This series of self-study lessons on Central Service topics was developed by the International Association of Healthcare Central Service Materiel Management (IAHCSMM). The lessons are administered by Purdue University’s Continuing Education Division.
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Flexible endoscopes were introduced in themid-1950s. They utilize the properties of glassfiber bundles in flexible instruments to let doctors diagnose and treat disease in ways not possible with rigid devices. Endoscopic procedures are a major part of nearly every hospital's practice. Use of endoscopic procedures greatly reduces the amount of surgical trauma. Patient suffering is reduced, recovery time is shorter, and the chance of nosocomial infections is lessened.
Flexible endoscopes (scopes) are long andcomplex devices used to see abnormalities andpathologies inside the body, to perform diagnostic tests, and to obtain tissue specimensfor biopsy. They are appropriately named:
Endoscopes have a control head and aflexible shaft with a maneuverable tip.Hundreds of fiber-optic fibers (rods) are arranged around one or more lumens. There are also lenses and mirrors, coils or springs,and cables running the length of the endoscope to control the tip's movement. An imaging cable is also usually included. A special covering allows the scope to be bent gently (not sharply at right angles) to maneuver inside the body.
Some flexible endoscopes are used only to examine internal organs. Others, such as a typical gastrointestinal scope, are more complicated and have a biopsy channel, a mechanical system to maneuver the scope, an optical system to transmit images for viewing,and another channel for irrigation.
Images travel through the scope to the eye-piece or monitor for viewing and can be transmitted optically or electronically from the distal tip. The scope's head is connected to a light source (and to a computer-driven monitor if it is a videoscope) by a light cord. The light source channel also contains an air pump and a water supply.
The endoscope's control section contains the fiber bundle or image-conducting cable, control wires to move the distal tip and, usually, several other channels. The largest channel is for instruments and allows passage of flexible accessories such as biopsy forceps, diagnostic brushes, and snares from a port in the scope's head through the tip and into the field of view within the body. Other channels are used for suctioning, to transmit air to distend the organ being examined, and for jets of water to clean the distal lens when it becomes soiled with bile, secretions, blood, feces, or other materials during
Endoscopes require several connectors:
The universal cord contains the light guidefiber bundle, air, water and suction channels,and electrical wiring. The insertion tube whichis inserted into the patient houses the distal tip.
Endoscopes have long, dark, and narrow channels which become contaminated with body fluids during medical procedures and create a perfect breeding ground for viruses and bacteria. Their complex design and numerous construction materials complicate the cleaning process and make them more difficult to reprocess than many smaller and more delicate instruments.
It is not easy to recognize infectious transmissions which are, unfortunately, a possible surgical complication involving the use of scopes. Although several studies have indicated that infection risk is low, the actual rate of disease transmission may be greater than studies suggest.
Endoscopes must always be thoroughly cleaned and high-level disinfected between uses. (Note: Sterilization is preferred [recommended] when the scope is passed through an inclusion.)
A common cause of irreparable damage to accessory instruments arises from forcing the accessory through the biopsy channel when an obstruction is encountered. This can cause the accessory instrument to buckle somewhere between the technician's fingers and where it enters the endoscope.
There are a variety of flexible endoscopes in use today.
Bronchosope. Bronchoscopy involves the direct visualization of the tracheobronchial tree and is done for:
Tiny forceps at the end of the bronchoscope are manipulated for a tissue biopsy. The diameter of a flexible scope is small enough to reach into the bronchi of the upper, middle, and lower lobes for examination or biopsy. The setup for flexible bronchoscopy includes the following:
The bronchial endoscope is passed through a "bite block" positioned betweenthe patient's upper and lower teeth to protect it from the usually severe and costlydamage that occurs when a patient bites itforcefully. (This block may be unneces-sary in patients who have lost their teeth.)
Cystoscope/Ureteroscope. A flexiblecystoscope is used to visualize the urethra and bladder. A ureteroscope is passed through the urethra and bladder, past theureter, and finally into the kidneys to look for obstructions such as kidney stones. It can also be used for patients who can not assume a lithotomy position, such as those with spinal cord injuries or severe arthritis. Flexible cystoscopy may be accomplished with the use of a local anesthetic.
The following instruments are required:
Note: These procedures are performed on a special type of operatingtable which allows for fluid drainage andcollection and for x-ray imaging.
Gastroscope/Esophagoscope. Gastroscopy is performed by a gastroscope and involves the visual inspection of the upper digestive tract (including esophagus,stomach, and duodenum) with aspiration ofcontents and biopsy, if necessary. Esophagoscopy is the direct visualization of the esophagus and the cardia of the stomach and removal of tissue or secretions for study.
The gastroscope is slowly passed through the mouth, esophagus, and into the stomach. The stomach is inspected, and its contents may be aspirated for cytologic analysis. A biopsy can be performed. Other procedures that can be done include cauterization of bleeding, polyp removal, and placement of assisted percutaneous feeding tubes.
Colonoscope/Sigmoidoscope. Colonoscopy involves the visual inspection of the entire large intestine witha colonoscope. Sigmoidoscopy involvesthe visual inspection of the lower part ofthe large intestine with a sigmoidoscope.These scopes are passed into the colonthrough the anus or ostoma. They areimportant diagnostic tools and may beused for biopsy and removal of polyps andto control bleeding ulcers.
The following instruments are required:
Manufacturers of endoscopes and accessories must be consulted for processing instructions. Recommendations of the hospital's Infection Control Committee and Centers for Disease Control (CDC) are also helpful.
Sterilization is not mandated for most flexible scopes because they do not penetrate skin or a mucous membrane or enter an area of the body that is normally sterile. However, accessories such a biopsy forceps must be sterilized. Most scopes can be completely immersed in liquid and must be thoroughly cleaned prior to disinfection. Use of automatic scope reprocessors does not replace the need to manually clean (including thorough brushing of) the endoscope.
Technicians reprocessing endoscopes should follow Standard Precautions. They should wear personal protective equipment including gloves, gowns, face masks and shields, and hair covers or other protective head gear. Scopes should be reprocessed in a large, well-ventilated area with an appropriate enzymatic detergent.
Cleaning is the most important step and should begin at the point-of-use during the procedure. Soft, lint-free cloths or sponges and brushes specifically designed for this use are needed. Cleaning accessories may be disposable or reusable. If reusable, they must be thoroughly cleaned after use and sterilized or disinfected, according to the manufacturer's recommendations.
Six basic steps are required to cleanand reprocess scopes:
IAHCSMM Central Service Technical Manual, Seventh Edition, 2007, Chapter 12, pages 216-229.
Anne Cofiell, CRCST, FCS
Charlie Hancock, BSEE, MBA
Richard Schule, BS, CST, CHMMC, FEL
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