The cardiac catheter laboratory, which in many health care facilities falls under the umbrella of perioperative services, generally sits geographically outside the traditional operating suite. Perhaps due in part to this geographical distance, standards that are routinely applied in the operating suite may not be applied in the cardiac catheter laboratory. One such standard is the management of accountable items such as swabs, surgical instruments, sharps and sheaths. Well-known standards and guidelines for managing accountable items recommend mandatory counting and documentation of all accountable items in environments where a surgical item may be left behind; yet, despite this, counting is not mandatory in the cardiac catheter laboratory.

The risk of items (or parts thereof) being unintentionally retained during percutaneous procedures, such as those performed in the cardiac catheter laboratory, are low; however, this complication still occurs, with several case studies reporting broken and fragmented surgical instruments and/or equipment being retained in patients following procedures.

As the complexity of percutaneous cardiac catheter laboratory cases increases, so does the potential requirement of reversion to open procedures should a serious complication occur; and this, in turn, is known to increase the risk of a surgical item being retained during the subsequent procedure. Performing surgical counts in the cardiac catheter laboratory would improve patient safety during the intra-procedural/intra-operative period by reducing the risk of a surgical item (or parts thereof) being unintentionally left behind, a complication that is likely to result in patient harm.

This discussion paper aims to not only highlight the vital importance of performing a full surgical count of all items used during cardiac catheter laboratory procedures but also to advocate for pre- and post-procedural inspection of sheaths, angioplasty balloons, stents and wires to ensure they are intact at the beginning and end of the procedure. These pre- and postprocedural inspections are vitally important, not just in the cardiac catheter laboratory but in all other areas, such as operating suites, endoscopy and interventional radiology, where endovascular devices are used.

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