instrument sharpness testing:
bone curette, chisels and osteotomes
plastic dowel rod
marking instruments for identification can be done:
clean fingers with alcohol to remove oils, grease, and any possible dirt
wipe alcohol on the site of the instrument where the tape will be placed to remove any lubricant or moisture
**the site should always be the shank of the instrument and never the rings
**cut tape on angle to allow its edge to lay flat
wrap the tape 1-one and 1/2 times around the device
after the tape is applied , autoclave the instrument to allow heat to help bond tape
other ways to mark instruments...
acid base etching-uses a stencil, solutions, and electricity to mark stainless steel
heat-fused nylon- color-coding referred to as "dipping", powder coating process that leaves a thin layer of color nylon on the instrument
laser etching- process is permanent and costly
**surg. instruments can also be marked with an electric etching process, but this marking method should not be used because it damages the surface of the instrument
repair vendors maintain instruments...
all surgical instruments are designed to be sharpened or restored
sharpen all cutting instruments: all scissors must be on a sharpening schedule based upon how frequently they are used
surgical instruments with moving parts must be lubricated after each use or in accordance with..
lubricants are abailable in spray form
the point of application should be the instrument's hinged area or any working component such as a moving sliding area
tray assembly tips
heavy instruments placed on bottom of tray
select tray that allows for adequate weight/space distribution
all curved instruments should be facing same direction
tissue & dressing forceps should be softly nested
delicate instruments shouuld be kept in micro cases or small protective cases
use of metal instrument holders called stringers assist in faster sterile field
laser-finished instruments (tray assembly)
with non-reflective black coating (ebonised) should never have metal-to-metal contact that can damage, chip, and scratch the finish during decontamination or tray assembly
a silicon nipple mat can prevent metal-to-metal contact as can a foam or lint-free towel
gomco and mogen circumcision clamps
gomco-are patented medical devices
mogen- the gap should be measured each year to assure that it is between 1.5mm to 2.5 mm
like gomco clamps, should never be repaired or sharpened because they do not have a cutting edge
the interior path through a needle, tube, or surgical instrument
powdered surgical instruments contain several working components and will be damaged if fluid is allowed to penetrate into the interior of the instrument, this is called?
power sources for surgical instruments, 3 types:
instruments powered by electricity require,
a cable that can be sterilized
common problems associated with electric power equipment
damage to electrical parts during sterilization
condensation that enters the equipment when seals wear out
electrical contacts become worn and affect equipment handiling
to care and handle electric-powered equipment include
do no immerse the equipment in any solution including water
do not use solvents or lubricats unless specified by the equipment manufacturer
use a nylon bristle brush to clean the distal tip
dry the equipment with a lint-free towel
electrical powered footswitch cleaning
follow manufactorer's instructions
avoid pulling on or stressing the power cord
use compressed gas (CO2) , require a hose that can be sterilized
stond-alone cylinder (tank) with a pressure regulator or "piped-in" through a wall- or column-
mounted regulator panel
nitrogen can also be used for pneumatic power, and tanks of this gas contain a regulator with..
one gauge- measures the pressure to the handpiece
second gauge- measures the amount of nitrogen remaining in the tank
care and handle air equipment
never immerse in any solution
properly insert the cleaning brush into attachments and burr guards
carefully wipe and rinse the outer case
use a decontamination hose to protect inner components
burr guards must be lubricated according to the manufacturer's instructions
least cumbersome of the 3 available power systems
is insterted into the instrument so the device is free to maneuver across sterile field
freedom of movement: batteries require charging, and requires increased handling
carefully follow manufacturer's recommendations for the flash sterilization of battery packs
care and handle of battery-powered instruments
never immerse handpieces, attachments, or batteries, into any solution including water
clean surgical debris from attachments and handpieces using nylon brush&mild detergent
rinse under running water while assuring that the water does not enter the batter contact area
used a decontamination battery to protect electrical components from moisture
popular powered surgical instruments
wire drivers, drills, and saws
saws designed to perform specific cutting actions, such as reciprocating or oscillating
prevent fluid invasion
by insuring that handpieces are attached to the hose during cleaning to prevent solutions from entering the motor
scopes that have transformed how surgery is performed
fiber optic light carriers and camera systems that enable surgeons...
to see inner body spaces/surfaces are very sensitive to pressure and bending
flexible endoscopes need to be...
"leak tested" before submersion to assure that internal electrical curcuitry can protect components from fluid damage
used to view the body's internal organs
through natural openings such as mouth, anus, or through small incisions
the decision to sterilize or high-level disinfect a scope is based upton its use according to the...
spaulding classification system
the society of gastroenterology nurses and associates (SGNA):
guidelines for use of high-level disinfectants and sterilants
safe and effective handling of glutaraldehyde
reprocessing flexible gastrointestinal endoscopes
reprocessing recommendations published by the
CDC and FDA
endoscopes and the spaulding classification system
classifies "critical items" - those that penetrate skin or mucouse membranes or enter an area of the body that is normally sterile
"semi-critical items" - only touch mucous membranes; ex: colonoscopes and gi endoscopes--require high level disinfection at a minimum to destroy: mycobaterium, vegetative bacteria, and non-lipid and small viruses, fungi, and some bacterial spores
endoscope manufacturers provide manual reprocessing instruction for..
each endoscope model
automatic endoscope reprocessor
automated equipment designed to clean, disinfect, and rinse flexible endoscopes
preferred for processing flexible endoscopes...
3 solutions approved for endoscope high-level disinfection:
peracetic acid solutions
when can an AER be used
not all endoscopes and their accessories can be reprocessed in an AER
if not specifically indicated in the AER labeling, ask AER manufacturers wheather the endoscope being used has been tested with their system
department-wide education is key to effective infection control in endoscopy, and should be updated....
with each new piece of equipment and with each change in the chemical or process that is employed
term flexible and endo
are assembled within an impervious material covering to produce an instrument that can bend gently to maneuver inside the body
**care must be taken to avoid breaking any fibers by bending the endoscope at sharp angles or by dropping it
the largest operating channel is the...
instrument (biopsy) channel
biospies are taken by...
threading a flexible biopsy instrument through the biopsy channel to obtain a tissue specimen
direct visualization of the tracheobronchial tree, and involves:
diagnosis to secure uncontaminated secretion for culture, to take a biopsy, or to find the cause of a cough or hemoptysis(spitting up bone)
flexible cystoscope is used to visualize the urethra and bladder
used to perform gastroscopy and involves the visual inspection of the upper digestive tract with aspiration of contents and biopsy, if necessary
colonoscopy involves the visual inspection of the entire large intestine with a colonoscope
sigmoidoscopy involves the visual inspection of the lower part of the large intestine with a sigmoidscope
6 basic steps are required to clean and reprocess endoscopes:
leak test (endoscope)
an endoscope processing procedure that ensures the device's flexible covering and internal channels are watertight
basic steps for leak testing a scope
remove all valves
attach the leak tester to the EtO venting connector
the most common area for leaks is bending rubber at the distal tip of the insertion tube; always check this area first
visually inspect scope for tears,hole,and joints that may leak
completely submerge scope under water
observe the control knobs
observe for holes in the scope's internal channels
steps for cleaning endoscopes:
detach all removable parts
high-level disinfection and liquid chemical sterilization
immerse endoscope in disinfectant which is in a basin large enough for the endoscope. do not coil it too tightly
use the cleaning adapters to fill all channels with disinfectant until no bubbles are seen exiting the channels
place all valves and removable parts in the disinfectant
cover with a tight lid
check the disinfectants label instructions to determine the correct immersion time, and set a timer for that time
when immersion is complete, purge the endoscopes channels with air to remove the disinfectant
a scope that fails a leak test should be...
immediately shipped to a service technician or manufacturer for repair
drying the exterior of the endoscope, and purging the remaining water from the channels ...
help prepare it for storage by minimizing the moisture necessary for bacterial growth
before storing, the scope should be...
completely dry both internally and externally
endoscopes should be stored...
with the insertion tube hanging vertically (not coiled)
with the weight of the control body supported and angulation locks off
in a dry, dust-free cabinet with good ventilation
consists of 2 distally-located cups or jaws that open or close when a control located at the proximal end is manaipulated
video cameras on scopes...
allow easier visualization and recording of the procedures as they are projected to a video monitor
the optical element for rigid endoscope systems is called a
**this elemnt is the most expensive and fagile part of the system
lenses must never be placed in an
lens inspection of a telescope
avoid touching the ocular or the objective lenses
examine non-video scope for optical clarity
inspect optical fibers surrounding the lens train at the tip of the scope
check the eyepiece seal for any visible signs of damage
laparoscopic instruments (used in abdomin)
used to perform surgeries with several small holes versus large incisions
some units conduct electricity to the working distal tip, and are typically insulated with a black material
non electric units do not have the black insulation coating
laparoscopic insulation is very suseptable to ...
to inspect the laproscopic insulation ...
the insulation should fit tightly against the collar, and this union should be tight and snug with no spaces visible
electronic testing devices can detect microscopic holes in the shaft of a laparoscopic instrument
instruments or sets borrowed from a vendor for emergency or scheduled surgical procedures that will be returned to the vendor following use
loaner instruments should be considered...
from the time instruments are received, facitity staff accep responsibitly for them and must ensure that...
every device is cleaned, disinfected, and sterilized according to the manufactorer's written instructions
inventorying the instruments and sets when they arrive is an important step.
comfirming that the correct irem and number of items are delivered, and that the equipment functions correctly
central service techs wearing proper protective attire ...
should check loaner instruments
decontamination--each manufacturer has specific instructions about the type of..
enzymatic detergent, temperature, and mechanical cleaning method to be used
virus-like infectious agents that cause a variety of neurodegenerative diseases in humans and animals including scrapie in sheep and goats, bovine spongiform encephalopathy (BSE) and creutzfeldt-jakob disease (CJD) in humans
after the loaner instruments have been sterilized they should be...
moved to a department area with low traffic flow and away from the direct airflow of cooling vents
microgrind, or supercut scissors are usually identified with...
a black handle
place where 2 parts of a ring handled instrument meet and pivot is called the ..
during instrument manufacture the process of _______ helps build a protective _______ _____ layer on each instrument's surface.
after applying instrument identifiation tape, instruments should be..
autoclaved to help the tape bond to the instrument
instrument marking tape should be wrapped approximately ____ around the instrument.
1 to 1 1/2
what is not an acceptable form of instrument marking...
electric etching (engraving)
purpose of a suction stylet...
is to unclog the suction during surgery
kerrison laminectomy rongeurs should be tested using...
an index card
scissors with tungsten carbide cutting edges are usually identified by..
the first step to inspect the insulation of a laparoscopic instrument is to
check the collar at the distal tip
which of the following steps happens when processing flexible endoscopes
which of the following should be used to thoroughly rinse (remove) all traces of disinfectant from an endoscopes channels
the purpose of using decontamination battery or cord when cleaning powered surgical instruments is
to keep fluid from entering the unit
endoscopes are often processed in a mechanical unit called:
an automatic endoscope reprocessor
the endoscope that would be dispensed for a procedure that required visualization of the lower part of the large intestine would be a
loaner instruments should
be decontaminated before use
information regarding cleaning processes for endoscopes should be provided by
the instrument manufacturer
not all endoscopes can be processed in an
electronic testing of laparoscopic insulation should be done