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Table 1 Strategies for prevention and management

From: Risk factors and preventive strategies for unintentionally retained surgical sharps: a systematic review

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 Quick and cheap [32, 42]
Low radiation dose [32, 42]
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 Quick and cheap [32, 47]
Low radiation dose [32, 47]
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