ANES 1502 - M13 PPT: Complex Surgical Instruments

1. Complex Surgical
Instruments
ANES 1502
ANESTHESIA TECHNOLOGY FUNDAMENTALS
COLLEGE OF DUPAGE

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. Powered Surgical Instruments (PSI’s)

4. What We See and Don’t See

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. Electrically Powered Instruments
 Cable attached to a
motorized hand
piece.

7. Electrical Powered Instruments
 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.

8. Pneumatic Powered Instruments
 Powered by
Compressed Gas.

9. Pneumatic Powered Instruments
 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.

10. Battery Powered Instruments
 Least cumbersome because there is no cord or cable. Requires batteries
and a battery charger.

11. Battery Powered
Example of a Battery Powered
PSI and Two Styles of Batteries

12. 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.

13. Fluid Invasion
 Occurs when water or
cleaning solution is
allowed to enter PSIs.
 Fluid invasion can severely
damage a PSI.

14. Decontamination Batteries and cords can protect
PSIs from Fluid Invasion

15. Attachments are Complex Instruments
Too!

16. PSI Accessories
 Chucks
 Keys
 Burr Guards
 Cords
 Batteries
 …and much, much more!

17. 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

18. PSI Instrument Cleaning
 PSI’s must be
processed manually.
 Care MUST be taken
to prevent Fluid
Invasion.

19. 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.

20. Basic PSI Processing Procedure
(You MUST Follow Manufacturer’s Specific Instructions)
 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.

21. Endoscopy Instruments
 Endoscopes greatly reduce patient trauma when physicians
perform minimally invasive surgery.

22. Endoscopeman*
*with permission from Lighthouse Imaging Corporation

23. 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.

24. Flexible Fiberoptic Endoscope
 Provides optical access using
a flexible, maneuverable
scope most commonly
inserted through a mucous
membrane opening.

25. 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.

26. Infection Control Concerns
 Flexible endoscopes pose significant infection control challenges. Their
configuration makes them difficult to clean and dry and they can harbor
bacteria.

27. 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.

28. Infection Control Issues
 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.

29. 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.

30. Additional Concerns:
 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.
 Inadequately trained personnel.

31. Additional Concerns:
 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.

32. Additional Concerns:
 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.

33. Liquid Chemical Processing Systems

34. Glutaraldehyde
 High Level Disinfectant
 Can be used manually or in automatic processors.
 Must be tested.
 Takes Time.
 Employee Safety Concerns (ventilation a must!)

35. Ortho-Phthaladehyde (OPA)
 High Level Disinfectant
 May be used manually or in an automatic processor.
 Must be tested.

36. Automatic Endoscope Reprocessors
(AERs)
 Automated equipment
designed to clean, disinfect,
and rinse flexible
endoscopes.

37. 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

38. 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

39. 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.

40. 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.

41. Endoscope Channels
Instrument
Channel
Optical
Channel
Air/Water
Channel*Suction
Channel
*Some Flexible Scopes have
separate Air and Water Channels

42. Distal Tip

43. Flexible
Fiberoptic
Endoscope
Video Monitor
Water Bottle Light Source
Suction
Canister

44. Common FFE’s

45. Bronchoscope
 Used for the direct visualization of the tracheobronchial tree.

46. Cystoscope
Ureteroscope
 Used to visualize the urethra and bladder (cystoscope)
and to look for obstructions such as kidney stones
(ureteroscope).

47. 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).

48. 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).

49. Care & Handling

50. Steps in Endoscope Processing
1. Preclean
2. Leak Test
3. Clean
4. High-Level Disinfect or Sterilize
5. Dry
6. Store

51. Fluid Invasion
 Fluid invasion can cause
damage to flexible
fiberoptic endoscopes.

52. 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.

53. Storage
 Scopes must be dry when
stored.
 Do not kink or bend.

54. Endoscope Accessories
 Diagnostic Accessories
 Therapeutic Accessories
 Follow manufacturer’s
instructions for the proper
processing of each type of
accessory.

55. Rigid and Semi-Rigid Endoscopes

56. An Important Note:
 The term “Rigid” is
misleading! Rigid
Endoscopes are VERY
DELICATE and can be easily
damaged.

57. 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.

58. Rigid Scope Guidelines - continued
 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.

59. Clean carefully and
check for missing parts.

60. 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

61. Laparoscopic Instruments
Minimally Invasive Instrumentation

62. Inspect Insulation for
Damage or Wear

63. Insulation Testers are available

64. Loaner Instrumentation
 Owned by the vendor and
brought in for a specific
case.
 Can have a significant
impact on Central Service
workload.

65. 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.

66. Loaner Instrument Processes
 ALL Loaner instruments must
be decontaminated by the
receiving facility before use.

67. Loaner Instrument Processes
 After cleaning and
decontamination, inspect and
assemble instruments for
sterilization. Defective instruments
should be documented.
 Sterilize according to
manufacturer’s instructions.

68. Loaner Instrument Processes
 After sterilization, place in a
low traffic area and handle
as little as possible before
use.

69. As technology advances, instruments (and the Central Service
Technician’s job) become more complex.