Forgotten cotton patty?

Leaving a cotton patty inside the head is not infrequent. No surgeon would deliberatel leave a patty or small guaze piece or a metallic object in the operative field. The consequences of retained foreign body could be very deletarious and can be responsible for death of patient. Every attempt is made to count patties, guaze pieces, and instruments at the end os surgery but when too large number of such things are used in surgeries or gauze pieces are cut further the count may not be correct and in my opinion many time count even if wrong is not documented in operation notes.

Yasargil introduced cotton patties and every body adopted this in their surgeries. A black silk tag, a radio-opaque line in patties ensure that one does not forget them inside operatie field, but if patties are further divided the exact count may not help. Peroperative and postoperative use of X-rays reveals forgotton radio-opaque objects. Post-operative CT or MRI may demonstrate them but surgicel and gel foam which are frequently used, make task difficult. A post-operative csf leak, meningitis, haematoma formation, abscess formation may point out the cause and forgotton patties is one of thing leading to it.

How I handle such situations?

Take cotton patties in batches of five only.

Each cotton patty should have a black tail of silk and preferably radio-opaque.

Do not divide a patty into small parts.

Take wet gauze pieces which are counted piece wise.

Instead of patties use taped guaze so that one end is always outside.

After use do not throw all around operative field. Assistant should be made aware where used patties are kept.

A cotton patty can be washed and reused.

If nurse assisting case is replaced with another nurse, ask to pass information about count to her successor.

Foley catheter balloon can be used along with patties so as to reduce no of patties used.

Good haemostasis is always recommended since brisk bleeding can upset whole team.

These steps still leave a scope for foreign bodies to be retained so keep a count and if any discrepency write in operation notes. If you happen to re-operate a case earlier operated by other surgeon, do not raise hue and cry because all of us will committ these rare mistakes. After to err is human.

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written by efrnh, July 27, 2013
I have used patties since the beginning of my training in 1957 in Mexico and 1959 in England, before the Yasargil Era. Back in Puebla in 1962 I could get only patties (cottonoids) intended for dental surgery and they had no threads so these were inserted by the instrument nurse and some times I had to use non threaded patties which led to inadverted retention of them in a couple of cases. All the measures mentioned by Dr. Sharmakchand are relevant but avoiding the use of non threaded patties is perhaps the most important of all. The threads can sometimes be lost or cut therefore counting pieces before closure is obligatory.

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