(1)
St. Johns, FL, USA
(2)
Helen Keller Foundation for Research and Education, International Society of Ocular Trauma, Birmingham, AL, USA
(3)
Consultant and Vitreoretinal Surgeon, Milos Eye Hospital, Belgrade, Serbia
(4)
Consultant and Vitreoretinal Surgeon, Zagórskiego Eye Hospital, Cracow, Poland
The VR surgeon never works alone at the operating table: as a minimum, there is a nurse assisting him. Although the relationship between the two is crucial, it is not discussed in publications.
Pearl
The VR surgeon is only as good as his nurse is. Without a nurse who is a true assistant, the surgeon cannot dedicate his undivided attention to the patient.
Surgeons who do not treasure their nurse do so at their own peril as well as their patient’s.1 Even the slightest problem – an instrument is not immediately available, the vitrectomy machine’s settings are different from what the surgeon expects etc. – will force the surgeon to unnecessarily divert his train of thought from the intraocular task to an “extraocular” problem. When this happens and especially if it does so regularly, it is frustrating – and the frustrated VR surgeon is at an increased risk of committing errors (see the Appendix, Part 2).
A good nurse should pay attention, among others, to the following:
Always hand the proper instrument to the surgeon (see Sect. 3.7).
This is not as straightforward as it sounds: many companies do not “color-code” their forceps or scissors, and it may be too dark in the OR for the nurse to see the tip of the tool. The surgeon does not examine the instrument handed to him before he inserts it into the eye; realizing only then that he was given the wrong forceps, or scissors instead of forceps, is very frustrating.
The instrument is placed in the surgeon’s outreached hand correctly (see Fig. 54.7).
I have seen nurses in various ORs neglect this rule, forcing the surgeon to turn the instrument around before being able to use it. I have also heard frustrated surgeons scream at the nurse when this happens – but this only poisons the well.2
Learn how to do scleral indentation well (see Chap. 28).
If the nurse does not look into the microscope3 while indenting the sclera, she may not realize that the height of the indentation changes, greatly increasing the risk of retinal injury.
Pay close attention to what the surgeon is doing and learn his individual habits.
Q&A
Q
Is a good nurse supposed to anticipate the surgeon’s next move?
A
Yes. A good nurse does much more than fulfill the surgeon’s verbal requests. She observes the surgeon’s every move, becomes familiar with the particular surgeon’s customs, and tries to prepare for the next surgical maneuver in advance. She also voices her opinion if she thinks something is not right or could be improved (see below).
To closely follow the operation, the nurse must be able to continually see what the surgeon is doing inside the eye. Preferably, she can look into the microscope, or at least view it on a high-resolution, properly placed monitor connected to the video camera (see Sect. 12.4).
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
