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Endoscopes

LEARNING OBJECTIVES:
1. List five commonly used endoscopes.
2. Name five healthcare fields utilizing endoscopes.
3. Discuss importance of thorough inspection and testing of scopes at cleaning.

Instrument 4. Recognize components common to all flexible endoscopes

Continuing The world of medicine has joined forces with the world of engineering. The
mantra of “If you can dream it, we can build it.” has taken us to places where
Education hands will not fit. Dr. Peter Blumencranz, a women’s cancer specialist in
Clearwater, Fl. ([Link]/[Link]), utilizes a scope that is small

(ICE) enough to thread into the milk duct of a woman’s breast and see cancerous
tumors long before they could be found with a mammogram or felt by manual
SELF-STUDY exam. Endoscopes permit earlier detection, less invasive treatment, and better
chance of cure for thousands of patients every year. Certified Instrument
Specialists (CIS) are challenged to process these delicate masterpieces. Their
goal is to assure the endoscope is clean, sterile, functional, complete and
available when needed for patient care. Professional dedication and acquired
skills contribute to the team effort to accomplish positive patient outcomes.
Endoscopes are the focus of this self study lesson.

Endoscopes can be divided into three broad cleaning and validating proper functioning of
categories: direct vision endoscopes, rigid the instrument. Laryngoscopes are a critical
fiberoptic endoscopes, and flexible fiberoptic piece of life saving equipment in an airway
endoscopes. Recalling the lessons in medical emergency. The CIS who processes them
terminology will help you determine the (cleans, inspects and tests) performs a vital
Carla McDermott, RN, CRCST, ACE medical field utilizing particular endoscopes. function for the patient.
Education Specialist, The ophthalmoscope is a direct vision scope
Morton Plant Mease Healthcare Rigid fiberoptic endoscopes are utilized in
used to examine the interior of the eye. An
Dunedin, FL surgical suites. Three surgical services that
otoscope is a direct vision scope used to
mailbox@[Link] routinely use this style scope are Orthopedic,
examine the ear canal and nasal passages.
Urology, and Ear, Nose & Throat (ENT). Rigid
Instrument Continuing Education (ICE) lessons
These examples are typically found in
fiberoptic endoscopes share a common
provide members with ongoing education in doctor’s offices and the hospital’s Emergency
design with similar components. The system
the complex and ever-changing area of surgical Department. They are relatively simple scopes
instrumentation is NOT interchangeable.
instrument care and handling. These lessons that are cleaned at the point of use. Seldom
are designed for CIS technicians, but can be of However, the light cable (fiberoptic bundle)
(if ever) would the CIS be asked to process this
value to any CRCST technician who works with may be interchangeable with the use of end
instrument. Laryngoscopes are direct vision
surgical instrumentation. adaptors. For this reason, some departments
scopes utilized by Respiratory Therapists and
package the light cable separately to
The ICE lessons are easy to use. Just read doctors to visualize the larynx and epiglottis
increase flexibility and improve utilization
and study the article, take the quiz at the end when placing an endotracheal breathing
of the article (see page 26), and log on to of the cables. For example, a lighted breast
tube into a patient’s airway. They are utilized
[Link] to grade and print your retractor may be used once a month or
in every area where an emergency cardiac
quiz results (click the Instrument CE banner or less. Packaging that light cable with the
arrest (CODE) cart is placed. Depending
navigate to [Link]/ICE_home.htm). retractor ties up financial resources (cost of
Successfully completed IC E lessons can help you on facility policy, these may or may not be
the light cable) by having it sit on the shelf.
gain recertification points. processed by the CIS. Manufacturers cleaning
Similarly, the ENT panendoscopy procedure
instructions are needed to assure proper
requires three different scopes, all of which
cleaning techniques are utilized. Several
can use the same light cable. This technique
styles are available, only one of which has a
would maximize utilization of resources and
submergible handle. Laryngoscopes used for
prevent unnecessary processing when light
this purpose are battery operated. Testing of
cables are opened with a scope, even when
the battery and light source should be part of
not needed.
 IAHCSMM
Instrument Continuing Education (ICE) Self-Study

Cleaning of rigid scopes and accessories instruments requires thorough instruction, scope and they are used for visualization
requires a sink or container that allows time to practice and time to learn. Details only, such as the scope used to see
submersion of the instrument. As with and critical points of information can not cancerous lesions inside breast milk ducts.
other surgical instruments, they must be be memorized during a one hour in-service. Another example is the intubation scope
completely disassembled for thorough The CIS is instrumental in preventing spread used by the anesthesiologist. Its purpose is
cleaning. Cleaning brushes must be long of infection proven to have occurred with to guide placement of an endotracheal tube
enough to pass completely through the these instruments. They also help maintain a into the patient’s air way. The next level of
scope, and bristles must touch all sides of balanced budget by identifying small problems scope includes one or two internal channels
the channel being cleaned. A brush too with scope integrity and having it repaired that provide a method of suctioning body
large can damage the instrument, and a before catastrophic damage can happen. A fluids and flushing with water to clear the
brush too small will not provide adequate prime example is performing a leak test on optical lense and/or thin the body fluids for
cleaning. Manufacturer’s written instruction the video colonoscope prior to submerging suctioning. These channels include a port
for cleaning may list appropriate size it in disinfecting solution. Recognizing the which permits connection to the suction
cleaning brush. Channel dimensions will need for a five hundred dollar repair prevents or fluid source. Additional channels and
be listed so appropriate size brushes can be the need for a four thousand dollar internal ports are incorporated into the scope that
selected as necessary. component replacement. permit introduction of a variety of accessory
instruments. These include: biopsy forceps,
One very important task in processing rigid The range in size and configuration of flexible
cytology sample brushes, snares, injection
endoscopes is the inspection. The light scopes is as varied as the clinical practice
needles and electrocautery probes; which
transmitting capability must be assessed. setting where they are used. Surgical and
represent the tools that permit earlier
Light cables and light carriers are delicate Anesthesia Services is second only to the
detection, less invasive treatment, and better
and can be easily damaged. Discovering Endoscopy Suite for overall number of
chance of cure for thousands of patients.
at the point of use an instrument is not scopes in use. It is beyond the scope (no
Channels require the correct length and
functional is not only frustrating, but can pun intended!) of this lesson to describe
width cleaning brush to provide appropriate
potentially be life threatening. all of them in detail, just as a one hour in-
cleaning. Historically, ports are the most
service is not sufficient to teach critical care
Inspection of the instrument includes a difficult area to clean.
and handling techniques. Even scopes that
physical examination of the instrument.
are approved for processing in Automatic Processing these intricate instruments is
Points to inspect include the connection post
Endoscope Reprocessors must be inspected the challenge accepted by the Certified
for the light source, either cable or carrier;
and leak tested by qualified personnel. Instrument Specialists, who work diligently to
and the distal surfaces that enter the body.
assure the patient is safe from transmission
Surfaces must be free of nicks, burs, flaking Flexible scopes have the same basic
of disease. Assuring the instruments used in
chrome or peeling laser non-reflective components:
the patient’s care are clean, sterile, functional,
coating. Any sign of abuse, mishandling or • The ‘head’ where the eye piece or video complete and available when needed
other damage requires the instrument be connection is located; the steering contributes to quality patient care. The CIS,
taken out of service until repaired. mechanism that permits flexion of the truly Instrumental to Patient Care ®.
Final inspection prior to storage or packaging insertion tip; control buttons to activate
for sterilization includes determining that all air/fluid/suction channels; and ports for Bibliography:
components and accessories are present placement of accessory instruments. International Association of Healthcare Central
and in working order. When computerized • The power cable attachment is just Service Materiel Management. Central Service
catalogs for endoscopes and/or sets are not below the ‘head’ portion. This cable Technical Manual. Sixth Edition. 2005.
available, photograph catalogs work well and provides connection to the light and/or International Association of Healthcare Central
both provide greater accuracy. For instance, video source. Service Materiel Management. Inspecting
a mediastinoscope set will likely include a Surgical Instruments, An Illustrated Guide. 2006.
• The ‘body’ is the length of the scope to
specialized suction tip and biopsy forceps the insertion tip. International Association of Healthcare Central
with a variety of bite size and angulations that Service Materiel Management. Instrumentation
would not be useful with any other scope. • The ‘insertion tip’ is the part introduced Resource Course: Identification Handling and
Taking care that these specialty instruments into the patient. Flexion of this section Processing of Surgical Instruments. 2006.
are not misplaced or mis-packaged requires is controlled by the steering mechanism
Society of Gastroenterology Nurses and
skill and professional dedication. and the most frequent site of internal Associates; 2006. SGNA Practice Guidelines and
damage to the scope. Position Statements; Chicago, IL.
Flexible fiberoptic endoscopes are unique.
Some flexible scopes may be considered
They are also incredibly expensive to purchase
‘blind’. There are no channels inside the
and to repair. Processing these intricate
 IAHCSMM
Instrument Continuing Education (ICE)
Endoscopes
Questions (circle correct answer):

1. The ophthalmoscope is used to 7. Light cables: 12. The CIS impacts:

examine the: a. require no testing by the CIS a. quality of patient care
a. ears b. may be interchangeable with b. financial stability of facility
b. tonsils adaptors c. physician satisfaction
c. eyes c. should be tightly coiled for storage d. all of the above
d. sinuses or sterilization
d. are always packaged with the 13. What three things are needed to
2. A direct vision scope is: scope learn appropriate processing
a. relatively simple in design techniques?
b. only found in surgical suites 8. Inspection of rigid scopes includes:
a. thorough instruction, time to learn,
c. more complex in design a. connection post for light source
time to practice
d. used to test vision b. cable/light carrier
b. thorough instruction with minimum
c. distal surface of the body
of 1 hr practice
3. Laryngoscopes are used: d. all of the above
c. adequate time, plenty of
a. by respiratory therapists
9. Rigid scopes should be removed doughnuts, some practice
b. during a cardiac arrest
from service: d. see one, do one, teach one activity
c. to examine the larynx
d. all the above a. when there are signs of damage 14. Automatic Endoscope Reprocessors:
b. because they are antiquated
a. are designed to replace the CIS in
4. Batteries in scopes need to be tested: c. before surfaces are smooth
the Endoscopy Suite
a. each time the scope is processed d. annually for thorough inspection
b. can be utilized for all endoscopes
b. only when the doctor complains
10. To process endoscopes, which of the c. require pre-cleaning and leak
c. every six months
following is required? testing of scopes
d. every three months
d. do not require monitoring
a. a minimum of 1 hour of in-service
5. Endoscopes are used by virtually every education annually 15. The most frequent site of damage
surgical specialty. b. a dedicated instrument care to a flexible fiberoptic endoscope
a. True professional is the:
b. False c. a degree in microbiology
a. port
d. years of on the job training
6. Cleaning of rigid fiberoptic b. power cable
endoscopes requires: 11. Endoscope reprocessing includes all c. insertion tip
the following except: d. body
a. only a small sink with running water
b. a brush at least half the length of a. inspection of the scope Sponsored by:
the scope b. inspection of the operator
c. the instrument be fully assembled c. inspection of the light cable/carrier
d. complete submersion, disassembly d. inspection of all accessories
and brushes of appropriate length
and diameter.

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