How to Find a Needle in a Haystack…During Surgery


The count of items used during surgery is often called surgical counting. Retained surgical items at the end of surgery (known as a “foreign object”) can have serious implications. Unintentional retention of objects during surgery has been identified as “never events”.

Surgical counting is one of the most important tasks of the circulating nurse in the operating room. During the procedure, the scrub nurse should be aware of the location of sharps (e.g., needles) on the sterile field.  Needles should be accounted for by the scrub nurse.

It is imperative that two individuals be involved in the count; one counting and the other witnessing that the count is correct. Many hospitals have printed forms to keep track of routinely counted items. Others use erasable count boards visible to all personnel. To facilitate counting, needles are counted according to the number on the package. The scrub nurse verifies the number with the perioperative nurse when the package is opened.

The Documentation of Surgical Counts

All counts should be recorded on a dry white board and/or count sheet as part of the patient’s record, together with the names and designations of personnel performing the counts. The documentation of counts should include the items on the instrument table at the beginning of the procedure, as well as those added during the procedure.

The results of surgical counts should be recorded as correct or incorrect. Used needles and blades should be contained in a disposable puncture resistant container. All parts should be accounted for if a needle or blade brakes.

Used needles should be kept on a needle pad or counter on the scrub nurse’s table. Broken or missing needles must be reported to the surgeon and accounted for in their entirety.

Searching for Foreign Objects

Sterile team members and the perioperative nurse initiate a search of the sterile and non-sterile fields. If the missing item is not revealed after a recount and search, the surgeon is asked to explore the wound. If the missing item is still not found, the hospital policy may dictate that an x-ray film be taken.

When the count is incorrect:

  • Perform a recount
  • Notify the surgeon and supervisor
  • Conduct a search (floor, garbage, linen)
  • Request x-ray to be taken
  • Document results on the count sheet and patient’s record

Needles are known to be the least counted item. A final reconciliation should occur prior to the removal of equipment and the patient from the operating room. This prevents items being inadvertently left under the patient.