Special Surgical Procedures II
LESSON 1: Eye, Ear, Nose, and Throat (EENT) Surgery
Section I: EYE SURGERY
1-5
1-5. SPECIAL SAFETY PRECAUTIONS
The precautions set forth for eye surgery should be scrupulously observed by the specialist as well as all other members of the operating room team, because errors or carelessness could cost the patient his sight.
a. Eye Medications. There must be absolutely no error in the administration of any solutions. In addition, all solutions must be sterile and fresh.
b. Room to Breathe. There must be sufficient ventilation for the patient beneath the drapes.
c. Quiet, Calm Room.
(1) To perform eye surgery satisfactorily, the surgeon must have a skilled and steady hand, and he must be able to concentrate on the operation. To maintain the needed quiet, calm atmosphere, all team members should keep conversation low and at a minimum. The movements of all team members should be executed smoothly and gently. This is especially important for persons working near the operative area. In addition, a sign should be placed outside the door to warn others that eye surgery is in progress and to keep traffic with its noise and confusion out of the area.
(2) When the patient has been given local anesthesia, it is necessary that he lie still without moving his head. Even though he is awake, his unaffected eye may be left uncovered; he may move if there is a loud noise or hurried activity near him.
(3) Eye instruments should be cleaned after each use during the operation with a nonfibrous sponge. After the operation, the instruments should be cleaned and dried thoroughly before storage. Microsurgical instruments should undergo ultrasonic cleaning with distilled water and appropriate cleansing agent. They should be individually hand held or immersed in ultrasonic cleaner as long as they are not touching each other. The instruments should be rinsed with distilled water and thoroughly dried.
NOTE: A regular preventive maintenance program should be established for
sharpening, realigning, and adjusting the precision eye instruments.
d. Instruments and Their Care. Eye instruments are delicate and are assembled and stored in specialized instruments cases. They are easily bent, broken, or dulled. These instruments are also expensive and they must be handled with these characteristics in mind.
(1) Eye instruments are never to be stacked--before, during, or after a surgical procedure. The specialist should carefully arrange the instruments on the table so that no instrument is touching another, and they must not be stacked or thrown down carelessly at any time.
(2) Eye knives require even more scrupulous care. The blades must be protected by suspension at all times when they are not actually touching the patient's eyes. In some instances, they are tested before use with a thin kidskin stretched over a drum. The knives must be capable of cutting without any pressure being applied to the knife.
(3) A basic eye surgery instrument set with the addition of other instruments, supplies, and suture materials as preferred by the surgeon, will usually suffice for all of the more detailed minor surgery performed on the eye. Examples of such minor surgery are tarsorrhaphy, repairs of eyelid lacerations, and repair of conjunctival lacerations. The basic eye instrument set will include:
(a) Self-retaining eye speculum.
(b) Lid retractor.
(c) Muscle hooks.
(d) Knife handle.
(e) Scissors (tenotomy, stitch, corneal, and iris).
(f) Forceps (suturing fine and heavy, iris, fixation, tying).
(g) Caliper.
(h) Needle holders (micro and heavy).
(i) Irrigating cannula (19- and 27-gauge).
(j) Iris spatula.
