Surgical Assisting Procedures Flashcards

During a phacoemulsification procedure, the surgeon requests a second instrument to perform bimanual irrigation/aspiration. The scrub technician notices the I/A handpiece tubing has a small kink near the cassette port. What is the MOST appropriate immediate action?

Answer: Replace the entire I/A handpiece set with a sterile backup before passing it to the surgeon

A kinked tubing near the cassette port can cause unpredictable flow rates or sudden pressure changes intraocularly, risking capsular rupture or corneal decompensation. The correct action is to replace the entire set with a sterile backup. Straightening a kink does not restore tubing integrity and the line may re-kink or develop a weak point. Flushing vigorously could worsen the deformity or dislodge particulates. The technician should not pass compromised equipment — patient safety requires proactive replacement before the surgeon is at risk.

A COT is assisting with a trabeculectomy. After the surgeon creates the scleral flap, the patient's eye becomes markedly hypotonus. Which intraoperative finding would MOST suggest inadvertent entry into the suprachoroidal space rather than the anterior chamber?

Answer: Choroidal elevation visible through the pupil with no aqueous flow from the sclerostomy

Suprachoroidal entry during trabeculectomy can cause suprachoroidal hemorrhage or effusion, presenting with choroidal elevation visible through the dilated pupil. Critically, if the sclerostomy has not yet been completed into the AC, there will be no aqueous flow from the intended drainage site. Iris prolapse and clear aqueous egress both indicate successful anterior chamber entry. Absent red reflex with shallow AC could suggest vitreous presentation or hypotony from AC entry, but choroidal elevation with no AC communication is the hallmark distinguishing suprachoroidal space entry.

During vitreoretinal surgery requiring silicone oil tamponade, the surgical technician is asked to prepare the oil infusion. The available silicone oil is labeled 5,000 centistoke (cSt). Compared to 1,000 cSt oil, which property of 5,000 cSt oil MOST directly affects how the scrub tech must handle the transfer setup?

Answer: It must be passed through a larger-bore cannula or dedicated high-viscosity injector due to greater resistance to flow

5,000 cSt silicone oil is significantly more viscous than 1,000 cSt oil. This high viscosity means it cannot be transferred through standard small-bore tubing or cannulas without generating excessive back-pressure, which could damage the injector or produce uncontrolled injection speed. A larger-bore cannula or a dedicated high-viscosity oil injector (e.g., the Alcon COQUILLE or equivalent) is required. Silicone oil does not crystallize at room temperature. 5,000 cSt oil actually emulsifies less readily than lower-viscosity oils. Both weights have similar specific gravity (~0.97) and both require similar positioning considerations.

A COT scrubbing for a penetrating keratoplasty (PK) notices that after the donor corneal button is placed and the first four cardinal sutures are thrown, the anterior chamber is flat and there is no formed AC despite BSS injection through the side port. The MOST likely cause requiring technician awareness is:

Answer: The trephine diameter of the donor button is too small, leaving a gap at the host-donor junction

When the donor button trephine diameter is smaller than the host bed (or there is a mismatch leading to a peripheral gap), fluid injected to re-form the anterior chamber escapes through the unsealed host-donor interface. This is a sizing complication. Graft orientation errors (endothelium up) are typically identified before suturing via the Munson sign or direct visualization of epithelium. A suture through Descemet would be a localized leak, not global flattening. A patent paracentesis is possible but less common when wound construction is proper; the donor-host mismatch is the classic intraoperative cause of inability to maintain AC during PK.

In a combined cataract and glaucoma procedure (phaco-trabectome), the technician receives a trabectome handpiece from the sterile field mid-case because the surgeon is switching to goniotomy. The handpiece tip has visible tissue debris. Per standard instrument processing protocol, which step is CONTRAINDICATED before reprocessing this handpiece?

Answer: Submerging the handpiece in an ultrasonic cleaner while the electrical connector is attached

The trabectome handpiece contains an electrosurgical electrode and an integrated electrical connector. Submersion of the handpiece in an ultrasonic cleaner with the electrical connector attached is strictly contraindicated — it causes corrosion of electrical contacts, potential irreversible damage to the transducer, and may void the manufacturer's IFU (Instructions for Use). Standard reprocessing requires disconnecting and protecting all electrical components before any wet processing. Enzymatic presoak of the non-electrical portions, exterior wiping on the sterile field, and internal lumen flushing (with connector removed/protected) are all acceptable steps per standard reprocessing guidelines.

During a retrobulbar block administered immediately before strabismus surgery, the patient develops sudden onset of bradycardia, hypotension, and loss of consciousness 30 seconds after injection. The MOST probable mechanism and the technician's FIRST priority action are:

Answer: Brainstem anesthesia from inadvertent intradural injection; call a code and support airway/circulation

Rapid loss of consciousness combined with cardiovascular collapse within 30 seconds of retrobulbar injection is the classic presentation of brainstem anesthesia (also called 'brainstem spread'). It occurs when the needle enters the optic nerve sheath and anesthetic tracks centrally through the subdural/subarachnoid space to the brainstem. This is a rare but immediately life-threatening emergency. The oculocardiac reflex occurs during traction on extraocular muscles, not from injection. Vasovagal syncope does not cause the rapid, severe hemodynamic collapse described. Anaphylaxis to amides is extremely rare and presents differently. The technician's first priority is to call an emergency code and support airway and circulation immediately.