Detection rates of missing microsurgical needles using intra-operative imaging.

BACKGROUND: Unintentional retention of foreign bodies in surgery is uncommon but potentially serious. Published data regarding the consequence of retained surgical needles is sparse. We aimed to characterize lost surgical needles at our institution. Secondarily, we aimed to determine whether or not retained microsurgical needles can be reliably detected. METHODS: Reports of missing surgical needles at our institution were reviewed. Surgical needles of relevant sizes were scattered across an anthropomorphic model at representative anatomical locations. Fluoroscopic images of the field were acquired using two resolution settings. Medical staff in our department attempted to locate needles in these images. RESULTS: A total of 46 323 procedures were performed in the main theatres in the 2.5-year period. Sixty-two needles were reported as missing. No patient harm was documented. Needles of chord length 16 mm (5-0) or greater were always detected. High-resolution fluoroscopy improves detection of needles with chord lengths of 9.3 (7-0) or 6.6 mm (9-0). Needles are consistently better detected in the lower limb for needles of chord length greater than 6.6 mm (9-0). Senior observers under ideal conditions can detect 7.1% of smaller needles. CONCLUSION: When a needle is lost during surgery, consider the following before ordering fluoroscopy. Needles of chord length greater than 13 mm (6-0) should be reliably detected whilst 3.8 mm (10-0) needles will not. For sizes in between, ideal conditions for detection may include an operating field in the lower limb, high-resolution fluoroscopy and a senior observer. It may not be necessary or cost effective to identify microsurgical needles with fluoroscopy.

A prospective audit of adherence to safe sleeping guidelines in a general paediatric ward and special care nursery.

AIM: Sudden Infant Death Syndrome (SIDS) remains one of the largest causes of infant mortality worldwide, and despite widespread educational campaigns compliance to safe sleeping guidelines remains low in many areas. Hospital staff play a significant role in educating parents on safe sleeping recommendations and providing appropriate sleeping environments for infants. The aim of the study was to evaluate adherence to safe sleeping guidelines in a special care nursery (SCN) and general paediatric ward (GPW). METHODS: A prospective audit of sleeping environments in a SCN and GPW with data collected on 10 safe sleeping compliance rules, based on national and international guidelines. RESULTS: Two hundred eleven sleeping environments were observed (161 in SCN, 50 in GPW). Supine sleeping compliance was high in both wards (83% SCN, 82% GPW). Overall the median compliance score was significantly lower in the GPW (7, IQR = 6-7) compared to the SCN (8, IQR = 7-9) (Mann Whitney U test, P < 0.001). Lowest compliance rates were seen in respect to removing soft items from the crib and infant positioning within the crib. CONCLUSIONS: Compliance with supine sleeping was high; however, nurses and parents may not be aware, or do not implement, the full suite of safe sleeping guidelines. Further research is required to determine specific reasons for poor compliance and on the effectiveness of educational programmes in improving hospital infant sleeping environments.

Severe burns due to biofuel heater injury: A case series.

BACKGROUND: Biofuel heaters are a new form of flame heating for indoor and outdoor use. Fuelled by methylated spirits, they are simple structures with few safety features, and can be associated with severe burn. We report five cases of severe burns in adults that occurred when refilling these heaters. METHODS: We undertook a retrospective audit of all adults presenting to the Royal Brisbane and Women's Hospital (RBWH) with a biofuel heater-related burn between 20 and 30th June 2014. RESULTS: Five patients required admission for management of their burns. Three were admitted to ICU for greater than 3 weeks, and remained inpatients for up to 78 days. Two did not require ICU and were managed in the burns unit. Average total body surface area (TBSA) burned was 24.7%, and patients went to theatre up to seven times for debridement and skin grafting. Average length of stay was 41.8 days. CONCLUSIONS: Biofuel heaters are easily accessible yet there is no Australian Standard to ensure they are safe or perform in the way they were intended. As such, people using them are at undue risk of severe burn, even when following the operating instructions. These products should be removed from the market to prevent further harm and potential mortality.

Insulin infusion for hyperglycaemia in very preterm infants appears safe with no effect on morbidity, mortality and long-term neurodevelopmental outcome.

BACKGROUND/OBJECTIVE: Hyperglycaemia is common in very premature neonates and is associated with increased risk of intraventricular haemorrhage, necrotising enterocolitis, sepsis and death. Administration of insulin may risk hypoglycaemia and associated complications. To determine effects of insulin infusions in very premature infants on morbidity, mortality and long-term neurodevelopmental outcome. METHODS: Retrospective audit of 97 infants delivered at <29 weeks gestation and admitted to The Canberra Hospital NICU. Data on insulin treatment, Blood Glucose Levels (BGL's) prior and during insulin therapy, episodes of significant hypoglycaemia and neurodevelopmental outcome at 12 months corrected age was collected. RESULTS: 17 (17.5%) neonates received insulin. Episodes of hypoglycaemia were infrequent (1.3%, 95% CI 0.5-2.9). Multiple regression analysis showed that insulin treatment was not associated with an increased risk of retinopathy of prematurity (OR 3.6, 95% CI 0.4-32.3) or mortality (OR 1.2, 95% CI 0.29-5.0). No significant difference in 12 month neurodevelopmental or anthropometric outcomes was detected in infants who received insulin. CONCLUSION: Insulin infusions for hyperglycaemia appear to be safe with infrequent episodes of hypoglycaemia, no increased risk of morbidity or mortality and no adverse effect on long-term neurodevelopmental outcome.