Care and handling of rigid endoscopes

Rigid Endoscopes: 7/20/2010
The Care and Handling

Rigid Endoscopes:
Kay Ball, PhD, RN, CNOR, FAAN
Kayball@aol.com
7/20/2010

Disclosure Information
AORN IS PLEASED TO PROVIDE THIS WEBINAR ON THIS IMPORTANT TOPIC. HOWEVER, THE VIEWS EXPRESSED IN THIS WEBINAR ARE THOSE OF THE
PRESENTERS AND DO NOT NECESSARILY REPRESENT THE VIEWS OF, AND SHOULD NOT BE ATTRIBUTED TO AORN.

Speaker: Kay Ball, PhD, RN, CNOR, FAAN Planning Committee:
1. Consultant/Speaker’s Bureau Susan Bakewell, MD, RN-BC
2. AORN Employee

AORN’s policy is that the subject matter experts for this product must disclose any financial
relationship in a company providing grant funds and/or a company whose product(s) may be
discussed or used during the educational activity. Financial disclosure will include the name of the
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Accreditation
AORN is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on
Accreditation.

AORN is provider-approved by the California Board of Registered Nursing, Provider Number CEP 13019.

Objectives
1. Discuss the evolution of rigid
endoscopy, including the history and
components of rigid endoscopes.
2. Describe reprocessing, storage, and
handling concerns associated with
rigid endoscopes.

Copyright 2010, AORN Inc.1 1


References

AORN RPs

Alexander’s Care
of the Patient in
Surgery

Endoscopy
Inspection of body organs or
cavities by means of an
endoscope, which is a device
consisting of a tube and
optical system

Evolution of Endoscopy

Hippocrates II (460-375BC)-looked into rectum



1012 AD Abulkasim-used
mirror to deflect light into
vagina
1585 Tulio Caesare Aranzi-
nasal cavity

1800’s
1805 Bozzani-large
tube, candles,
urethra (censored)
1826 Segalas-
obturator, mirrors
1835 Desmoreaux-
”Father of
endoscopy”
urethroscopy

1850’s
Louis Pasteur -
Infection Control



Late 1800’s
1869 Cmdr Panteleoni-
birth of hysteroscopy
1877 Nitze-crude optical
system
1880 Edison-
incandescent light bulb
1887 Dittel-add light
bulb to endoscope

End of 1800’s
Done in most med centrs:
Cystoscopy
Proctoscopy
Laryngoscopy
Esophagoscopy

1900’s
1901 Ott-Ventroscopy
1901 Kelling-
coleoscopy (dog)
1907 1st Gastroscope
1910 Jacobaues-
laparoscopy human



1900’s
1912 Trendelenburg
1918 Arthroscopy
1924 CO2 insufflation
1929 Kalk-135° lens -
better visualization

1932 Semiflex
gastroscope

Mid 1900’s
1933 Lap (Dx to Rx)
1941 1st fulg of tubes
1952 Quartz rods
1967 Harold Hopkins
1968 Fiberoptics
1977 Insufflator (Semm)

Lap Chole

Mid 1980’s



Clinical Applications Today

Rigid endoscopy moving into Endo Suite

Rigid scopes
Arthroscopes
Cystoscopes
Laparoscopes
Sinus scopes
Pediatric scopes
Hysteroscopes



Cystoscopy

Hysteroscopy

Laparoscopy



Arthroscopy

New endoscopes
Semi-rigid endoscopes

Instrumentation Advancements

Components of Rigid
Endoscopes



Rigid Endoscope
Eye piece
Body
Light guide connector
Shaft
Distal end

Handling tips

Eye Piece



Eye Piece

Diopter Gauge



Oils from skin

Cloudy Image

Cloudy Clear

Decrease Fogging
Use anti-fogging solutions
anti-
Heat scope to body temp
Use endoscope warmer
Warm irrigation solution
Warm insufflation gas
Replace faulty seals



DeFogger

Scope Warmer

Warmer
Warmer

Video technology for
rigid endoscopy



White Balancing
Method for the camera to reference
white so it can properly identify all
primary colors



Videoconferencing

Continuing Education

Body



Connectors

Light Guide Connector



Illumination

Light Cable Connection

Glass Fibers



Decreased light output
Damaged light cable
Debris on ends of light cable
Mixed brands of adapters
Wrong adapter
Old or dirty light bulb
Wrong light bulb



Replace when
>33% broken fibers



ECRI
Label all fiberoptic light sources with:

“Warning: High-intensity fiberoptic light
High-
sources and cables can ignite drapes and
other materials. Complete all fiberoptic
cable connections before activating the
light source.”

Light Sources
Xenon (higher cost, focus down to small
area, preferred for video)

Metal halide (Less expensive, shorter
life, easy to handle)

Halogen (popular in Dr offices, low light,
not for video)



Xenon Lamps

Metal Halide Lamps



Light Source Brightness

Manual
Automatic (adjusts
according to video image)

Shaft



Internal Shaft Lumens



Distal End



Rigid Scope

Negative
Prism Lens Lens

30 degree Rod
objective lens Lens

Lens System
0-degree angle: straight forward
30-degree angle: forward oblique
30-
70-degree angle: lateral
70-
90-degree angle: lateral
90-
120-
120-degree angle: retrospective



Rigid Video Endoscope

Rigid Video Endoscope
5 mm
Image and brightness of
a 10 mm scope
One-
One-Piece VideoScope
Technology
No Scope
No Camera
No Coupler
No Light Cable



Rigid Endoscope with
Flexible Tip

Reprocessing

Trends Guiding Reprocessing

Technology advancements
Complexity of devices



Trends Guiding Reprocessing

Instrument technology -
FDA requirements

Reusables must have
reprocessing
instructions

Decontamination during the procedure

During Transportation



Decontamination

NO Saline

Attire



Disassembly



Solutions & Tools

Chemical Solutions
Protease will break apart protein
Lipase will break apart fats
Amylase will break apart starches
Carbohydrase will break apart
carbohydrates

Proper Cleaning Supplies



Brushes and Devices

Various Sizes of Cleaners

Ultrasonic Cleaning



Cleaning
No ultrasonic cleaners -
damage tiny glass fibers

Rinsing

Manual vs. Automated



Automated Cleaning

Drying Endoscope

Impact of Sterile Dirt

Increases adhesion formation
Increases immune response
Delays healing



Checking Integrity & Functionality

Checking Integrity & Functionality

Disinfection vs. Sterilization



Spaulding’s Classifications
Critical (Sterilize)
Semi-
Semi-critical (Disinfect)
Non-
Non-critical (Clean)

Glutaraldehyde Disinfection

GLUT

Broad spectrum antimicrobial “cold” disinfectant

Device Preparation

Thorough cleaning first!!



Glut Test Strips

Glut Action

Bonds Protein



Exposure Levels
0.04 ppm Detect odor
0.2 ppm Exposure level
0.3 ppm Irritant
0.4 ppm Pouring



Ventilation
Vent

Glut

Processing Area

Glut Ventilation System



Soak Time Controversy

Controversy
FDA Prof. Org
45 min soak 20 min soak
25 degrees C. Room temp.

Glove Recommendations

?



Spill Procedure

Ammonia

Other “cold soak” solutions
25 min. soak for HLD?

Hydrogen peroxide?

8 min. soak for HLD?

Phosphoric acid?

Automatic Processor



Sterilization Options
Steam
Ethylene Oxide
Sterilize Peracetic Acid
Hydrogen
Peroxide (Plasma
or vapor)
Ozone

Steam Sterilization

Autoclavable Scopes

Number of
sterilizations?

Best sterilization
method?



Action of Steam Sterilization

Types of Steam Sterilization

Gravity
displacement
Prevacuum

Monitoring

Bacillus
Stearothermophilus



Flash Sterilization

Autoclavable Scopes
How are they marked if steam sterilizable?

Ethylene Oxide Sterilization



Heat /Moisture Sensitive Devices


Instrument preparation
Wash, rinse, dry
ETO + H2O = Ethylene Glycol
ETO + Saline = Ethylene Chlorhydrine


Sterilization Parameters Concerns
Concentration Aeration
Humidity
Temperature
Time
Biological Monitoring
Bacillus Atropheus
(formerly Bacillus Subtilis)



EO Advantages
Effective sterilizer for heat &
moisture sensitive devices
EO readily diffuses at low temps
No lumen restrictions
Compatible with materials
Low cost

EO Limitations
Long cycle length and aeration
Installation requirements
Flammability
Toxicity
Cost of ensuring safety

Peracetic Acid Sterilization

TM
STERIS System 1
to
TM
STERIS System 1E



Peracetic Acid Sterilization

Low temp
Immersible devices

PA Advantages
Short cycle time
JIT
Variety of trays and containers
Quick connects for lumens
Closed system, ventilation not
required



VHP
Vaporized Hydrogen Peroxide
H
Uses H2O2 vapor to destroy
O O
microbes without using plasma
H
Free radicals disrupt & destroy
microbes
Non-
Non-toxic byproducts (water
vapor, O2)
Sterilization < 1 hour

VHP
Series of pulses in process
Evacuation phase
H2O2 injection phase
H2O2 hold phase
Transition phase
Phases repeat x 4

VHP Cycles
V-PRO 1 Sterilization Cycle
Sterilization Cycle
1000.000
Condition Sterilize Aerate

100.000
Pressure (mm Hg)

10.000

1.000

Pulse 1 Pulse 2 Pulse 3 Pulse 4

0.100
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56
Time (min)



VHP
Chemical indicator and challenge pack
Geobacillus stearothermophilus – most
resistant to VHP process
Compatible with a variety of materials to
be sterilized

VHP
Lumen restrictions:
Inner Diameter Length
> 1mm (3Fr) < 125mm
> 2mm (6Fr) < 250mm
> 3mm (9Fr) < 400mm

•Lumen cycle = 55 min
•Nonlumen cycle = 28 min

What can NOT be processed in the VHP System?

PAPER or CELLULOSE PRODUCTS
Count Sheets
Huck Towels
Gauze
LIQUIDS or POWDERS
SINGLE USE or IMPLANTS
COPPER or MATED NYLON
ITEMS or MATERIALS that ABSORB LIQUID
Foam, Sponges



VHP Advantages
Easy to use

Press start

VHP Advantages
Short cycle time compared to EO
Simple installation
Shelf-life with wrapped devices
Non-toxic, environmentally friendly
(byproducts are water vapor and O2)
Conditioning phase – minimizes aborts due to
moisture
H2O2 cup sealed and vented – easy to insert,
automated

VHP Advantages
2. Injection system
punctures cartridge

3. One cycle’s
worth of
sterilant is
1. Close the cartridge drawn into
interface door a reservoir



VHP Limitations
Can’t process cellulose or paper (must
use nonwoven or polypropylene wraps)
Must use containers and trays cleared for
this sterilizer
Lumen restrictions – no flexible
endoscopes, no long narrow lumens

Gas Plasma Sterilization

1993



Gas Plasma Action

PLASMA
Free radicals + collisional byproducts sterilize

Gas Plasma Sterilization
Low temp H2O2 in gas plasma to
inactivate microorganisms without
harmful residues
Heat and moisture sensitive devices
45 -75 minute cycles, different with each
system model
H2O2 cassette enclosed
Lumen restrictions depending on model

Ozone Sterilization



Ozone Sterilization
Natural process
O2 exposed to intense electrical field
Separates oxygen molecules into
atomic oxygen (O)
O combines with other oxygen
molecules (O2) to form triatomic
oxygen (O3) or Ozone
Sterilization in approximately 4
hours
No toxic residuals – O2 + water
vapor

Ozone Sterilization

Ozone Advantages
Easy to Use
Low Temperature
Safe, No Toxic Residuals
Cost Effective
Compatible with Anodized
Aluminum Containers
Cleared for multiple channel flexible
endoscopes



Ozone Limitations
Long cycle time (compared to H2O2)
Need source of oxygen or O2 tanks to
supply system
Not widely accepted
Material compatibility??

Storage

Transporting



Wet
Storage?

Sheath Protectors

COMMON CAUSES OF
ENDOSCOPE DAMAGE

95% of repairs are procedure related!



Repairs
Original
Manufacturer
vs. 3rd Party
Repairs

Mobile Repair Services

Mobile Repairs

Summary



Questions??

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Care and handling of rigid endoscopes

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