Information for Circulator

Please, tape this sheet to the wall after reading it – so in case someone else takes over the job, we would find it.

Help clean and disinfect areas in which we will be working – daily! Wipe all surfaces with alcohol or Clorox wipes. Ask Ghanaian clinic personnel to wash floors of OR (operating room) and clinic daily-they usually do NOT do it on their own.

Help unpack, sort, organize materials in supply area and OR.

Learn names of supplies and also where they are-you will need to find and open them QUICKLY during surgery.

Pull items needed for surgery and open as needed (sterile technique)

Prepare retrobulbar injection-withdraw 7 cc of 2% of Lidocaine into 10 cc syringe and put long blue needle at end. All injections should be prepared in the morning, before starting surgery. Always make as many syringes as many patients we have for surgery for the day. The syringes can be kept for next day if they are unused. Leave paper cover on syringes to mark that they are unused.

Be prepared to assist with A-scan and keratometry and calculations for IOL. (Intraocular lens.)

Keep OR in a quite and calm mode – filter unauthorized visitation. Only 1 person can be inside in addition to surgeon, OR nurse, scrub-nurse and translator.

Check and double-check for correct eye to be operated – always check necklace of patient before doing surgery!

 

1. DILATE

Check the necklace of the PT (patient) to see which eye will be operated on, and if he/she needs to be dilated. Place a tape above eye to be operated on.A few patients will have secondary IOLs and they must NOT be dilated. It will be marked on the necklace as “DO NOT DILATE”.

Instill 1 drop of RED, BLUE, YELLOW and BLACK drops to eye to be operated on, marked with tape, at least 45 minutes before surgery. These drops will dilate the patient’s pupil. Without the dilating drops we cannot perform the surgery. It takes about 45 minutes till the drops are fully effective and about 4 hours for them to wear off. Always dilate the first 3 patients in the morning, and always 1 more as soon as one surgery is completed. Before lunch dilate 3 more patients so they would be ready to go after lunch-brake. It is VERY IMPORTANT to dilate the patients ahead of time-not doing it can cause big delays in the OR. Make sure you dilate the eye which will be operated. (Dilating the other eye will do no harm though, but it increases the chances of a mistake-we might operate on that eye instead.)

 

2. BATHROOM

Make PT go to bathroom-even if he says he does not need to go, he MUST! (It is messy if they pee in the OR, and you will need to clean it up)

 

3. PREOP INSTRUCIONS

Give PT the preoperative instructions with the help of a translator. If the PT is very apprehensive, arrange for relative to come into OR with the patient.

 

4. BLOOD – PRESSURE

Measure blood-pressure, and write it on back of necklace. If it is above 180/110, we will give the patient medicine before injection or possibly cancel the surgery.

 

5. INJECTION

Be prepared to assist with anesthetic injection. Put PT on bed in front of OR, surgical eye facing outside. Scrub lids before with Ocucoat lid scrubs, give 1 drop of numbing drop (white cap) and 1 drop of iodine. After this the doctor will inject the anesthetic. The anesthesia lasts for about 60-90 minutes.

 

6. INTO OR

  1. Take shirt/blouse off PT, take cellphone away, put hat and gown on and put PT on OR table for surgery, make sure comfortable with pillow under knees. Make sure PT does not touch the sterile field.
  2. Never leave patient alone, always hold his hand and talk to him in a calming tone, even if he does not understand. Many patients are completely blind.
  3. Clean skin around eye and the eyelids with iodine swab
  4. Help monitor patient – keep them calm and prevent them from touching clean eye
  5. Have drops ready to administer during and after surgery as requested
  6. Turn microscope on and off as requested – also adjust power during surgery.
  7. Be comfortable with procedure involved in case 12 volt car battery power required
  8. Help adjust sterile drape over patient’s face from underneath – make sure they breathe easily.
  9. Locate and open items during surgery that may not be on the sterile table
  10. Be aware of items and meds that are used infrequently but which must be accessible
  11. Be very familiar with operation of autoclave – see separate notes
  12. Have patient chart near and make sure PC IOL is pulled and placed on top of chart
  13. We have 2 different kind of IOL’s: posterior (PC) and anterior (AC). Most of the time we will use the PC lens, the AC lens is the backup. Always pull ONLY THE PC IOL. If we need the AC, it will be pulled during surgery.
  14. Show IOL and chart to surgeon prior to opening the IOL once the lens is requested
  15. Have tape and patch ready for patching after surgery
  16. Have alcohol swabs ready for cleaning certain items between cases
  17. Help patient get off table and back to responsible person
  18. Prepare table for next patient and tidy area at end of each case
  19. Clean instruments and autoclave them for next case
  20. Help prepare area for next day at end of the day’s surgical cases
  21. Post op drops ready for next day to give out to patients
  22. Supplies pulled for next day’s surgery
  23. Assist with drawing up meds as requested
  24. Anticipate needs and the upcoming steps – ask questions and be proactive
  25. Do not get discouraged by all these instructions-they are easier to learn than what they seem. Have fun !

 

7. FIRST DAY POSTOP:

  1. Remove bandages from patient’s face – have trash bag handy
  2. Have sterile gauze and water handy for eye clean-up
  3. Have pressure-reducing pill (Diamox – orange football or white) available
  4. Be able to give instructions for eye care at home – with translator
  5. Make sure each patient and family gets the instructions – and no one leaves without it. Always ask them if they have any questions.
  6. Discharge patient and family with lots of care and compassion.