I questioned a nurse last week in a case where a sponge was left inside a patient during gynecologic surgery.

She was a "scrub nurse" who assisted the doctor with instruments during surgery. It was her obligation, together with the "circulating nurse" to keep track of how many instruments were used; how many needles were used, and how many sponges or lap pads were used.

A lap pad is a 6" x 6" white cloth used to soak up fluid during surgery. Attached to this is a blue string which is radio-opaque. Attached to the blue string is a large white plastic disc. The reason the string is attached to the cloth is so that it will show up on x-ray, if an x-ray is taken.

The scrub nurse and circulating nurse are supposed to count the number of pads used during surgery. They are supposed to confirm each other's count. This is to ensure that there is nothing left behind in the patient at the time surgery is completed. You don't want the nurses and doctors to have that 'aha' moment where someone says "Oops, I can't believe I left that inside of you!"

In this particular case the patient complained of abdominal pain immediately after her surgery and continue to have worsening abdominal pain over the next 2-3 days. An x-ray revealed that there was a lap pad left in the patient's belly.

When I asked the nurse how many pads she counted at the end of surgery, she told me that the count was correct. She also told me that the circulating nurse had the same correct number as she did. She informed me that three days later, a nursing supervisor showed her the patient's x-ray which clearly showed a lap pad still in the patient's belly.

I asked her to explain how her count was correct if there was a retained pad in the patient's belly. She stressed that her count was correct and could not explain how this happened.