Eliminating Infusion Bubbles And Uncontrolled Reflux By The Constellation Vitrectomy System

Abstract

Purpose: : To identify the sources of and eliminate infusion bubbles and uncontrolled reflux from the Alcon Constellation® Vitrectomy system.

Methods: : Surgical and analytical videos were evaluated to identify the source of intraoperative bubbles, which localized to the duckbill valve (DV). Intraoperatively we modified the infusion tubing and its control by removing the DV. The DV was re-purposed as a one-way valve to block reflux originating from the vitrectomy console.

Results: : Infusion bubbles at the DV developed with each transitory tubing pressure drop upon opening of the infusion clamp. Modification of the infusion and aspiration tubing resulted in elimination of infusion bubbles and console-originated reflux in 20 eyes. Since instituting these modifications, Infusion bubbles developed in only 1 eye in which the scrub nurse forgot to make modification to the setup. Placement of the DV to block reflux eliminated uncontrolled and purposeful console-originated reflux.

Conclusions: : Intraoperative modification of Constellation® tubing may eliminate two potentially harmful problems until manufacturer correction is instituted. Since our modified connections represent off-label connectivity, the manufacturer cannot contact potentially affected surgeons or suggest temporary alternative connectivity improvements.

Keywords: vitreoretinal surgery