Second OpinionsEye surgery prep
Eye surgery prep
We're rewriting our protocols and procedures, and I'd like to find out what others do for surgical eye prepping before cataracts, blephs, and other cases. Thanks.
Started by: Diane Klotz (Administrator/Director/Manager/Owner/Exec. Officer) at March 21, 2013 (9:37 am)
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How are facilities disinfecting the Abraham Lens used with the YAG Laser in between patients?
Leslie C. (Administrator/Director/Manager/Owner/Exec. Officer) at May 9, 2013 (11:12 am)
Well, it sounds like most people are using Betadine and are talking about prepping the eyes for ophthalmic surgery.
However, I am still wondering what ENT surgeons and plastic surgeons, for example, are using in place of Technicare now that it is no longer available FOR FULL HEAD AND NECK PREPS. Yes, Betadine works, but it is a pain to wash off the entire face and scalp and hair after facelift and browlift (or ENT procedures, I would imagine). Has anyone come up with anything other than Betadine that is similar to Technicare, that is safe to use around the eyes, and that does not stain the skin like Betadine?
Is the PCMX someone mentioned that is the same ingredient as in Technicare ok if it gets in the eyes, or is it NOT because of 4% (as opposed to 3%) concentration OR the other inactive ingredients? Is it just that Technicare did not have that warning about eye irritation that the PCMX has, but they are essentially the same?
And also, what about what to use for prepping for foley catheter insertion in someone allergic to Betadine? Is Chlorhexidine not to be used on vaginal mucosal as well as other facial mucosas?
Robert Grenley (Medical Director/Chief Surgeon) at April 22, 2013 (8:32 pm)
I would never chance using anything with chlorahexidine near the eyes,ears or mucous membranes.The label clearly defines the product uses and would not cross those boundaries and risk harming a patient. We have used sterile saline and sometimes inse. Betadine prep and a saline rinse. It would be wonderful to have an acceptable standard product for times like this.
Carol b. (Other) at April 7, 2013 (9:00 am)
We use Alcon's Betadine solution which is included in our cataract packs. We instill a few drops of the Betadine in the operative and then wash the area around the operative eye, cleanse the eye lashes with a cotton tip and then irrigate the eye with sterile saline. We use Hibiclens 4% on patients with Betadine allergy but do not use this on the cornea!
Beth Johnson (Director, Surgical Services/Director of Nursing) at March 26, 2013 (11:37 am)
Dr. Grenley asks an excellent question which I also asked a few months ago on this website. We are all forced to use Betadine solution. I do not use Betadine soap of course and we use a dry technique, around the eyes. In those patients with Iodine allergy I know a lot of plastic surgeons who use Dial Liquid soap and we use this, but is this Sub-obtimal? Dial has excellent bacteriocidal activity. We hoarded our Technicare but now what? Any word if it is coming back? What about using surgeons hand preps without Chlorhexidine? Using Betadine and then washing it off risks infection unless it is left on for at least five minutes, it seems to me. Otherwise it hasn't had time to work. There needs to be some consensus here as this is an important issue on many fronts not the least, SSI. I use permanent sutures in the deep plane of the facelift which I soak in Bacitracin solution. I have seen a suture infection in one of my patients and in several "threadlift" patients that were sent to me. I think that this is due to poor sterile technique in those cases,(not my own, of course). What do opthomalogists use in Iodine allergy patients when they place lenses for cataract surgery? BTW, I have seen several extensive contact type, "hives" in patients to CloraPrep but never seen one in Chlorahexidine and rarely in Betadine in many hundreds of cases compared to many more with ChloraPrep.
David Stephens, MD
Medical Director, David Stephens, Center for Plastic Surgery, Bellevue, Washington
David Stephens (Medical Director/Chief Surgeon) at March 22, 2013 (2:17 pm)
Following topical anesthetic w/ properacaine drops and tetracaine gel, We place a drop of 5% Ophthalmic Betadine solution in the eye prior to cataract and other intraocular or corneal surface surgeries (ie: superficial keratectomy, corneal transplant or DSEK, trabeculectomy, pterygium), then clean the lash lines w/ q-tips soaked in 5% betadine and around the eye going outward from the opening to the center of the nose on the side of the surgical eye, to the level of the nasal labial fold across the cheek and up & laterally to the surgical cap which is close to the hairline and never returning w/ the same sponge towards the eye opening. This is repeated w/ 3 5% betadine soaked sponges and then dried w/ a sponge using caution not to drag edges from the outside edges of the prep across the eye opening.
For patients allergic to betadine, we use an antibiotic drop in the eye pre-op . (Our surgeons do not consider a iodine contrast allergy to be cross reactive w/ betadine. So betadine is used on these pts and we have had no reactions.) We then prep the external portion of the eye w/ the soft portion of a sterile PCMX surgical hand scrub sponge wet w/ sterile water.
According to the article "Allergic to PVP? A Discussion of Alternatives" by Jean Hill, RN,MSN, CRNO and Lisa (Mary) Hill, RN, BSN published in the Journal of the American Society of Ophthalmic Registered Nurses (ASORN)in 2004, comparing many of the products mentioned in responses here plus more, PCMX (Chloroxylenol) which is what was in Techni-Care in 3% concentration and has good bacteriacidal and viricidal action. My surgical scrub sponges are in 4% concentrationand have other inactive ingrediants. This was recommended to me by an ASORN member who was on the TASS (Toxic Anterior Segment Syndrome) task force that came up w/ the recommendations for Decontamination and Sterilization of Intraocular Surgical Instruments recommended by ASCRS. She did a visit to another facility I worked at as a Alcon TASS consultant when we had a TASS case and made this recommendation to me. The MSDS sheet for PCMX states it may cause eye irritation so we are cautious not to get it in the eye.
For Bleph and Lateral Tarsal strip type procedures the eye is topically anesthetized, then prepped externally only w/ 10% betadine swabs in the same concentric fashion w/ special attention to the corner folds of the eye for Lateral Tarsal strip.
Jan J. (Director, Surgical Services/Director of Nursing) at March 22, 2013 (1:00 pm)
Betadine 5% flush, 10% face prep. If allergy we use baby pHisoderm (from local pharmacy)
M. Clay (Administrator/Director/Manager/Owner/Exec. Officer) at March 22, 2013 (10:17 am)
Betadine Solution - if allergic we use baby shampoo.
E. Whitton (OR Manager/Supervisor) at March 22, 2013 (6:47 am)
We use Betadine and if an allergy exists, then saline. We would never use anything with CHG in it.
Valerie Mills (OR Manager/Supervisor) at March 22, 2013 (6:01 am)
What are people using on the face now that we don't have Technicare any longer? We have had to use betadine, and it is a pain to wash off, particularly after a facelift when the whole head and scalp are prepped. Any suggesetions?
Robert Grenley (Medical Director/Chief Surgeon) at March 21, 2013 (8:09 pm)
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