Surgical Assisting 4% Flashcards
1
Q
I&C Incision and curettage is usually for…..
A
Subacous material such as chalazion
2
Q
I&D incision and drainage is used for….
A
Pus filled pockets
3
Q
*Sx procedure in which upper and lower eye lids down together
A
Tarsorrhaphy
4
Q
When is a tarsorrhaphy performed?
A
When there’s a sick K and we want to protect it
Done in office or operating room
Can be temporary or permanent
5
Q
What is checked during a “time out” for sx?
A
Pt ID
surgical site and side
Procedure confirmed
(Everyone must be preset and agree and marked in chart)
6
Q
What is a chalazion clamp used for?
A
Positioning the skin where the chalazion is.
7
Q
What is a needle holder used for?
A
Holding needles
(Usually has locking mechanism on the handle)
8
Q
What is a lid speculum used for?
A
Keeping eyes open during a procedure
(Available in adult and pediatric and may have spring type or screw on it)
9
Q
What are scissors used for?
A
Used for cutting supplies or tissue (Can be sharp or blunt, straight or curved)
10
Q
What are forceps used for?
A
Used for grasping supplies and tissue (Can be toothed, smooth, or serrated, curved or straight)
11
Q
Instrument, needles, and cannulas are measured in_______.
A
Gauges
12
Q
The bigger the number gauge on the instrument the __________it is. The smaller the number the______it is
A
Smaller
Bigger
13
Q
What are corneal burrs used for?
A
Smoothing K tissue after pterygium sx or after FB removal
14
Q
What is cautery used for?
A
Hemostasis and tissue closure
15
Q
What size blade is typically used to incise a chalazion?
A
11
16
Q
*What is a curette used for?
A
Scooping the sebaceous material out from inside the chalazion.
17
Q
What should be done first before drawing up med from a vile?
A
Wipe top with alcohol
18
Q
You typically use a ______needle to draw up medication
A
Larger
19
Q
Fill the syringe with______to equal the amount of med you need to draw up and push it into the vile
A
Air
20
Q
What are injectable steroids used to treat?
A
Uveitis and AMD
21
Q
What are the side effects of injectable steroids?
A
GLC and CATS
22
Q
What are anti VEGF drugs used to treat?
A
Wet AMD
23
Q
VEGF stands for ….
A
Vascular Endothelial Growth Factor(a protein that’s in everybody’s body)
24
Q
Anti VEGF injection does what?
A
Blocks the VEGF protein and decreases the abnormal blood vessel growth that happens with WET AMD.
25
Subconjunctival injection drugs are used for….
Intraocular infections
26
Subconj injections are absorbed into the bloodstream by_______________and ______________
Epistle rap and conj vessels
27
Retrobulbar and peribulbar injections ate what type of injections
Anesthetics
28
LASER stands for …….
Light Amplification by stimulated emission of radiation
29
Light travels in _____
Waves
30
How is wavelength of light measured?
From peak of one wave to the peak of the next wave in “meters” or parts of meters
31
What color has the shortest wavelength in the visible spectrum?
Violet
32
What color has the longest wavelength in the visible spectrum
Red
33
*What is the visible spectrograph there human eye
400-700 nanometers
34
When wavelengths rise and fall in unison this is called?
Coherency (or coherent light)
35
LASER emit monochromatic light of the same_________and_______
Frequency and polarity
36
What does PRP stand for?
Pan Retinal PhotoCoagulation
37
What is PRP used for?
To treat DM, BRAO, and iris NV following CRAO.
(retinas that are poorly produced with oxygen)
38
What lasers are used to do a PRP?
Argon or Diode
39
Instrument used for positioning the skin so we can incise the chalazion. It has a smooth foot plate.
Chalazion clamp
40
What is the purpose of the hemostat part of the chalazion clamp?
To keep the bleeding at a finite area
41
Explain the process of drawing up medications
Use alcohol wipes to cleanse top of vial
Use larger needle to draw up meds than what will be used for injection
Fill syringe with air equal to amount of medication you need to draw up
Express air from syringe into vial (this forms a vacuum)
Extract appropriate amount of medication plus a tad more
Remove syringe from vial and draw back slightly to allow a tiny bit of air into the syringe
Holding syringe needle end up, tap on syringe while pushing up on syringe plunger until all air bubbles are out
Passively recap needle
Replace needle with gauge for injection
42
Pts with _____ will typically have excess VEGF protein
WET AMD
43
Sunlight can never be made___
coherent
44
What makes LASERS to powerful?
First it emits a single ray of light, second is that the light is coherent, and third is that it takes all that light down to a tiny pin point and this very narrow light makes it very powerful.
45
Each wavelength of light has a selective absorption of different types of tissue and generally the longer the wave length the _____ light penetrates into the eye.
Deeper
46
We generally use ____lasers for posterior segment procedures and ___or ____laser lights for anterior segment procedures
Red
Green or blue
47
With PRP we are making _____to kill off peripheral retinal tissue. This reduces the requirement for _____ in the retina so that the little bit of it that is profused to the retina goes to the primary real estate of the retina, the macula.
burn holes
oxygen
48
All of the burn holes from PRP leave a permanent_____
VF defect because it kills off peripheral retinal tissue so that the macula can be save and the oxygen goes to the it instead of other parts of the Retina
49
What does PDT stand for?
Photo Dynamic Therapy
50
True or false
PDT does not do damage to the retina like PRP does.
True
51
What is PDT used for?
To treat WET AMD
52
Explain how PDT is performed and how it works.
A light activate drug (photo-dynamic drug) is injected into pts vein.
It then travels through the blood stream to the retinal vasculature.
The doctor then refers to a previously done angiofluorescein angiogram and identifies abnormal blood vessels that need treated
Then the doctor uses a low powered laser to activate this light activated drug, which closes abnormal blood vessels
53
What does SLT stand for?
Selective Laser trabeculoplasty
54
*What is SLT used for?
To treat open angle glc.
55
Both ____ and ___ treat open angle glc and can diminish or eliminate the need for glc meds.
SLT and ALT
56
What is the advantage of SLT over ALT?
SLT is repeatable and ALT is not
57
How long does it take for SLT and ALT to wear off?
about 24 mos
58
What is the next step after ALT and pt still have uncontrolled IOP
sx
59
True or False
SLT can only be performed one time
false
60
Both ALT and SLT make a burn hole in the _____
Trabecular meshwork
61
As the TM scars and contracts following the burn form ALT and SLT the outflow of aqueous humor can be ____
increased
62
How long does it take ALT and SLT to take full affect?
6 weeks (due to healing and scarring of tissue of TM)
63
What is the advantages of treating GLC pts with lasers as opposed to drops?
better compliance
no systemic side effect
pt may have medical insurance(which will cover the procedure) but not have medication insurance.
64
Laser procedures are ____, we will instill a drop of pilocarpine to constrict the pupil and also give them a drop to help prevent a post op pressure spike.
Painless
65
Argon is a ____light which is absorbed by ___objects
blue-green
Red (such as blood vessels)
66
Argon Laser is used to....
coagulate blood or sealing off blood vessels, used to cut sutures, and also argon laser trabeculoplasty to treat POAG
67
YAG stands for
Ittrium Aluminum Garnet
68
*What is a YAG LASER used for?
To clear PCO and to perform LASER peripheral iridotomy (LPI)
69
Over time after CAT sx there epithelial cell on the posterior capsule that can migrate centrally which will cause and ____
opacification (PCO) also referred to an after cataract
70
What is the main risk of a YAG laser
RD but rare
71
How is YAG performed
Dr. makes a hole in posterior capsule to clear the pts visual axis.
72
LPI are used to treat pts who have ______
anatomically narrow angles ( to prevent acute narrow angle attack)
73
How is LPI performed
A hole burned into the iris
(can be performed with YAG or Argon LASER)
74
If there is any unusual jolting of the laser it should be checked by________before it is used again to make sure the LASER beam has not become out of alignment.
a laser technician
75
Surgeon should always use the ____energy setting needed to get the job done
lowest
76
You should post LASER safety signs on the door so that ....
everyone knows to wear eye protection
77
Whenever you are in the LASER suite you should wear___
LASER safety goggles to protect your eyes from LASER light exposure
78
LASER lights can bounce off of ____objects
shiny
79
Do not press any buttons on the LASER unless_______
Your doctor tells you to
80
Only have LASER serviced by _____
trained LASER technicians
81
Keep the LASER___ and also be sure to clean and disinfect the ____after use
clean
LASER lenses
82
What is used to impede the growth of bacterial in instrument wash?
Lubrication or instrument milk
83
How often should you lubricate your instruments?
Every 5 procedures and after ultrasonic cleaning because they remove all lubricants.
84
Any instrument that can be unlocked or disassembled you should do so prior to______
sterilizing
85
You should avoid_____instruments in the sterilizer.
crowding
86
What are the different types of anesthesia used in ophtalmology?
Topical
Direct Infliltration Subcutaneously
Nerve Block
Retrobulbar
Peribulbar
87
A surface anesthesia that causes a loss of sensation just of the mucous membranes.
Topical
88
Surface anesthesia of skin and paralyzes underlying musculature
Direct Infiltration Subcutaneously
89
An injection anesthetic directed at the site of emerging nerve and area supplied by nerve
Nerve block
90
What are the 2 main types of nerve blocks that we use?
Retrobulbar and peribulbur
91
Anesthetic nerve block injection into the muscle cone,
is a complete anesthesia of globe and paralysis to muscles attached to globe to prevent unwanted eye movement
Retrobular
92
______means loss of sensation
anesthesia
93
_____means loss of eye movements
akanesia
94
Anesthetic injection into the soft tissue around the globe directed to floor and roof of socket; provided only anesthesia not akanesia.
Peribulbar
95
Rinse all instruments immediately after use with______
distilled water
96
Why can't you use BSS to rinse instruments?
Because the salt crystallizes on them
97
Any instrument that is cannulae or has a lumen must be ____
irrigated well and dried with compresses air
98
Why should you not let the instruments touch when using an ultrasonic cleaner (US cleaner)?
Because the delicate tips of the instruments can get damaged
99
Why should you not crowd the instruments in a sterilizer?
Because you must allow permeation of material
100
What are the sterilization musts?
*Do not crowd items in sterilizer
-must allow permeation of material
***Instruments must be clean of debris, tissue, blood, lubricants before sterizing
*Inspect packages for integrity before using(rips or tears)
*Use sterilization indicator tips
*Use biological monitoring kit
101
Sterilization is ____based not___based
event
time
102
As long as your package is not wet, torn, or compromised you can _____
open it and use it on the sterile field
103
Why do we put dates on sterilized instruments?
So that if we have a bad spore test we can recall instruments that have been sterilized since the last good spore test.
104
Before opening an instrument to use on the sterile field you must check to see if.......
the indicator strip shows item is sterile
105
What are some different methods of sterilizing instruments?
Boiling
Dry heat
Moist heat (autoclave)
Chemical (aka cold sterilization)
EO gas
Radiation
UV light
106
What are the advantages and disadvantages of boiling sterilization?
It is inexpensive
20 minutes kills most organisms
It is slow
Takes many hours to kill resistant spores and encapsulated bacteria
Instruments can rust if not dried properly
Instruments with sharp points can be dulled
107
What are the advantages and disadvantages of Dry Heat sterilization(Oven)?
Can sterilize gowns, glove, instruments, drapes
Maintains a constant temperature
Takes quiet some time (360 degrees for 60 mins)
Must clean regularly
108
Method of sterilization that is good for gowns, gloves, instruments, and drapes but takes 60 minutes?
Dry heat (oven)
109
Autoclave is ___heat
moist
110
What is the most common and practical method of sterilization?
Autoclave
111
Which method of sterilization is steam under pressure?
Autoclave
112
___heat destroys bacteria much better than ___heat
moist
dry
113
Time required for autoclave varies depending on ____
type of material
(cloth takes longer and steel shorter)
114
The higher the temperature the _______
shorter time that is required
115
What should you do to avoid condensation with autoclave?
Warm instruments with dry cycle first and make sure autoclave venting very well
116
Don't remove packs until.....
they are bone dry
117
Water acts as a ___ and it ___bacteria through any non waterproof area.
Wick
wicks
118
If you put wet instruments out on counter to dry ________ occurs
strike through contamination
119
What should you use in autoclave to avoid mineral build up?
distilled water
120
Be sure to clean autoclave regularly with ....
special autoclave cleaner
121
Chemical sterilization is sometimes referred to as _____
cold sterilization
122
When is it good to use Chemical/Cold sterilization
When something by get damaged by heat (like plastic)
123
What are the disadvantages of Chemical/cold sterilizaition?
Some chemicals have poor sporicidal activity
Can be corrosive to instruments
Long sterilization time
124
What is the main advantage of chemical/cold sterilization?
inexpensive
125
EO (ethyl oxide gas) is very _____
affective
126
What is EO gas and Radiation sterilization best for?
Items that can be damaged by heat or exposure to liquid disinfectants
127
What are advantages to using EO Gas & Radiation sterilization
Can be used on most materials
Can sterilize materials that cannot be sterilized by other means
Effective against all organisms
Good penetration
Can be applied to completely sealed items such as sutures
128
What are the disadvantages of EO Gas & Radiation sterilization
Slow
Costly
Flammable
Toxic
Requires special equipment
129
_____can occur in OR or due to exposure to sterilization with EO gas
Magnetization
130
You can get ______to demagnetize your instruments
demagnetizing trays
131
Which method of sterilization can sterilize entire rooms, including he air inside the room?
UV lights
132
UV sterilization system is used in tandem with a _____
surface sterilization lamp
133
UV lights are effective to sterilize ___and___ suspended in the air
viruses
bacteria
134
What type of environment is the OR?
Amoric(free of particles)
Positive pressure (HVAC system constructed to have positive air structure)
135
During a long procedure the particle count in OR can rise to _____
More than 1 million particles per cubic foot
136
___and ___are vehicle to transporting particles with microorganisms
Air
dust
137
You must use ___wipes and eliminate _____ in OR
lint free
Talcum powder, fibers (cotton balls, lint producing material)
138
____and ___explode droplets into the environment
coughing and sneezing
139
Organisms are forcibly expelled when you ....
This creates bacterial covered dust and materials that settle on sterile surfaces and skin.
talk, cough, or sneeze
140
What should you do if you are in an OR and you have to cough or sneeze?
Do so toward the sterile field because if you turn your head everything comes out the side of your mask
141
Never turn _____ to the sterile field
your back
142
On average _____-____contaminated particles are shed by our skin every minute, some shed _____ particles per minute(shedders)
4,000
10,000
up to 30,000
143
When you work in OR you want to bath___
daily with antibacterial soap
144
You must wash your hands before and after every_____
pt contact
145
Wear ___sleeves in OR and ____hair regularly
long
shampoo
146
What is the most common route of transmission of microorganisms in the OR
direct person to person contact
147
Errors should be readily __________
Admitted and corrected
148
Every patient should be considered a potential source of ___
infection
149
_____ and ______ are observed whether or not a patient is known to have an infectious condition
Standard Universal Precautions and routine aseptic techniques
150
What is your main duty when assisting in sx
To maintain a sterile field
151
What are the responsibilities of sx tech
*Maintain sterile field
*Assist in surgical operations under supervision of surgeon, RNs or other surgical personnel
*Set up surgical instruments and equipment
*Check that instruments and equipment are working properly
*Gown and glove themselves and others
152
What are the preoperative patient instructions for local anethesia
*Encourage deep breathing
*position limbs to encourage circulation
*empty bladder
*coughing, squeezing, of eyelids detrimental
*Reassure pt they won't see or feel anything unpleasant
153
A method to help maintain a sterile field by having very rigid rules which help keep contamination at bay
aseptic technique
154
What are the principles of aseptic technique
1. Know what is clea
2. Know what is contaminated
3. Know what is sterile
4. Keep clean, contaminated and sterile items seperate
5. Resolve contamination (resolve immediately)
6. Learn to realize when you have broken technique
155
If a sterile package wrapped in a pervious woven material drops on the floor it must be considered______
unsterile
156
If the wrapper is impervious and area of contact is dry, the item may be ________
transferred to the sterile field
157
Packages which have been dropped on the floor should_______
not be put back in sterile storage areas
158
If a sterile table or unwrapped sterile items are not under constant observation, it mus be considered _____
nonsterile
159
If a sterile package wrapped in any material other than plastic or another moisture-resistant barrier becomes wet, it must be considered_____
non sterile
160
_____means allows passage of air through
pervious
161
_____materials allow the implosion of air into the packaging
pervious
162
If there is ever a doubt about the sterility of any item it must be____
considered non sterile
163
_____means air tight
impervious
164
What is the center of the sterile field
the pt
165
What is included in the sterile field?
everyone wearing sterile attire and all furniture and equipment that is covered with sterile draps
166
Sterile person should touch only _____items or areas.
Non sterile person should touch only ____items and areas.
sterile
non sterile
167
Only ____items should touch sterile surfaces
sterile
168
We must maintain a ___clearance at all times between all sterile and nonsterile items and areas
1 foot
169
What are the different ways to set up a sterile field?
sterile drape
may tray
sterile instruments (emasis basin)
Or combination of sterile drape and basin
(always good to set up on a sterile tray)
170
When opening supplies pull back package ____ and hands____ to allow lots of clearance for someone who is sterile to grab the sterile supplies or you to drop it on the sterile field without sterile item touching any part of the sterile packaging that is not sterile.
wide
wide
171
You want to keep sterile field tight which means.....
You want to have your back table, mayo tray, and other draped areas close to one another and pt within close proximity of one another
172
When possible pt and sterile items should be set up close enough so that there is not room for someone to walk between them because....
this increases the risk of contamination
173
wet penetration =
contamination
174
If a drape or any other non waterproof sterile barrier is made wet contamination has occurred and is called____
strike through contamination
175
Water acts as a _____ and carries bacteria through the barrier to the other side
wick
176
What should you do before performing the surgical scrub?
remove all hand and wrist jewelry
make sure nails are short and trimmed
no artificial nails or nail polish
tuck jewelry (necklaces, earrings) into scrub top or cap
177
What are the 2 methods of surgical scrubbing
timed method
counted stroke method
178
Both surgical scrubs methods are___
effective
179
Skin is never made sterile, it is made____
surgically clean
180
What is the purpose of surgical scrub
to remove as many microorganisms as possible form hands and arms by mechanical and chemical means
181
Explain the time method of surgical scrub
5 minutes per anatomical feature, fingers, hands, arms to 2 inches above elbow
182
The surgical scrub procedure that allots a prescribed amount of time to each anatomic area or to each step of the procedure is
timed method
183
surgical scrub that uses a prescribed number of strokes per anatomical structure (fingers, hands, arms to 2" above elbow)
counted stroke method
184
True of false
skin can be made sterile
false
185
When Microorganisms are markedly reduced by the use of chemical, physical or mechanical means this is called...
surgically clean
186
Skin can be made surgically clean through use of ......
chemical, physical, or mechanical means
187
What is included in aseptic attire
mask, cap, gloves, gown, shoe covers
188
Gowns are only considered sterile from....
chest height in the front to waist height or the height of the sterile field in the front and from 2 inches above the elbow to tips of gloves (not including gloves on the gown-covered with sterile gloves)
189
How should you put the surgical gown on
grasp from the inside of the front of the gown and then put on
190
Sterile persons should keep their hands...
at or above waist and insight at all times
191
Tables are considered sterile ____
only at the table level(anything below table height, anything falling or below table edge is not sterile)
192
When moving around OR sterile person should pass ...
face to face or back to back
193
Sterile persons should ___sterile fields and keep their backs to the_____field
face
non sterileq
194
The prep table is kept separate from the main____and removed immediately after the prep is done
instrument table
195
____are used to keep the lids and lashes out of the operative field when we do intraocular sx
drapes
196
Lids and lashes are the most common origin for the bacteria which causes____
enophthalmitis
197
What are the 2 types of drapes
Fenestrated and non fenestrated
198
_____drapes have pre-cut holes to expose eye
-Steri-strips may be used with it to keep lashes covered
Fenestrated
199
_____drapes have clear plastic area to place over the eye
*Eyelids are pulled opened with a weck-type spear, drape is place over the eye
*Weck spear is then discarded, as it has touched the patient's skin which is not sterile
non fenestrated
200
Set up your back table in _____ and put the instrument tray at back of table leaving a working space in the front. It's important to also label all solutions.
definite order of use
201
What are some things that could be included on your back table
towels, gloves, drapes, supplies, basins, waste receptacle, label solutions, instrument tray in back, work space in front
202
Arrange mayo tray in a _____pattern
consistent
203
If there are instruments you only use occasionally keep them _____from your main instruments tray in peel packs so that you can bring them out just when needed
separate
204
When should you count your sharps and sponges
before and after a procedure and before pt leaves the room
205
If your count of sharps and sponges before and after procedure does not match you should.....
notify surgeon and RN immediately
206
To prevent a sharps injury recap needle with a _____
passive one handed recapping technique
207
*When passing surgical instrument always pass to the surgeon so the handle is_______
toward the surgeon
208
When removing gloves remove them___
inside out
209
What does the phacoemulsifier use to emulsify the CAT
ultrasound
210
Why is it important to keep BSS flowing
to keep eye temp down
211
After CAT is emulsified it is then _____
irrigated and aspirated out of the eye
212
It's very important to clean the tubing and tips of the phacoemulsifier to prevent_______. It should be irrigated with____
salt build up in tip
Sterile water
213
What is the most complex and important part of the phaco machine
phaco pump
214
What are the 2 types of phaco pumps
Vacuum based and flow based
215
Which pump creates more vac when pump works harder
Vacuum pump
216
Which phaco pump creates more flow (cc of fluid/min)when pump works harder
Flow based
217
List facts about the phaco irrigation system
It has an adjustable height form surgical eye
Height is adjusted at different phases of sx
218
It is crucial to keep the BSS fluid flowing because....
it maintains anterior chamber
keeps temp at safe level inside the eye
219
The phaco has an ____handpiece with a vibrating phaco needle(the tip*)
ultrasonic
220
The ___the pt CAT the ____ultrasonic power is acquired to emulsify it
harder
more
221
You must ____the hand piece prior to sx to help adjust between small variations between the phaco needle and the hand piece
tune
222
A viscus solution which is injected into the AC to protect the K epithelial cell when pt has intraocular sx
Visoelastic
223
It is important to ____and ____ to clear visoelastic out of the eye to help prevent a post op IOP spike
irrigate and aspirate
224
What are the types of viewing systems used for retinal sx
contact system and non contact systems
225
______system neutralize refractive power of eye
contact
226
______systems use binocular indirect ophthalmoscope(BIO) and erected image binocular indirect ophathlmoscope (BIO)
non contact
227
VISC (vitreous infusion suction cutter) is used to perform what?
A vitrectomy
228
With the VISC the surgeon introduced the unit at the ____
Pars Planna 4-7mm from the limbus
229
Vitrectomies are used to ___
Clear blood from the vitreous and following RD or following CAT sx when there is vitreous loss
(Does not always improv VA acuity)
230
The vitrectomy unit is comprised of….
An illumination system, high frequency diathermy, air infusion system and a high speed cutter
231
A corneal refractive procedure Using the excimer laser where a K flap is made, the flap is folded back, the laser beam reshapes the K, then the flap is folded back in place.
LASIK
232
What laser is used for LASIK
Excimer
233
What is the K flap in LASIK created with
Microkeratome or Femtosecond Laser
234
What does PRK stand for
Photorefractive Keratectomy
(Surface ablation)
235
What LASER is PRK performed with
Excimer
236
Which refractive sx removes the top layer of the K and then excimer laser performs refractive correction
PRK
237
What are the differences between PRK and LASIK
PRK:
No flap so no risk of flap dislocation, K is less altered, no cutting laser or knife or microtome
More pain and slower va recovery
LASIK:
Uses cutting blade and has a flap
238
What are advantages disadvantages of LASIK
Uses cutting blade and makes a hinged flap
239
How thick is the flap made in LASIK
100-180 micrometers
240
What does ALK stand for
Automated Lamellar Keratoplasty
241
Refractive sx for severe myopia or mild to moderate hyperopia, microkeratome makes a partial flap on the K. If myopic, second, thin button of tissue is removed, discarded. If hyperopic, flap replaced, K steepens as it heals correcting hyperopia
ALK
242
Advantages and disadvantages of ALK Compared to other refractive sx
Advantages:
Heals quickly
VA stabilizes quickly
less discomfort
Disadvantages:
Outcome not as predictable
Risk of irregular astigmatism
Glare
May never be able to wear CL again
243
What does LRI stand for
Limbal Relaxing incisions
244
245
What are the advantages of LRI vs other refractive sx?
Less discomfort, less glare, faster healing than K relaxing incision
But not as effective
246
LRI can correct up to
8 D of cyl
247
LRI is typically reserved for pts with
0.5D-4.0 D of cyl
248
Refractive sx that make 9mm incisions made at precise locations at limbus steep axis K, can be performed in office setting at SL
LRI
249
LRI can be done in conjunction with other procedures or as …
A single procedure
