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California's Central Valley is home to about five Kaiser-affiliated hospitals, offering emergency and other medical services 24 hours a day, seven cslifornia a week. West Lancaster, CA Driving directions References Kaiser Permanente: Quick Facts. Written by Max Stirner. Max Stirner is a New York-based writer and editor with over a decade of experience. Richmond, CA 1 0.

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Alcon infiniti settings

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Cavitation bubbles appear, implode and propagate energy waves, which break up the lens material. Increasing phaco power is achieved by increasing the stroke length. Continuous, Pulse and Burst You can also make phaco more efficient by modifying the timing or duration of ultrasound power, according to Dr.

The basic power settings available include continuous, pulse and burst modes. Figure 2. In phaco pulse mode, the time between pulses, known as the off time, allows the phaco needle to cool, reducing the heat and energy delivered into the eye. The ratio of the total phaco-on and phaco-off time is expressed as a percentage. A percent duty cycle, for example, means that the power is on half the time and off the other half, according to Dr.

However, she adds, you can alter the duty cycle to change the on-and-off times. For example, you can program your machine to provide a percent duty cycle, which results in 20 milliseconds of energy followed by 80 milliseconds of no energy in each cycle.

Figure 3. In the phaco burst mode, bursts of equal levels of energy are delivered more rapidly as the pedal is depressed. Park emphasizes selecting the right pulse rate and duty cycle for the right circumstances. During sculpting, for example, energy creates a groove and, therefore, higher pulse rates tend to work better because the narrower time intervals between pulses produce a smoother delivery of ultrasound energy.

For quadrant removal, she says, a lower duty cycle tends to be a better choice most of the time because a long interval between pulses allows for the aspiration of nuclear fragments. Burst, the third mode, also helps in special situations. The more the pedal is depressed, the shorter the off period is between each burst.

In other words, the bursts of energy are delivered more rapidly as the pedal is depressed. At the maximum point of depression, the time between bursts becomes infinitely smaller and essentially constitutes a continuous delivery of energy. The vacuum and fluidics of the phaco machine are used to aspirate the cataract fragments and give small bursts of power only when necessary, she notes.

Long pulse mode is a to millisecond pulse duration. Remember Your Parameters Dr. Auran, also the surgical curriculum director for the Columbia University ophthalmology residency program, says intelligent use of phaco parameters is essential. Increased IOP also stabilizes the chamber, especially in the presence of high aspiration and vacuum or when leaking incisions are involved. We can minimize post-occlusion surge in these situations. Auran points out that, according to in vitro data, increasing the IOP to as high as mmHg in the Alcon Centurion system can make the machine more efficient.

Auran notes that vacuum varies when the phacoemulsifier is turned on, requiring you to use vacuum for aspiration only. Quick taps of the tip will advance the tip deeper into the nuclear fragment, enabling a firmer hold. Auran says you can ensure the best use of vacuum to hold a lens, capsule or iris against the instrument tip. Increasing vacuum can also increase phaco efficiency in some machines, to some extent. Meanwhile, a very high vacuum setting decreases efficiency, 6 but does allow for the aspiration of soft and medium pieces of the nucleus, which can be aspirated with minimal or no phaco power, notes Dr.

Meanwhile, when you increase aspiration you increase phaco efficiency, Dr. Auran points out, noting that high aspiration can help with sticky material, such as the epinucleus and cortex, and for viscoelastic removal.

However, high aspiration can also be risky. Appreciating Variable Power Dr. Auran says increasing phaco power generally increases efficiency. Higher power can increase the risk of corneal injury, wound burn, iris damage and capsular rupture. Are there any other approaches to increase efficiency?

One example, Dr. Park points out, is limiting power to prevent excessive heat build-up. She also urges you to use the innovations in phaco technology that augment longitudinal phaco, when indicated.

Remember that transversal ultrasound helps emulsify the nucleus in more than one direction, increasing cutting efficiency. The main advantage of torsional phaco is increased energy efficiency, but the main disadvantage is significant tip movement. Note that transverse and torsional phaco are proprietary.

Figures 4 and 5. When performing an anterior vitrectomy during cataract surgery, James D. Auran, MD, recommends removing the vitreous at 4, cuts per minute and aspirating fluid in the third pedal position. For lens removal with the vitrector, make careful adjustments to draw the lens pieces away from vitreous without aspirating the vitreous while slowing the cut rate to to cuts per minute, he says.

This opens the cutter port enough to produce sufficient aspiration and vacuum to engage the lens pieces. Meanwhile, remember that specific phaco units perform differently. Auran adds. The Whitestar Signature Pro, when used with longitudinal power and a degree bevel straight tip, increases efficiency up to percent. Efficiency is optimal at 90 percent power in the transverse mode with a cm bottle height and vacuum at mmHg. Auran explains how phaco modes can help keep your surgeries safe, efficient and responsive to the needs of varied patients.

Unlike torsional or transverse power, longitudinal power will likely draw the nucleus toward the tip. The chop mode is for holding the lens, he continues. Some surgeons go right to quad, drawing pieces of the lens toward the phaco tip, relying on increased aspiration and vacuum and as much phaco power as needed. The torsional or transverse modes, less likely to repel nuclear particles, might be best.

Epinuclear settings are for handling the rubbery outer layer of the nucleus, again with moderate to high vacuum and aspiration, as needed, with minimal or no phaco power and high IOP to push the capsule posteriorly, as appropriate, he notes.

To prevent this, elevate the IOP, pushing the capsule bag back and making it taut. When engaging and stripping cortex in the periphery, use moderate vacuum and high aspiration.

Once cortex has been drawn into a safe area in the center at the iris level, increase aspiration and vacuum to aspirate cortex. Polish is best used with a silicone tip, according to Dr.

It involves very low settings while you keep the pressure high and capsule taut. Very low vacuum and aspiration are indicated to gently remove cells while minimizing the risk of aspirating capsule material. Viscoelastic can be used to viscopolish the lens capsule. Removing viscoelastic requires the same settings as for the epinucleus, including high IOP to keep the capsule away from your tip and increased vacuum and aspiration to remove the viscoelastic.

Figure 6. Auran emphasizes the need to prepare for an unexpected complication. Lower the IOP to nearly zero before withdrawing the tip.

Halt all irrigation. Wiggle your sideport instrument sideways within the incision to potentiate controlled fluid egress from the sideport. Then withdraw the phaco tip quickly through the main incision, taking care not to depress the base or lift the roof of the incision while withdrawing the instrument. For an anterior vitrectomy, Dr. Remove the necessary panels to inspect and clean, as required, the accessible internal console cavities of the Infiniti TM system.

Normalize the leads so the meter displays 0 ohms or record the measured displayed resistance and subtract it from the measured resistance below to get actual ground resistance.

Inspect system hardware. Ensure nuts, bolts, and screws are tight. Clean, repair, or replace as necessary. Replace footswitch cable as necessary. Check and tighten all four casters console wheels. Use a finger to check that all four Fluidics module hub rollers spin freely.

Note: 2 Power Supply fans cannot be checked without removing covers. Replace connector as required. Pneumatic Line Filters. Verify that display shows Setup screen. Verify procedural steps can be selected. Verify Adjust Button see Fig. Press the OK button. Press the Ok button and then exit to surgery screen.

Repeat 2. And hold with force to restrict valve plunger from moving. Select Surgery. Verify footswitch icon located in upper part of display indicates position 0. Verify the following:. Observe the change from position 0 to 1 then 2.

While depressing the footpedal, move and flex the footswitch cable and verify that there is no intermittent response to Coag power or the footswitch icon. Select any surgical step. Select Footswitch icon, Treadle , and turn Vibration on. Increase level to maximum setting.

Press Save, then OK. Verify that when the footswitch icon changes from 1 to 2 and 3, the footpedal detent vibration is felt accordingly. Verify the appropriate triangle appears next to footswitch icon during the time each of the following switches is activated.

Flex the footswitch cable during switch activation. From Setup screen, select Custom then About.