This document discusses complex surgical instruments used in medical procedures. It provides an overview of powered surgical instruments, which can be electrically, pneumatically, or battery powered. These instruments are delicate and difficult to clean due to their complex internal mechanisms. The document outlines the multi-step process required to properly clean, disinfect, and sterilize powered instruments according to manufacturer guidelines. It also discusses endoscopic instruments, including flexible fiberoptic and rigid endoscopes. Endoscopes pose challenges for cleaning due to internal channels and crevices. The document stresses the importance of following regulations and guidelines as well as manufacturer instructions to safely reprocess these specialized medical devices.

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.