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Endoscope In-Service


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A detailed overview of endoscope handling and maintenance best practices to ensure maximum up time and minimizing repair costs. Overview covers rigid and flexible endoscopes, terminologies, common issues, best practices. Target audience include physicians, surgical technicians, OR nurses, Sterile Processing technician, biomedical engineers

Published in: Healthcare

Endoscope In-Service

  2. 2. INTRODUCTION • 70% of endoscope repairs are caused by accidents • Cost of equipment failure is more than repair or replacement cost • Education / Training • Accident Prevention • Demystifies diagnostics & facilitates informed repair decisions • Managing repair expenditure is a cross-functional effort • This presentation is Chapter I …
  3. 3. GOALS FOR THIS SESSION • Fundamentals of endoscope (functionality, construction, nomenclature, common issues) • Enhance awareness of proper “care and feeding” of these high precision, delicate, expensive devices • Provide a starting point and roadmap for on-going repair cost management
  4. 4. ENDOSCOPES OVERVIEW Common functionalities of all scope types: • Provide illumination (via fiber optics or LED’s) • Provide Visualization (via an image bundle or CCD) • A working channel for irrigation, biopsy or other therapeutic devices • An interface to related devices and accessories (processor, light source, video printer, sheaths, suction pump, etc.)
  5. 5. CLASSIFICATION Fiber Optics Video (CCD) Ultrasound Direct View Video Ureteroscope Operative (Offset)
  6. 6. COMMON SPECIFICATIONS • Working length • Diameter (distal, or insertion tube) • Direction of View (DOV) • Field of View (FOV) • Channel Size (biopsy, working) • Reprocessing Methodology When is this information important: • Looking for compatible scopes (loaner, replacement, etc.) • Cross referencing one manufacturer’s model against another Selecting appropriate accessories (cleaning brushes, instruments, light cable, reprocessing equipment Note: “cheat sheet” available on line or customer service can help if make and models are available (or visa versa)
  7. 7. COMMENTS ON NOMENCLATURES • Terminologies are not universal and vary by manufacturer or user e.g. telescope, lens refer to the same instrument… • Or too general so that they create confusion e.g. a cystoscope can be a rigid scope or a flexible scope. • Or different names for the exact same device: e.g. A rigid cystoscope and a hysteroscope e.g. a 4mm 30 deg arthroscope is physically the same as a 4mm 30 deg ENT scope or SinuScope • Awareness of these issues reduces stress and confusion!
  8. 8. RIGID ENDOSCOPE ANATOMY Objective Lens Objective Lens Light Fiber Rod Lens Ocular Ocular Eye Piece Eye Piece Rod Lens Light Cone
  9. 9. COMMON FAILURES POOR IMAGE QUALITY Partial Image Scratched lens Foggy Image Rainbow Image Debris in view Out of focus Shadows in view
  10. 10. COMMON FAILURE ILLUMINATION & MECHANICAL • Illumination: • Low light output • Burnt/ Broken fibers • Shadows • No light • Etc. • Mechanical: • Wandering image • Bent / Dent shaft • Damaged Tip • Etc. Burnt light cone Laser damaged tip Bent shaft Hole in shaft
  11. 11. FAILURE MODES • Impact, shock or stress – Glass components easily damaged • Reprocessing (chemical, heat, pressure) • Accelerates aging and staining of lenses • Reduces light transmission • Darkens image overall • Wear and Tear • Lens delaminate • Fiber bundle becomes porous, retains moisture • Other joints, seals failure causing leakage • Spacer coating flakes off, casting off debris
  12. 12. FLEXIBLE ENDOSCOPE OVERVIEW FUNCTIONALITIES RECAP • Visualization • Illumination • Angulation (2-way, 4-way) • Working Channel (biopsy, therapy) • Air/Water (insufflation, cleaning) • Suction • Remote control of video capture, printer, etc. More Functionality = More Complexity Complexity = Higher Repair Frequency + More Training + Higher Repair $
  14. 14. FLEXIBLE ENDOSCOPE NOMENCLATURES CONTINUED ETO Connector Water Resistant Cap Universal Cord (Light Guide Tube) Light Guide Connector “E/L Connector”
  15. 15. WHAT’S INSIDE
  16. 16. COMMON FAILURES FLUID INVASION Inside view of punctured channel Failed Water(resistant) Cap Internal Corosion
  17. 17. COMMON FAILURES IMPACT & STRESS Note: often times there is no observable external evidence of tubes being crushed or collapse. Colonoscopes are especially vulnerable due to their long I/T Video scopes with heavy U-cord connectors are also vulnerable to handling mishaps Small diameter scopes (intubation, ENT, etc. ) especially Ureteroscopes (DUR-8, URF-P3, et.c) can not tolerate any amount of weight / pressure on the I/T and almost any damage is “catastrophic”
  18. 18. COMMON FAILURES ANGULATION SYSTEM & TUBES The repair of the same angulation prolem, e.g. loss of articulation in one or more directions, can range from a minor adjustment to a major angulation system rebuild. This determination can only be made by fully disassembling the scope for inspection at the repair facility. Insertion tube stiffness will change with age (becoming softer). Frequent use of stiffness control on some models and setting in highest stiffness level (e.g. while in storage) will significantly shortens life of stiffness control harness and insertion tube.
  19. 19. A BRIEF COMPILATION OF BEST PRACTICES • Leak Test • Best defense against catastrophic failure /damage. • Simple procedure but must be properly done • Learn about “false positives” as well as “false negatives” in leak testing • Handling • Practice handling with colonoscope • Practice switching hands. • Observe “coiling radius” • Minimize number of hand-offs from bed side to processing and back • Plugging in and removing E/L connector to light source • Protect distal end at all times Complete document available on line or via email
  20. 20. BEST PRACTICES CONTINUED • Work Flow • On alert during vacations & holidays • Staff turnover (shift change, new personnel, rotation, etc.) • Case load vs. inventory • Bench Marking – Data collection & analysis • What metrics to measure? Cost / procedure, MTBF, cost of ownership, repair history, failure analysis, etc. • Pay-as-you-go or service contract? What kind of contract? • Working with Vendors • Insist on explanation of repairs and any options available (in language that you can understand) • Review history and expenditure and ask for help identifying any trends or opportunities for reducing expenditures • Maintain or have vendor maintain complete repair history • Seek a second opinion for major repairs
  21. 21. RECAP  Majority of repairs are from accidents  Training helps in accident avoidance  Scopes are delicate, sophisticated, expensive devices (electro, opto, mechanical) operating in very harsh environment of water, chemical, heat, and sharp tools.  Surveyed a large swath of endoscope landscape and terminologies frequently encountered  Reviewed a number frequently encountered failures, and causes  Reviewed a number of best practices for managing repair expenditures
  22. 22. FURTHER READING Olympus -Physician Handling Tips to Minimize Flexible Endoscope Damage Olympus- Endoscope Disinfection Guide Surgical Optics – User Tips - Various Topics • AORN Journal 12/11/2007 Benefits of process change (Rigids) • AORN Recommended Practices for Use & Care of Endoscopes (January 1998) • Endonurse 04/01/2008 The High Price of Scope Leaks • Materials Management Nov 11, 2010 Nancy Scholssberg, R.N. • Lower endoscope costs with repair reduction plan
  23. 23. RESOURCES • To request electronic copy of this presentation • To schedule department specific sessions • To get help with work flow, or repair history review/analysis • Discuss repair cost reduction plans Contact: Surgical Optics LLC email: Cell phone: 408-569-9029