If the phacoemulsification machine is the workhorse of cataract surgery, then the phaco handpiece is the bridle and reins, as well as the nervous system. Without it, the surgeon could not deliver power to the phaco tip, nor direct it to perform intricate microsurgery. At a cost of $5,000 and up, handpieces represent a significant investment for your facility, and it makes good sense to handle and maintain them with the utmost care. Unfortunately, these delicate devices don't always get the respect they deserve. "For such expensive equipment, it's amazing what we see," says Jeff Bua, Quality Director for Ophthalmic Group of Knoxville, Tenn., which repairs phaco handpieces. "They get dropped, or the cord is accidentally cut with a diamond knife." In this article, we'll help you understand your phaco handpieces and provide tips for keeping them in great shape.

Understanding handpieces
Phaco handpieces have three functions:

• To irrigate the eye, keeping it inflated during surgery;
• To phacoemulsify, breaking up the cataract; and,
• To aspirate, removing debris.

The handpiece converts electrical energy into mechanical movement at the tip. The tip moves at around 40,000 KHz (anywhere from 20,000 to 50,000 times per second), which breaks up the cataract. The movement comes from applying voltage to piezo crystals inside the handpiece.

"The crystals are very fragile and under high stress," notes Herbert "Cam" Cameron, III, President of American Optisurgical, Inc., Lake Forest, Calif. Therefore, to keep the handpiece in working order, experts stress gentle cleaning to thoroughly remove debris but keep the delicate crystals intact. Here are three steps to do so:

1. Immediately after surgery, flush all ports of the handpiece to remove salt and debris, which can compromise the surgical procedure by increasing the fluid resistance. "It's critical to rinse, because both eye debris and balanced salt solution are corrosive. If you don't get this material out, it will bake on in the sterilizer and leave deposits," Mr. Cameron warns.

Gina Stancel, RN, Patient Care Coordinator for Eye Centers of Florida, recommends flushing both ports of the handpiece with 30 ccs of sterile water. Mr. Cameron recommends using 60 ccs of sterile water, as well as air. Experts also recommed against using wire cleaning instruments or steel brushes to clean any part of the handpiece.

2. Next, examine the handpiece for dents or nicks, and examine the tip, silicone sleeve, and cord. Place the handpiece on the tray for autoclaving.

3. After autoclaving, cool the handpiece at room temperature; this takes at least 15 to 20 minutes. Although this step is critical to handpiece longevity, this is often "too long" to wait in busy facilities.

"When you're doing a ton of cataracts, it's tempting to use the them too quickly," admits Joy Leister, RN, Clinical Coordinator for the surgery center at Lancaster General Health Campus, Lancaster, Pa., Ms. Stancel comments: "Because we are so fast, there is no cooling period other than the time it takes for us to set the case up."

Experts warn against taking shortcuts, however, such as immersing the sterilized handpiece into cold water, which, according to Mr. Cameron, may depolarize and destroy the crystals. He recommends referring to the operator's manual fo cooldown times.

Another concern is condensation on the plug end of the handpiece, which can occur during autoclaving. Be certain this plug is dry before attaching it to the phaco machine.

"It takes a little tap to remove the obvious moisture before the nurse inserts it in the machine. We have plugged in ?wet' ends and shorted out the handpiece. Some companies have caps you put on the end before sterilization, but they are hard to remove and obviously very hot, so a lot of techs do not put them on," Ms. Stancel says.