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Yigit Akduman, Javeria Azhar, Talha Allam, Ece I Akduman, Levent Akduman; Smallest Needle and Vitrectomy Trochar/Plug Sizes Identified on X-Rays: To Avoid Unnecessary Radiation and Operating Room Turnover Time. Invest. Ophthalmol. Vis. Sci. 2014;55(13):5865.
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Obtaining x-rays is a common part of the operating room protocol for intraoperatively lost needles, trochars and sclerotomy plugs at the end of an ophthalmic surgical case. However, smaller needles and trochars escape the detection threshold of routine x-rays. This practice pattern exposes patients and personnel to unnecessary radiation, prolongs the room turn over time and sometimes provides false assurance to the surgeon when a needle is not detected by x-ray. We studied various needle and trochar/plug sizes to determine the smallest sizes identified by x-ray.
We placed surgical needles from sutures ranging from 0/0 to 10/0 in size and 3.8 to 40.0 mm in length on a phantom x-ray skull model. We also placed 19 and 20 gauge plugs as well as a 23 gauge vitrectomy trochar on the phantom skull. We imaged them using the standard radiography doses and techniques.
Needles from 7/0 size and bigger sutures were visible on x-rays. The needles from smaller size sutures were not visible regardless of the location. Needle length did not seem to matter. The 19 and 20 gauge sclerotomy plugs were visible whereas the 23 gauge trochar was not visible on x-rays. Needles overlying complex bony anatomy such as the inferior orbital wall were less likely to be seen due to multiple overlapping shadows in contrast to needles placed over simpler osseous structures such as the frontal bone.
Our study shows that obtaining x-rays when needles attached to sutures thinner than 7/0 sutures, and 23 g and smaller trochars lost during surgery in the operating room does not help detect the lost needles but exposes the patient and personnel to unnecessary radiation, and prolongs operating room turnover time.
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