Chapter 12 complex surgical instruments


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Chapter 12 complex surgical instruments

  1. 1. Complex Surgical Instruments Chapter 12
  2. 2. Objectives: As a result of successfully completing this chapter, students will be able to:  Provide an overview of and discuss procedures to care for and effectively process powered surgical instruments.  Explain basic concerns important when handling and processing endoscopic instruments.  Discuss detailed information about flexible endoscopes.  Review general processing and inspection requirements for rigid and semi-rigid endoscopes and laparoscopic instruments.  Identify basic protocols important at each step in the loaner instrumentation process.
  3. 3. Powered Surgical Instruments (PSI’s)
  4. 4. What We See and Don’t See
  5. 5. Powered Surgical Instruments Look Simple – Are Complex Look Durable – Are Delicate Look Plain – Are Expensive Look Easy to Clean – Are Difficult to Clean
  6. 6. Electrically Powered Instruments  Cable attached to a motorized hand piece  Require a cable that can be sterilized (One end attached to the instrument handpiece and the other to a motor or adapter that is connected to a 110 volt outlet)
  7. 7. Pneumatic Powered Instruments  Powered by Compressed Gas  Powered by compressed gas. They require a hose that can be sterilized (One end attaches to the instrument handpiece and the other to a stand alone cylinder tank or a wall or column mounted regulator panel)
  8. 8. Battery Powered Instruments  Least cumbersome because there is no cord or cable  Requires batteries and a battery charger
  9. 9. Example of a Battery Powered PSI and Two Styles of Batteries
  10. 10. PSI Processing Concerns  PSIs are complex instruments that are difficult to clean and easy to damage  Central Service Technicians should follow manufacturer’s processing instructions carefully
  11. 11. Fluid Invasion  Occurs when water or cleaning solution is allowed to enter PSIs  Fluid invasion can severely damage a PSI
  12. 12. Decontamination of Batteries and Cords can protect PSIs from Fluid Invasion
  13. 13. Attachments are Complex Instruments Too!
  14. 14. PSI Accessories  Chucks  Keys  Burr Guards  Cords  Batteries  …and much, much more!
  15. 15. Common PSIs  Dermatomes/Dermabraiders – used to harvest skin grafts or reshape skin surfaces  Cebatomes – used to remove cement  Sternal Saws – used to split the sternum for open heart surgery  Dental Drills – used for teeth and jawbones  Micro Drills – used for middle ear bones and to drive very small wires  Wire Drivers, Drills and Saws – come in various sizes and are used to work on small to large bones.  Saws - designed to perform specific cutting actions such as reciprocating or oscillating
  16. 16. PSI Instrument Cleaning  PSI’s must be processed manually.  Care MUST be taken to prevent Fluid Invasion.
  17. 17. Basic PSI Processing Procedure (You MUST Follow Manufacturer’s Specific Instructions)  Remove all bits, burrs and blades from the unit, disconnect from the power source  Disassemble and remove debris at point of use, keep the instrument moist  Separate devices with internal mechanisms from simple devices. Generally, simple components can be soaked  Attach handpiece to a hose of specialized cleaning attachment to reduce the risk of fluid invasion during cleaning  Clean the exterior with an approved germicidal detergent  Pay special attention to recessed areas, moving levers, switches, etc.  Clean recessions and cannulas using a stiff bristle brush  Clean, rinse and inspect the hose, cable or battery pack. Look for signs of damage or excessive wear  Lubricate and test as required by the manufacturer  Dry all components  Package and sterilize as recommended by the manufacturer
  18. 18. Endoscopy Instruments  Endoscopes greatly reduce patient trauma when physicians perform minimally invasive surgery.
  19. 19. Endoscopeman* *with permission from Lighthouse Imaging Corporation
  20. 20. Rigid Endoscopes  Provide an optical view and in some cases minimal access through a rigid instrument. The scope is inserted through a sheath inserted via a small incision.
  21. 21. Flexible Fiberoptic Endoscope  Provides optical access using a flexible, maneuverable scope most commonly inserted through a mucous membrane opening.
  22. 22. Regulations and Guidelines  Several regulatory agencies and professional associations provide input into proper scope handling and processing practices.  For a list, please refer to pages 207- 209 in the text.
  23. 23. Infection Control Concerns  Flexible endoscopes pose significant infection control challenges. Their configuration makes them difficult to clean and dry and they can harbor bacteria.
  24. 24. Infection Control Issues  Inadequate training of employees who clean and handle scopes  Adequate time for thorough processing  Commitment of employees (and policy writers) to safely reprocess scopes  Failure to adequate inspect scopes prior to processing  Failure to follow manufacturer’s instructions for reprocessing  Failure to follow label direction on processing chemicals  Using the scope without a leak test  Poor manual cleaning habits  Failure to use automatic endoscope reprocessors in accordance with manufacturer’s instructions  Improper drying and storing procedures
  25. 25. Additional Concerns:  Failure to leak test correctly  Failure to manually clean all channels  Failure to flush all channels with disinfectant solution  Failure to fully immerse  Failure to adequately time the length of disinfectant contact  Use of disinfectant solutions after their expiration date  Failure to process all scopes in the same manner (Standard Precautions)  Failure to sterilize biopsy forceps  Inaccessible manufacturer’s instructions  Variations in staff training  Improper reprocessing of reusable cleaning supplies.
  26. 26. Additional Concerns:  Inadequately trained personnel  Lack of competence reviews for scope processing and procedures  Improper storage and transport  Pressure from physicians to process scopes more quickly so they can perform more procedures on more patients  Difficulties processing these complex instruments  Space constraints  Absence of, or an inadequate quality control program.  Poor water quality  Facility processing equipment  In order for endoscope processing to be successful, each of these concerns must be addressed
  27. 27. Liquid Chemical Processing Systems
  28. 28. Glutaraldehyde  High Level Disinfectant  Can be used manually or in automatic processors  Must be tested  Takes Time  Employee Safety Concerns (ventilation a must!)
  29. 29. Ortho-Phthaladehyde (OPA)  High Level Disinfectant  May be used manually or in an automatic processor  Must be tested
  30. 30. Automatic Endoscope Reprocessors (AERs)  Automated equipment designed to clean, disinfect, and rinse flexible endoscopes
  31. 31. Advantages of AERs  Process consistency  Reduced staff exposure to chemicals  Timed cleaning  Consistent exposure to the cleaning agent  Timed contact with liquid disinfectants  An air flush cycle to remove excess moisture  Use of copious and consistent amounts of rinse water
  32. 32. When using AERs:  Follow manufacturer’s instructions to connect the scope to the AER  Place removable parts in the AER if possible  Attach channel cleaning connectors to all channels  Follow manufacturer’s instructions for using disinfectants  Set the machine for the recommended time
  33. 33. Staff Education  All staff must be thoroughly educated in the proper cleaning, processing, and handling of endoscopes  Page 215 in the text contains a sample competency checklist for endoscope training
  34. 34. A Closer Look at Endoscopes  Although they look similar, endoscopes vary greatly in configuration  Some scopes are only used to visualize and do not have channels, while others have internal channels
  35. 35. Endoscope Channels Instrument Channel Optical Channel Air/Water Channel*Suction Channel *Some Flexible Scopes have separate Air and Water Channels
  36. 36. Distal Tip
  37. 37. Flexible Fiberoptic Endoscope Video Monitor Water Bottle Light Source Suction Canister
  38. 38. Common FFE’s
  39. 39. Bronchoscope Used for the direct visualization of the tracheobronchial tree
  40. 40. Cystoscope Ureteroscope Used to visualize the urethra and bladder (cystoscope) and to look for obstructions such as kidney stones (ureteroscope)
  41. 41. Gastroscope Esophagoscope Used for the visual inspection of the upper GI tract (gastroscope) and for the direct visualization of the esophagus and the cardia of the stomach (esophagoscope)
  42. 42. Colonoscope Sigmoidoscope Used for the visual inspection of the entire large intestine (colonoscope) and the visual inspection of the lower part of the large intestine (sigmoidoscope)
  43. 43. Care & Handling
  44. 44. Steps in Endoscope Processing 1. Preclean 2. Leak Test 3. Clean 4. High-Level Disinfect or Sterilize 5. Dry 6. Store
  45. 45. Fluid Invasion  Fluid invasion can cause damage to flexible fiberoptic endoscopes
  46. 46. Leak Testing  Detects leaks that can compromise the safety of the scope  Scopes that fail a leak test must be removed from service and repaired
  47. 47. Storage  Scopes must be dry when stored  Do not kink or bend
  48. 48. Endoscope Accessories  Diagnostic Accessories  Therapeutic Accessories  Follow manufacturer’s instructions for the proper processing of each type of accessory
  49. 49. Rigid and Semi-Rigid Endoscopes
  50. 50. An Important Note:  The term “Rigid” is misleading! Rigid Endoscopes are VERY DELICATE and can be easily damaged
  51. 51. Rigid Endoscope Guidelines  Always follow manufacturers’ recommendations  Never soak instruments for cleaning or high level disinfection in a metal soak pan  Instruments may need to be soaked in a vertical position  Utilize flush ports when available to circulate (under pressure) enzymatic detergent through the channels  Lenses must never be placed in an ultrasonic cleaner  Gently brush clean the exterior and accessible lumens with the appropriate brush  Thoroughly rinse with distilled water and rough dry  Inspect instruments for cleanliness, missing parts, and damage.  Thoroughly air-dry instruments  Remember that these instruments are fragile and must be handled carefully
  52. 52. Clean carefully and check for missing parts
  53. 53. Inspection  Check surfaces of the telescope for visible damage  Inspect for clarity using white paper with writing on it  Check the eyepiece seal for visible damage
  54. 54. Laparoscopic Instruments Minimally Invasive Instrumentation
  55. 55. Inspect Insulation for Damage or Wear
  56. 56. Insulation Testers are available
  57. 57. Loaner Instrumentation  Owned by the vendor and brought in for a specific case  Can have a significant impact on Central Service workload
  58. 58. Loaner Instrument Processes  Log Receipt of Loaner Instruments and Implants. Include the following information:  Date  Time  Signature of delivery person  Initials of receiving person  Doctor’s name  Patient’s last name  Number of trays  Inventory check of tray(s) for completeness  Inventory check of tray(s) for damaged items.
  59. 59. Loaner Instrument Processes  ALL Loaner instruments must be decontaminated by the receiving facility before use  After cleaning and decontamination, inspect and assemble instruments for sterilization. Defective instruments should be documented  Sterilize according to manufacturer’s instructions  After sterilization, place in a low traffic area and handle as little as possible before use
  60. 60. As technology advances, instruments (and the Central Service Technician’s job) become more complex...