Q: How often should endoscopes be checked for maintenance? Are there generally blatant signs when a scope is not working properly and should be checked?
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A: Scopes should be leak tested after every procedure and before disinfection. The most effective leak test is to submerse the entire scope and follow orignial equipment manufacturer (OEM) instructions. If a leak is detected, the scope needs to be sent in for repair immediately. Scopes should be checked for maintenance on a weekly, monthly, or quarterly basis depending on the number of scopes used and procedures performed.
There are blatant signs that a scope should be checked. One of the most common is when a video scope starts taking pictures by itself, or when it will not take pictures. Usually this is a sign of fluid invasion. The fluid has entered the video switch block controls and the scope needs to be sent in for repair immediately. If a picture is cloudy on a video scope, users should look for a buildup of gluteraldehyde on the distal lens. If there is a buildup or debris on the lens, clean the lens with a rubbing alcohol wipe. If there is no buildup or debris on the lens, the video scope probably has fluid in the distal end. The scope needs to be sent in for repair immediately.
If a fiber optic scope is cloudy, look for a buildup of gluteraldehyde or debris on the distal lenses. If there is no buildup or debris, look for fluid in the eyepiece and distal lenses. If there is any sign of fluid, send the scope in for repair immediately.
Other signs are clicking and/or sluggishness in the angulation controls, significant movement of the insertion tube when angulating the distal end, poor light transmission, color fluctuations in the video image, blockage or friction when passing a brush through the biopsy and/or suction channel, poor water and/or air flow, poor suction and tears or significant dents in the insertion or light guide tube. Users should call their repair company and/or sales representative for inspection and/or advice.
Another sign is fluid in the water resistant cap when it is removed after the disinfection process. If fluid is present, redo the leak test. If the leak test is negative, more than likely the water-resistant cap is not so water resistant. Leak test the water resistant cap.
Scopes should be checked for rough edges, sharp nozzles, and cracking/deteriorating glue as all of the above can pose a significant risk to patient safety.
Q: What are the most common repairs made to endoscopes?
A:
Air/Water nozzle unclog and/or replacement
Bending rubber replacement
Angulation adjustment
Biopsy channel replacement
Suction channel replacement
Minor fluid invasion (typically the OEM deems fluid invasion to require a major overhaul).
Major fluid invasion
Q: What services should endosuite managers be looking for in a company that offers to repair scopes?
A: Honesty, , and customer service! Scope repair companies should be able to tell you why a repair is necessary. Test your repair company. Tell them you suspect a scope has a major fluid invasion, send it in for repair and see what they quote. If you are going to experience the cost savings of using an independent service organization, they must be honest. is equal to honesty. Check out the of their replacement parts. Without , pricing and turnaround time mean nothing. Last but of great importance as well is customer service. Everybody makes a mistake once in a while. How does the lab honor a warranty? Do they continually look for reasons to charge more money for their mistakes? The following are a couple good questions to ask:
Who does the repairs?
Where do the repair technicians receive their training? It is good practice to know who is actually doing the repairs. This allows the endosuite managers to speak directly with technicians in case of immediate need for communication.
How are the technicians paid? Do they receive a percentage of their billings? *What is their turnover?
What parts are used in the repair process? Specifically, what type of bending rubber glue is used? Some companies use glues.
What type of replacement biopsy channels are used? Ask to see the biopsy channel. Some of the biopsy channels being used are high but some are of very poor . Variations in can cause premature kinking and are more susceptible to puncture via biopsy forceps or cleaning brush.
What type of replacement suction channel is used? Ask to see the suction channel. Is there a spring wrap at each end of the suction channel to avoid premature kinking? Check out the of Teflon used in the channel. Variations in can cause premature kinking and possibly more susceptible to puncture from a cleaning brush.
What is the process for repairing the bending section mesh covering the bending section? Ask to see the mesh and the different sizes available. Is the mesh replaced or is Teflon tape used to bandage the mesh? Teflon tape can affect the movement of the bending section that can cause a variety of problems.
What type of replacement insertion tubes are used? Is the insertion tube manufactured with a dual opposing flat coil spring? If the insertion tube is overly Flexible Endoscope or flimsy, it may have one flat coil spring. This can cause a variety of mechanical problems as well as physician complaints of the scope being too Flexible Endoscope . Does the coating hold up against cleaning and disinfecting? If the insertion tube is not coated/protected properly, the insertion tubes can prematurely leak, split open, and/or buckle. The same questions apply for the light guide tube.
Does the company support the recoating and/or retubing of insertion tubes? Metal components of the insertion tube tend to wear with use. If the tube is recoated toward the end of the insertion tube life cycle, mechanical problems may develop. This defeats the investment of the repair.
What type of replacement light guide lenses are used? Ask to see the light guide lenses. Is the entire assembly replaced or is the top lens replaced or is optical glue used to replace the lens. Poor lenses and/or repair can cause the light to spray improperly producing a dark image while inside the patient. This can be construed as a bad video chip.
Does the company repair video chips? Ask to see the video chip. If they repair the video chip, ask about the process. Ask about the warranty?
Loaners! Does the company provide loaners? Ask to see their loaner inventory. Ask about the availability of loaners.
Ask to see their repair facility. Meet the technicians. Meet the repair staff. Ask as many questions as possible. A good repair company has nothing to hide!
Ask about the number of repair technicians and the number of scopes repaired.
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Ask about the number of customers they have in the market place. Sometimes more means less. Repairs take time. The larger the volume of scopes being repaired may mean there is less time spent on each scope repair to insure high .
Q: Are some scopes more fragile than others? Are there any brands known within the industry that generally require more repair than others?
A: Small diameter fiber optic scopes are more fragile than other scopes.
Special protection should be used during storage and transport.
Each brand of scopes has advantages and disadvantages. For liability reasons, We cannot mention a particular OEM, but managers should look into the warranty and what kind of support they will receive after the purchase. If they are buying used equipment, make sure the company has their own repair capabilities. Some scopes are made to last and others are what we call resposable scopes. They are not made to be worked on. Once they break they typically require a major overhaul by the OEM. This defeats the purpose of buying a less expensive scope.
Q: If a scope is treated ideally, how long is the expected lifespan? How long should endonurses and technicians expect to be able to trust a scope that has been repaired before worrying about sending it in again?
A: Ideally a scope can last quite a long time but the life span depends upon the number of procedures and the number of scopes used to perform those procedures. Obviously an account with a sufficient number of scopes to meet the procedure volume will experience a greater life span. The lifespan also depends upon proper handling, use, care, and maintenance.
A scope is typically not sent in for repair until it develops a problem. Obviously a scope repaired with parts and workmanship will last much longer than a scope repaired with low parts and poor workmanship.
Q: How should scopes be treated to prevent excessive repair bills?
A: Scopes should be treated according to OEM specifications. Most nurses and technicians do an excellent job in the handling of endoscopes. We recommend having dedicated cleaning personnel. This avoids the number of people involved in the handling process. Fewer people involved can reduce excessive repair expenses. Dedicated cleaning personnel can reduce repair bills by routinely performing proper cleaning and disinfection procedures as proscribed by the OEM. Familiarity with the scopes can prevent damage before it occurs. A technician familiar with the scopes can usually notice buckles or kinks in the channels and other signs as listed above that if detected would be a minor repair charge. Leak testing is by far the most important step in reducing repair expenses.
What&#;s emerging in the endoscopic technology realm is not unlike what&#;s been transpiring in the automotive industry.
When it comes to automobiles, consumers can choose between three types of automobiles to drive &#; cars that run on gasoline, cars that run on a hybrid system of electricity and gas and cars that run on electricity. In the U.S. marketplace, surveys show, by and large, that gas-powered cars represent the largest percentage, followed by hybrids and then electric-powered models.
Similarly, healthcare organizations increasingly are being given the opportunity to choose between three types of flexible and rigid endoscopes &#; those that are completely reusable, those that are completely disposable and those that could be called &#;hybrid&#; for infection control purposes because they are reusable devices with a select number of disposable components that can be discarded after use (e.g., distal covers and adaptors, etc.).
With the advent and emergence of minimally invasive surgical techniques back in the s, surgeons routinely used reusable endoscopes in the operating room. But given the growing number of reports of cleaning, disinfection and sterilization challenges that have contributed to patient infections &#; some of which prove fatal in time &#; healthcare providers have been searching for something different.
While reinforcing education, training and certification of sterile processing professionals, switching the reporting of Sterile Processing & Distribution (SPD) to the OR, reassigning sterile processing responsibilities to dedicated Endoscopy departments, or changing the types of high-level disinfection or sterilization procedures &#; including technologies &#; may be making a difference for a variety of healthcare organizations, more are looking at the devices themselves and turning to the device manufacturers to offer solutions.
Enter alternatives to reusable models that either fully embrace the single-use concept or merely incorporate disposable components that can be swapped out even as the reusable framework remains.
Healthcare Purchasing News has been exploring the concept and emergence of single-use technology in endoscopy for several years now, locating startup companies looking to take the market by storm, but also gauging reactions of current endoscope manufacturers about this influx and potential demand shift.
Not surprisingly, endoscope manufacturers lean toward their &#;party line&#; in terms of product offerings, with the single-use product companies anticipating a complete market shift to disposables while those companies that manufacture reusable models temper their expectations, acknowledging that a minority of healthcare providers will embrace fully disposable models or reusable models with disposable components.
Further, they admit that the majority certainly are aware of and interested in the possibilities and prospects of altering their inventory mix.
HPN reached out to more than a dozen executives at manufacturers of endoscope devices and related reprocessing supplies and equipment about their forecast of any market shift during the next 10 years. They were able to choose from among five different potential market scenarios and to share their reasoning.
1. Fully reusable endoscopes will remain. Healthcare organizations will continue to rely on fully reusable flexible and rigid endoscopes for the majority of minimally invasive surgical (MIS) procedures
2. Hybrid models will become a minority segment. Healthcare organizations will increasingly shift toward using hybrid flexible and rigid endoscopes that incorporate disposable components that can be discarded after use, but the hybrid models WILL NOT surpass the use of fully reusable models
3. Hybrid models will become the majority. Healthcare organizations will increasingly shift toward using hybrid flexible and rigid endoscopes that incorporate disposable components that can be discarded after use, and the hybrid models WILL surpass the use of fully reusable models
4. Disposable/single-use only models will become a minority segment. Healthcare organizations will increasingly shift toward using fully disposable flexible and rigid endoscopes, but the disposable models WILL NOT surpass the use of fully reusable models
5. Disposable/single-use only models will become the majority. Healthcare organizations will increasingly shift toward using fully disposable flexible and rigid endoscopes, and the disposable models WILL surpass the use of fully reusable models.
Yes, SPD, there is a future
Starting with observations from more of the fringe elements, none of the executives believe that healthcare providers will continue using reusable models exclusively.
But that doesn&#;t mean the sterile processing function is doomed &#; at least for endoscopy. Why? Because reactions are mixed as to how much the use of disposable/single-use models or components will overtake the use of reusables. In fact, half the executive respondents feel hybrids are the answer while the other half supports disposable/single-use models.
This translates into the notion that reprocessing won&#;t be dead after all, but also that it has not quite reached the &#;Houston, we have a problem&#; stage either.
More than a third (35.7 percent) feel that hybrid models &#; reusable endoscopes that contain disposable/single-use components &#; will occupy a minority segment of the market.
Contact us to discuss your requirements of define rigid endoscope. Our experienced sales team can help you identify the options that best suit your needs.