SURGICAL OPTICS LLC

ENDOSCOPE INSERVICE

INTRODUCTION

• 70% of endoscope repairs are caused by accidents

• Cost of equipment failure is more than repair or replacement cost

• Education / Training• Accident Prevention• Demystifies diagnostics & facilitates informed repair decisions

• Managing repair expenditure is a cross-functional effort

• This presentation is Chapter I …

GOALS FOR THIS SESSION

• Fundamentals of endoscope (functionality, construction, nomenclature, common issues)

• Enhance awareness of proper “care and feeding” of these high precision, delicate, expensive devices

• Provide a starting point and roadmap for on-going repair cost management

ENDOSCOPES OVERVIEW

Common functionalities of all scope types:

• Provide illumination (via fiber optics or LED’s)

• Provide Visualization (via an image bundle or CCD)

• A working channel for irrigation, biopsy or other therapeutic devices• An interface to related devices and accessories (processor, light source,

video printer, sheaths, suction pump, etc.)

CLASSIFICATION

Fiber Optics

Video (CCD)

Ultrasound

Direct View

Video

Ureteroscope

Operative(Offset)

COMMON SPECIFICATIONS

• Working length• Diameter (distal, or insertion tube)• Direction of View (DOV)• Field of View (FOV)• Channel Size (biopsy, working)• Reprocessing Methodology

When is this information important:• Looking for compatible scopes (loaner, replacement, etc.)• Cross referencing one manufacturer’s model against anotherSelecting appropriate accessories (cleaning brushes, instruments, light

cable, reprocessing equipment

Note: “cheat sheet” available on line or customer service can help if make and models are available (or visa versa)

COMMENTS ON NOMENCLATURES

• Terminologies are not universal and vary by manufacturer or usere.g. telescope, lens refer to the same instrument…

• Or too general so that they create confusione.g. a cystoscope can be a rigid scope or a flexible scope.

• Or different names for the exact same device:e.g. A rigid cystoscope and a hysteroscopee.g. a 4mm 30 deg arthroscope is physically the same as a 4mm 30 deg ENT scope or SinuScope

• Awareness of these issues reduces stress and confusion!

RIGID ENDOSCOPE ANATOMY

Objective Lens

Objective Lens

Light Fiber

Rod Lens

Ocular

Ocular

Eye Piece

Eye Piece

Rod Lens

Light Cone

COMMON FAILURESPOOR IMAGE QUALITY

Partial Image

Scratched lens Foggy Image

Rainbow Image

Debris in view

Out of focus Shadows in view

COMMON FAILURE ILLUMINATION & MECHANICAL

• Illumination:• Low light output• Burnt/ Broken fibers• Shadows• No light• Etc.

• Mechanical:• Wandering image• Bent / Dent shaft• Damaged Tip• Etc.

Burnt light cone Laser damaged tip

Bent shaft Hole in shaft

FAILURE MODES

• Impact, shock or stress – Glass components easily damaged

• Reprocessing (chemical, heat, pressure) • Accelerates aging and staining of lenses• Reduces light transmission• Darkens image overall

• Wear and Tear • Lens delaminate• Fiber bundle becomes porous, retains moisture• Other joints, seals failure causing leakage• Spacer coating flakes off, casting off debris

FLEXIBLE ENDOSCOPE OVERVIEWFUNCTIONALITIES RECAP

• Visualization• Illumination• Angulation (2-way, 4-way)• Working Channel (biopsy, therapy)• Air/Water (insufflation, cleaning)• Suction• Remote control of video capture, printer,

etc.

More Functionality = More Complexity

Complexity = Higher Repair Frequency + More Training + Higher Repair $

FLEXIBLE ENDOSCOPE NOMENCLATURES

FLEXIBLE ENDOSCOPE NOMENCLATURES CONTINUED

ETO Connector

Water Resistant Cap

Universal Cord(Light Guide Tube)

Light Guide Connector“E/L Connector”

WHAT’S INSIDE

COMMON FAILURESFLUID INVASION

Inside view of punctured channel

Failed Water(resistant) Cap Internal Corosion

COMMON FAILURESIMPACT & STRESS

Note: often times there is no observable external evidence of tubes being crushed or collapse.

Colonoscopes are especially vulnerable due to their long I/T

Video scopes with heavy U-cord connectors are also vulnerable to handling mishaps

Small diameter scopes (intubation, ENT, etc. ) especially Ureteroscopes (DUR-8, URF-P3, et.c) can not tolerate any amount of weight / pressure on the I/T and almost any damage is “catastrophic”

COMMON FAILURESANGULATION SYSTEM & TUBES

The repair of the same angulation prolem, e.g. loss of articulation in one or more directions, can range from a minor adjustment to a major angulation system rebuild. This determination can only be made by fully disassembling the scope for inspection at the repair facility.

Insertion tube stiffness will change with age (becoming softer).

Frequent use of stiffness control on some models and setting in highest stiffness level (e.g. while in storage) will significantly shortens life of stiffness control harness and insertion tube.

A BRIEF COMPILATION OF BEST PRACTICES

• Leak Test• Best defense against

catastrophic failure /damage.• Simple procedure but must be

properly done• Learn about “false positives” as

well as “false negatives” in leak testing

• Handling• Practice handling with colonoscope• Practice switching hands.• Observe “coiling radius”• Minimize number of hand-offs from

bed side to processing and back• Plugging in and removing E/L

connector to light source• Protect distal end at all times

Complete document available on line or via email

BEST PRACTICES CONTINUED

• Work Flow • On alert during vacations & holidays• Staff turnover (shift change, new personnel, rotation, etc.)• Case load vs. inventory

• Bench Marking – Data collection & analysis• What metrics to measure? Cost / procedure, MTBF, cost of

ownership, repair history, failure analysis, etc.• Pay-as-you-go or service contract? What kind of contract?

• Working with Vendors• Insist on explanation of repairs and any options available (in

language that you can understand)• Review history and expenditure and ask for help identifying any

trends or opportunities for reducing expenditures• Maintain or have vendor maintain complete repair history• Seek a second opinion for major repairs

RECAP Majority of repairs are from accidents

Training helps in accident avoidance

Scopes are delicate, sophisticated, expensive devices (electro, opto, mechanical) operating in very harsh environment of water, chemical, heat, and sharp tools.

Surveyed a large swath of endoscope landscape and terminologies frequently encountered

Reviewed a number frequently encountered failures, and causes

Reviewed a number of best practices for managing repair expenditures

FURTHER READING

Olympus -Physician Handling Tips to Minimize Flexible Endoscope Damage

Olympus- Endoscope Disinfection Guide

Surgical Optics – User Tips - Various Topics

• AORN Journal 12/11/2007 Benefits of process change (Rigids)

• AORN Recommended Practices for Use & Care of Endoscopes (January 1998)

• Endonurse 04/01/2008 The High Price of Scope Leaks

• Materials Management Nov 11, 2010 Nancy Scholssberg, R.N.

• Lower endoscope costs with repair reduction plan

RESOURCES

• To request electronic copy of this presentation • To schedule department specific sessions• To get help with work flow, or repair history review/analysis• Discuss repair cost reduction plans

Contact: Surgical Optics LLC www.surgical-optics.com email: sales@surgical-optics.com Cell phone: 408-569-9029