Chapter 12 complex surgical instruments

1. Complex Surgical
Instruments
Chapter 12

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
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)

7. Pneumatic Powered
Instruments
Powered by Compressed
Gas
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)

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

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

10. 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

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

12. Decontamination of Batteries
and Cords can protect PSIs from
Fluid Invasion

13. Attachments are Complex
Instruments Too!

14. PSI Accessories
Chucks
Keys
Burr Guards
Cords
Batteries
…and much, much more!

15. 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

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

17. 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
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

18. Endoscopy Instruments
Endoscopes greatly reduce patient trauma
when physicians perform minimally
invasive surgery.

19. Endoscopeman*
*with permission from Lighthouse Imaging Corporation

20. 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.

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

22. 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.

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

24. 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
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

25. 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
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.

26. Additional Concerns:
Inadequately trained personnel
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
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

27. Liquid Chemical Processing
Systems

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

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

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

31. 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

32. 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

33. 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

34. 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

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

36. Distal Tip

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

38. Common FFE ’s

39. Bronchoscope
Used for the direct visualization
of the tracheobronchial tree

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

41. 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)

42. 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)

43. Care & Handling

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

45. Fluid Invasion
Fluid invasion can
cause damage to
flexible fiberoptic
endoscopes

46. 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

47. Storage
Scopes must be
dry when stored
Do not kink or
bend

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

49. Rigid and Semi-Rigid
Endoscopes

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

51. 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
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

52. Clean carefully and
check for missing parts

53. 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

54. Laparoscopic Instruments
Minimally Invasive Instrumentation

55. Inspect Insulation for
Damage or Wear

56. Insulation Testers are
available

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

58. 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.

59. Loaner Instrument Processes
ALL Loaner instruments
must be decontaminated by
the receiving facility before
use
After cleaning and
decontamination, inspect
and assemble instruments
for sterilization. Defective
instruments should be
documented
Sterilize according to
manufacturer’s instructions
After sterilization, place in a
low traffic area and handle
as little as possible before
use

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