Surgery

Preparing Instruments for Surgery

With newly developed procedures and instruments, a review of cleaning techniques improves safety.

Andrew E. Mathis, PhD, Medical Editor

A key part of the job for many ophthalmic medical technicians (OMT, which includes, COA, COT, and COMT) is preparing instruments for surgery. For the ophthalmic OMT, the sheer number of procedures can be dizzying. Phacoemulsification, PRK, PTK, LASIK, glaucoma surgeries, and posterior-segment procedures can be included in a large practice, and each of these surgeries comes with its own set of unique instruments. Here are some tips to guide the OMT when assisting in eye surgery.

Guiding Principles

According to Aaron V. Shukla, PhD, COMT, who is the program director of the Ophthalmic Technician Program at St. Catherine University in St. Paul, Minneapolis, MN, and who has worked as an OMT assisting in anterior-segment surgeries, the qualities of a good surgical tech begin with a full understanding of general concepts of surgery.

“Today, I teach the general concepts of ophthalmic surgery,” Dr. Shukla says, “including the concept of a sterile field, gowning, gloving yourself and someone else, handling and opening packages, preparing back tables and scans and knowing the instruments.” He continues, “For me, these were the anterior-segment instruments, needles and sutures, as well as medication for surgery, how to draw it and prepare it and how to prepare the patient, dilate and drape — all of the steps of surgery.”

Patty Dow, who is a surgery tech in the practice of Timothy D. McGarity, MD, in Columbia, MO, believes instrument order should be a guiding principle. “We make sure all the instruments are sterilized properly, and we check indicators,” she says. “I lay out my instruments in the order in which we use them. This definitely helps when you are moving quickly.”

Laurie K. Brown, COMT, COE, OSA, who works in the practice of Drs. Fine, Hoff man & Sims in Eugene, OR, adds, “Watching tips and instrument integrity is an efficiency, cost, and safety issue of great weight. Also, handing them off in the position they will be used while minimizing risk to patient, surgeon and assistant is a constant mindfulness objective.”

Sterile Procedures

Another key concern during surgery — one, in fact, that has become increasingly urgent over the last several years — is maintaining proper sterile procedures in the OR. As species of bacteria have evolved to become increasingly resistant to antibiotics, infectious complications such as endophthalmitis threaten vision more than ever before.

Ms. Brown says, “We used to just wipe instruments down and flush out cannulas and sterilize the instruments between cases when I first started. We then moved to visiting the cleaning room with a more cursory cleaning, and now we are fully cleaning all instruments in between cases as in an end-of-the-day cleaning.”

She also notes that at Fine, Hoffman & Sims, they stay abreast of the most recent information on infection prevention and implement their own guidelines accordingly. “All the cleaning and sterilization changes are based on data and are absolutely for the better,” she says.

Learning New Procedures

With new ophthalmic surgical procedures under development all the time, some measure of time must be spent learning new procedures and being accustomed to new instruments.

“The newest technology I was trained on was a laser for LASIK,” Dr. Shukla says. “Before that, in the 1990s, we were trained for phaco cases using IOLs. With some of the changes, the injectors and instruments had to change also.”

At Drs. Fine, Hoffman & Sims, the newest procedure being used is the iStent, a minimally invasive glaucoma stent. “Our doctors, OR staff and first assistants went through comprehensive training,” Ms. Brown says, “and our first cases have gone very well. Our training highlighted what additional instruments would be needed and how they will be used, in addition to the implantation technique.”

Many instrument manufacturers now offer training for their products. In some cases, they will often hold in-office trainings for ophthalmic techs, as well as the doctors and nurses.

Challenges With Change

However, change does not always happen smoothly, Ms. Brown adds. “Sometimes, it’s hard for staff to make changes at times when they feel they haven’t had a problem. It is important to always revert back to the goal of doing what is best for the outcome first and foremost and limit opportunities for undesirable outcomes.”

Determining staff roles can also be difficult at times, and changes in regulation have complicated these relationships. Ms. Brown explains, “Medicare’s recent condition for coverage of ASCs really rocked our workflows. It definitely raised the cost of healthcare in some areas where it was needless.”

She continues, “An example is the use of highly trained ophthalmic technicians in patient care in an ASC. The fact that now a technician cannot instill drops or do any charting is a shame and huge inefficiency. The fact that a licensed nurse has to be the assistant for ophthalmic laser procedures not requiring injectable anesthesia is also a huge cost and inefficiency to our practice.”

Ms. Dow mentions that the paperwork has become more voluminous, and turnover times for surgery rooms have decreased. But this has been less of a challenge in the practice where she works. “We have a great staff at our surgery center,” she says, “and we all work together accomplishing what needs to be done.”

Be on Your Toes

All of these changes can be confusing and interfere with the allied health professional’s role in the OR. Ms. Brown offers some helpful tips: “Throughout a case, an assistant should be continually thinking ahead, checking the tray in addition to being ready one step ahead of the surgeon and anticipating the next move. This requires watching the case events carefully for the needs of the surgeon. Being solidly prepared for the usual makes you more efficient for anticipating alterations needed.” OP