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Ophthalmic Surgical Instruments

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Ophthalmic Surgical Instruments CIS SELF-STUDY LESSON PLAN Lesson No. CIS 272 (Instrument Continuing Education - ICE) Sponsored by: Ophthalmic Surgical Instruments BY JON WOOD, BAAS, CIS, CRCST, CLINICAL EDUCATOR, IAHCSMM Instrument Continuing Education (ICE) lessons provide members with ongoing education in the complex and ever-changing area of surgical LEARNING OBJECTIVES instrument care and handling. These lessons are 1. Identify common eye instruments used during an eye muscle procedure designed for CIS technicians, but can be of value 2. Review toxic anterior segment syndrome and ways to avoid the postoperative to any CRCST technician who works with surgical inflammatory reaction instrumentation. 3. Discuss the function of eye instrumentation during an eye muscle procedure Earn Continuing Education Credits: Online: Visit www.iahcsmm.org for online grading at a nominal fee. he success of every Central Objective 1: Identify common eye By mail: For written grading of individual lessons, Service/Sterile Processing instruments used during eye muscle send completed quiz and $15 to: (CS/SP) department and, procedures Purdue University - Online Learning ultimately, the success of every Instrumentation can differ from Ernest C. Young Hall, Room 526 155 S. Grant Street Tprocedure performed in surgery, depends healthcare facility to healthcare facility West Lafayette, IN 47907 on the quality of the instruments and is generally selected based upon the provided. Ensuring each surgical surgeon’s specific procedure needs and Scoring: Each quiz graded online at www.iahcsmm.org or through Purdue University, procedure has functional instruments preferences. The following is a list of with a passing score is worth two points (2 contact available and instrument sets that are common eye muscle instrumentation: hours) toward your CIS re-certification (6 points) correct, complete and ready for use when or CRCST re-certification (12 points). needed is an essential, yet challenging Basic Eye muscle set More information: IAHCSMM provides online responsibility. This lesson will identify • Jameson muscle hook grading service for any of the Lesson Plan commonly-used instruments found in • Graefe Strabismus hook (See Figure 1) varieties. Purdue University provides grading services solely for CRCST and CIS lessons. Direct ophthalmic surgery, review steps to avoid • Stevens tenotomy hook any questions about online grading to IAHCSMM toxic anterior segment syndrome (TASS) • Manson double-ended strabismus hook at 312.440.0078. Questions about written and explain how ophthalmic instruments • Desmarres lid retractor grading are answered by Purdue University at 800.830.0269. are used during eye muscle procedures. • Bishop-Harmon tissue forceps Check for Be sure the screw cleanliness intact, area debris free, and function no stress fractures Check tips Ensure screw is in place, area is debris free Figure 1: Graefe Strabismus Hook Figure 2: Castroviejo Caliper CIS SELF-STUDY LESSON PLAN Check for cleanliness. Be sure wire is intact. Figure 3: Vannas Scissors Figure 4: Wire Eye Speculums: Barraquer Wire (Left) and Solid Eye Speculum (Right) • Castroviejo fixation forceps (0.3mm or reactions with enzymatic and detergent transferred to the patient. According to 0.5mm) solutions, residuals from viscoelastic the Association for the Advancement • Moody locking forceps materials and cross-contamination of of Medical Instrumentation (AAMI), • Castroviejo caliper (See Figure 2) instrumentation from other services. eye instruments, especially intraocular • Vannas scissors (See Figure 3) As with any instrument being sterilized, instruments, should be processed • Westcott curved tenotomy scissors all sterilization parameters must be separately from other instruments. • Troutman-Castroviejo corneal section monitored closely to ensure the physical, This separation reduces the potential scissors chemical and biological indicators for cross contamination from other • Barraquer needle holder have been met. Any failures in these services, such as orthopedic and general • Castroviejo needle holder, curved areas should be investigated before instrumentation. The following steps can (with/without lock) instrumentation is released for use. be helpful in reducing the risk of TASS: • Lancaster eye speculum Improperly-sterilized instrumentation • Barraquer eye speculum (See Figure 4) can potentially transfer harmful • Carefully following the instrument • Jeweler bipolar forceps forceps (See microorganisms to patients, resulting in manufacturer’s IFU for cleaning; Figure 5) an infection. Enzymatic solutions and • Using only enzymes and detergents detergents should be compatible with recommended by the manufacturer; Objective 2: Review toxic anterior the instrumentation and diluted and • Having a designated cleaning area for segment syndrome and ways to avoid a rinsed according to the manufacturer’s intraocular instrumentation; postoperative inflammatory reaction instructions for use (IFU). Failure to • Keeping cleaning tools separated from TASS is an acute postoperative follow the IFU and adequately rinse tools used with other services; inflammatory reaction in which a residual enzymes and detergents from • Cleaning and disinfecting cleaning noninfectious substance enters the instrumentation can cause TASS. tools regularly; anterior segment of the eye and Viscoelastic material is a solution • Flushing lumens completely in introduces toxic damage to the used in cataract surgery to create and accordance with the IFU; intraocular tissues. The inflammatory maintain space in the anterior chamber • Rinsing with the recommended critical process of TASS generally begins 24 of the eye during the phacoemulsification water for the amount and time stated hours after eye surgery; when it occurs, and implantation of an intraocular lens in the IFU; patients may experience blurred vision, (IOL), as well as protect the corneal • Allowing adequate time for ocular pain, redness and corneal endothelium. When viscoelastic reprocessing between patients; and edema. In severe cases, TASS can cause material is allowed to dry and harden on • Inspecting instrumentation under permanent damage to the iris and instrumentation, it can be difficult to see lighted magnification. impairment of the pupil and require and remove. Viscoelastic material that additional surgery to restore vision. is not removed creates an ideal place for Several factors can contribute to TASS, bacteria to grow and biofilm to form. If including sterilization process failures, not removed, microorganisms can be CIS SELF-STUDY LESSON PLAN the lid speculum to expose the eye. or have imperfections in the blades can There are two types of lid speculums. rip and tear tissue. The tissue layers Check for debris. Electrode The first type uses a thumb screw to of the eye can be as thin as the skin tips should be intact expand the blades and retract the eye on a grape, so sharp scissors in good lids. It is important to inspect the blades working order are important. Once the to ensure they are free of nicks or burrs, incision is made, the scissors are used which could damage the eye lids during to dissect tendons and episcleral tissue Check for cracking the procedure. The thumb screw should until the sclera is reached. Bleeding or other damage move freely without having to place can occur when making the incision significant tension on it; if the thumb or during the dissection phase. The Figure 5: Jeweler Bipolar forceps screw does not move easily, refer to the Jeweler-type bipolar forceps are used manufacturer’s IFU. It is essential to only to cauterize blood vessels and control use lubricant that is approved by the bleeding. Inspection of the bipolar tips Objective 3: Discuss the function of eye manufacturer as unapproved lubricants is important because the tips of the instrumentation during an eye muscle could result in unintended inflammation, forceps act like electrodes. An electrical procedure or TASS. The second type of lid speculum current is used to cauterize as it passes The eye muscle procedure is indicated is a wire speculum, without a screw, through one side of the forceps electrode when there is a misalignment of the which provides tension on the eye lids. It and returns through the other side eyes and one or both eyes do not look is important to ensure the speculum can of the forceps electrode, restricting at the same place at the same time. provide tension; this is done by pressing the electrical current so it only passes This misalignment is called strabismus together the ends with the thumb and through the tissue between the tips or and the condition occurs as a result of index finger. The speculum should be electrodes. If the forceps tips do not poor neuromuscular eye control. Eye replaced if it does not spring back against approximate as intended, the patient alignment is important for good depth the thumb and index finger during the may be burned or harmed by cauterizing perception and for avoiding “seeing test. unintended structures. double.” When eyes are misaligned, the Once the lid speculum is in place, Once the sclera is exposed, the brain receives two separate images, which forceps are used to hold the conjunctiva Jameson and Stevens muscle hooks can create confusion and double vision. tissue, which is the clear thin membrane are used to isolate the targeted muscle. Over time, the brain will compensate and that covers the anterior part of the sclera. Muscle hooks come in different sizes and eventually ignore one of the images, Small forceps are used
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