Although it is a rare event, retained sponges or gauze after a vaginal delivery are a source of concern in the delivery room. A surgical item retained vaginally could lead to adverse outcomes for the patient, such as pain and vaginal discharge. For the OB/GYN, the outcome could include not only a dissatisfied patient who may have lost confidence in the healthcare system, but also potential legal action.
A manual count of instruments after a procedure is the typical method used to avoid retained surgical items, but this is often not standard for vaginal deliveries. In addition, counting instruments is not foolproof and can still result in a retained foreign body after a surgical procedure. Vaginal sweeps are another method used in delivery rooms, but this can be distressing for patients, may be done incorrectly, and could also still miss a retained sponge.
In order to reduce the risk, a new device has come on the market to help account for all sponge and gauze used during labor and delivery. This new technology, the RF Assure Delivery System, is currently available from RF Surgical Systems Inc. The system is a combination of tags embedded in sponges, gauze, and towels and a scanning device, the Verisphere, that can detect those tags via a low energy radio frequency. What is different about this technology is that it does not use a wand and a mat but rather a handheld scanner that is optimized for scanning the vaginal canal in a prone patient.
The scan can be completed in as little as 15 seconds and, with a range of about 8 inches when scanning for retained sponges, can be done in such a way as to be inconspicuous to patients. For finding items in the surrounding room, John Barnhill, vice president of global marketing and business development for RF Surgical, says, "The Verisphere has a total range of 16 inches, but range can extend to 23 inches depending on position and orientation of the Verisphere to the tagged sponge."
Barnhill notes that most hospitals are using one RF Assure unit to serve two or three labor and delivery suites and that the system is only recommended for vaginal deliveries. After the initial cost of the system, Barnhill estimates that the additional cost for a typical vaginal delivery that uses 6 to 10 sponges is between $3.60 and $6.00. The authors of a study published in the September 3, 2014, issue of the Journal of the American College of Surgeons estimate that the cost of radiofrequency technology is cost-effective when compared with the potential costs of x-rays, operating room time, surgery, and legal fees associated with retained surgical items.
Is this a device you would find useful in the delivery room?
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Williams TL, Tung DK, Steelman VM, Chang PK, Szekendi MK. Retained Surgical Sponges: Findings from Incident Reports and a Cost-Benefit Analysis of Radiofrequency Technology. J Am Coll Surg. 219;3:354-364. doi: 10.1016/j.jamcollsurg.2014.03.052 Available at: http://www.journalacs.org/article/S1072-7515(14)00384-6/abstract