Table 1 Strategies for prevention and management
METHOD TO PREVENT AND/OR MANAGE RSI | PROS | CONS | WAYS TO IMPROVE METHOD |
|---|---|---|---|
Manual counting | RSI 100 times more likely if there is a count discrepancy [17] When combined with technological advancements, this can improve its accuracy [37, 38] | RSI can still occur with a correct count [39] | Quiet OR and reduce multi-tasking during count [40, 41] Change focus of count to RSI prevention rather than checklist [41] |
Intraoperative Radiography | CT does not appear to be superior to intraoperative X-ray [4] | False negative rate increases as needle size becomes smaller [23, 43] needles smaller than 13 mm are not detectable [22, 34, 44] Dependent on radiologist’s knowledge of the lost needle and its last location [23, 45] | Development of standard policy of indications for radiography Education for all members of the team to improve communication between radiology and surgical team [31] |
Computer-aided Detection (CAD) | Automatic detection rate as high as 86% [33, 46] Potential of faster and more cost-efficient solution than radiography [33, 46] | Currently in developmental phase [36] Unable to identify small needles [36] Relies on large dataset of needles and images to train the system [33, 36] Requires confirmation of results by surgeon and/or radiologist [6, 47] | Continued development of database and system |
Magnetic Retrievers | Allows surgeon to follow metallic objects in real time, thereby expediting their removal [48] Reduces search time for small and medium sized needles [48] | Risk of injury to organs during retrieval [16, 48] Not FDA approved for sharps retrieval | Continued development to ensure patient safety. |
Sharps Finder Device | Able to detect needles not visualized by x-ray [49] May act as a rule out mechanism preventing unnecessary radiation exposure. Expedites the identification of surgical sharps [49] | Only used to identify the location of a surgical sharp [49] | More clinical trials needed to determine degree of efficacy |
METHOD TO PREVENT AND/OR MANAGE RSI | PROS | CONS | WAYS TO IMPROVE METHOD |
Manual counting | RSI 100 times more likely if there is a count discrepancy [17] When combined with technological advancements, this can improve its accuracy [44, 45] | RSI can still occur with a correct count [39] | Quiet OR and reduce multi-tasking during count [37, 42] Change focus of count to RSI prevention rather than checklist [42] |
Intraoperative Radiography | CT does not appear to be superior to intraoperative X-ray [4] | False negative rate increases as needle size becomes smaller [23, 49] needles smaller than 13 mm are not detectable [22, 34, 50] Dependent on radiologist’s knowledge of the lost needle and its last location [23, 41] | Development of standard policy of indications for radiography Education for all members of the team to improve communication between radiology and surgical team [31] |
Computer-aided Detection (CAD) | Automatic detection rate as high as 86% [33, 51] Potential of faster and more cost-efficient solution than radiography [33, 51] | Currently in developmental phase [36] Unable to identify small needles [36] Relies on large dataset of needles and images to train the system [33, 36] Requires confirmation of results by surgeon and/or radiologist [6, 52] | Continued development of database and system |
Magnetic Retrievers | Allows surgeon to follow metallic objects in real time, thereby expediting their removal [53] Reduces search time for small and medium sized needles [53] | Risk of injury to organs during retrieval [16, 53] Not FDA approved for sharps retrieval | Continued development to ensure patient safety. |
Sharps Finder Device | Able to detect needles not visualized by x-ray [54] May act as a rule out mechanism preventing unnecessary radiation exposure. Expedites the identification of surgical sharps [54] | Only used to identify the location of a surgical sharp [54] | Need clinical trials to determine degree of efficacy |