The Journal of the American Medical Association (AMA) recently warned of a growing but under-recognized problem – medical litter. The warning didn’t refer to swabs, scalpels and needles in waste containers but to medical debris left behind in the patient’s body.
“Patients who harbor such material may subsequently experience complications such as local tissue rejection, inflammation, perforation, blood vessel obstruction and death,” according to the AMA.
The federal Food and Drug Administration (FDA) sounded the same warning recently. It listed as culprits broken stents, torn balloons, broken guides for catheters used in heart operations and stray parts from medical devices. These range from catheter tips and drill bits to orthopedic bone screws.
Reporting on the AMA warning, Canada’s Globe and Mail newspaper cited case histories: a woman who suffered unexplained pain for eight years until technicians discovered a broken biopsy needle left in her breast; a woman who learned the pain that continued after surgery on her knee, which continued long after the wound had healed, was the result of a 2-inch scalpel blade left inside her leg; and a teacher who missed most of a year with her third-grade class while doctors grappled with a metal blood-clot filter that shifted and pierced a vein – and couldn’t be removed.
The FDA database lists 72 deaths and 4,675 injuries associated with “unretrieved device fragments” since 2003.
The FDA reports are likely to be underestimates, according to Dr. Mark Estes, president of the Heart Rhythm Society, a research and advocacy agency that has pushed for better enforcement of cardiac device standards. In the Globe and Mail article, he explained that the monitoring system is passive. “The FDA accepts what comes in from doctors and manufacturers. There is tremendous under-reporting of devices.”
Even worse, according to the Globe and Mail, some health workers don’t tell their patients about the broken devices, sending them home with pieces that have the potential to migrate throughout the body, or to interact with future procedures such as magnetic resonance imaging.
Ergonomists and other professionals called in to address problems like these often look first at systems with flawed ergonomics. Some examples are poorly-designed shifts that leave hospital personnel short of quality sleep, as well as inadequate methods for checking procedures.
Sources: Globe and Mail; FDA