoperative and Postoperative Counts

• Counts are repeated whenever new items are added or when there is a change in personnel.

• During closure, counts are performed in a specific order: on the field, then the mayo stand, then the back table, and finally any items off the field.

• If a discrepancy is found, the count is repeated and documented. If unresolved, an x-ray is performed.

Organization of the Human Body

Body Planes

Body planes are imaginary lines used to divide the body into sections for anatomical study and surgical reference.

• Coronal (Frontal) Plane: Divides the body into anterior (front) and posterior (back) sections.

• Sagittal Plane: A vertical plane dividing the body into right and left parts. The median (midsagittal) plane divides the body at the midline.

• Parasagittal Plane: Any sagittal plane not on the midline.

• Transverse (Horizontal) Plane: Divides the body into superior (upper) and inferior (lower) sections.

Directional Terms

Directional terms describe the locations of structures relative to other structures or locations in the body.

• Anterior (ventral): Toward the front of the body.

• Posterior (dorsal): Toward the back of the body.

• Superior (cranial): Toward the head or upper part of a structure.

• Inferior (caudal): Away from the head or toward the lower part of a structure.

• Medial: Toward the midline of the body.

• Lateral: Away from the midline of the body.

• Proximal: Closer to the origin of a body part or the point of attachment.

• Distal: Farther from the origin of a body part or the point of attachment.

Body Quadrants and Regions

The abdomen is divided into quadrants and regions for clinical and surgical reference.

• Quadrants:

  • RUQ: Right upper quadrant

  • RLQ: Right lower quadrant

  • LUQ: Left upper quadrant

  • LLQ: Left lower quadrant

• Regions:

  • Epigastric: Upper central region

  • Hypogastric: Lower central region

  • Iliac/Inguinal: Lateral to the hypogastric region (left/right)

  • Hypochondriac: Lateral to the epigastric region (left/right)

  • Lumbar: Lateral to the umbilical region (left/right)

Body Cavities

Body cavities are spaces within the body that contain internal organs.

• Dorsal Cavity: Contains the cranial and spinal cavities.

• Ventral Cavity: Contains the thoracic and abdominopelvic cavities.

• Thoracic Cavity: Surrounded by the rib cage, contains the heart and lungs.

• Abdominal Cavity: Contains digestive organs.

• Pelvic Cavity: Contains urinary and reproductive organs.

Prepping & Draping

Skin Preparation (Prepping)

Prepping is the process of cleaning and disinfecting the patient's skin before surgery to reduce the risk of infection.

• Purpose: To remove transient and reduce resident microorganisms on the skin.

• Timing: Performed after anesthesia, catheterization, and positioning, but before draping.

• Technique: Use a widening circular motion from the incision site outward. Prep areas with higher contamination last.

• Solutions: Common solutions include alcohol-based preps (rapid action), chlorhexidine, and povidone-iodine (betadine).

• Dry Time: Alcohol-based preps require drying before draping to prevent fire risk.

Draping

Draping isolates and protects the operative site from contamination using sterile barriers.

• Materials: Nonwoven disposable fabrics, woven reusable fabrics, or plastic adhesive drapes.

• Types of Drapes:

  • Fenestrated Drapes: Have an opening for the surgical site (e.g., laparotomy, extremity, head drapes).

  • Non-fenestrated Drapes: Used to cover areas not involved in the procedure but must remain sterile.

  • Specialty Drapes: For equipment (e.g., c-arm, microscope, robot) and furniture (e.g., back table, mayo stand).

• Contamination: If a drape is contaminated or damaged, it must be replaced or covered with an impermeable material.

Examples and Applications

• Example: During a C-section, a cavity-within-cavity count is performed when closing the uterus before closing the abdomen.

• Application: Proper prepping and draping reduce surgical site infections and maintain a sterile field.

Table: Comparison of Draping Materials

Material	Properties	Advantages	Disadvantages
Nonwoven Disposable	Compressed synthetic fibers (e.g., nylon, polyester)	Lightweight, strong, disposable, good barrier	Single-use, environmental impact
Woven Reusable	Cotton fibers, reusable	Reusable, cost-effective over time	Requires reprocessing, may develop holes, less effective barrier
Plastic Adhesive	Clear, adhesive backing, may be antimicrobial	Good visibility, strong barrier, may reduce infection	May cause skin irritation, single-use

Additional info:

• "Time Out" is a surgical safety protocol where the surgical team pauses before incision to confirm patient identity, procedure, and site, reducing the risk of errors.

• Prefixes and suffixes (e.g., -oma) are commonly tested in medical terminology quizzes and are essential for understanding anatomical and pathological terms.