can recommend alternative modalities which may be more effective.
5. Two-person confirmation
The most commonly retained surgical device is a guidewire, which is
used in almost every type of catheter-based delivery system. In the
OR, it's your anesthesiologists who frequently put in central lines for
monitoring and fluid delivery during an operation.
During the insertion of the central line, the guidewire can be inad-
vertently left in the catheter and is not recognized to be in the venous
system. The guidewire has been retained because there was an error
or a distraction during insertion or because the anesthesiologist has
an imperfect technique. But it's a patient-safety problem if the
guidewire is retained and not removed.
To prevent the failure to immediately recognize a retained guidewire, a
second person — a nurse, an anesthesia technologist — has to check to
see that the guidewire is back in the central line insertion kit after the
procedure. If it's not in the kit, then it's likely in the patient and X-rays
must be obtained, and if necessary, interventional radiologists must
remove the retained guidewire.
OSM
A P R I L 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 9 3
Dr. Gibbs (drgibbs@nothingleftbehind.org) is the director of NoThing Left
Behind (nothingleftbedhind.org), a national surgical patient safety project to
prevent retained surgical items.
