Common Causes of Preventable Repair
Insertion Tube Damage (Perforations, Buckles, Chemical Damage)
Perforations on a Gastroscope are sometimes caused by dislodging of a bite block during a procedure and the patient biting the endoscope. Other sources of perforations are raising and lowering of bed rails and improper loading of an AER – Automated Endoscope Reprocessor.
Buckles occur when the physician applies too much strain on the root brace of the endoscope. The root brace is the transition point from the hard control body or handle to the flexible insertion tube. This area is meant to provide gradual transition and is not designed to be pressed in a 90-degree angle. When physicians rest the endoscope control body on the patient bed and push downward for added support, the result is often a buckle in the insertion tube. The best way to address this is by explaining to the physician how this occurs and lowering the patient bed to avoid future resting of the control body.
Chemical Damage is always caused by use of non-compatible high-level disinfectant or sterilization process. Ensure that the chemicals and sterilization processes that you use have been validated by the manufacturer and are materially compatible with your endoscopes.
Biopsy/Suction Channel Damage (Perforations, Accordioned Channels)
Suction channel damage is always due to the use of endoscopic devices.
Perforations are always caused by utilizing a device that is too large for the channel of the endoscope. Careful determination of minimum channel size necessary to utilize the accessory is key to eliminating channel damage. Just because you can insert the device through the endoscope, does not mean that it is compatible because a device is fully closed when it is inserted into the channel of the endoscope. Once tissue is captured, the size of the cups or jaws of a device become larger and scrape or cut the channels. Perforations also occur by premature deployment of a needle; the sheath of a needle should always be visualized prior to deployment of the device.
Accordioned channels are almost always caused by failing to remove all fluid from an esophageal balloon prior to removing it from the endoscope channel. The devices used to inject and remove saline from the balloon catheter never removes all the fluid. The best way to eliminate remaining fluid is to remove the device and attach a syringe to pull out the remaining fluid. Once the fluid is completely out, the balloon should be able to be pulled back through the channel. If at any time it is difficult to pull, stop, remove the endoscope from the patient and cut the balloon off the catheter.
Bending Rubber (Perforations)
The bending rubber covers the bending section on the endoscope and is purposely thin to allow the physician to angulate the endoscope when they turn the Up – Down and Right – Left control knobs. It is important to secure the bending section of the endoscope when transporting, cleaning and hanging the instrument and to never transport additional items such as forceps or needles along with the endoscope. It is also important to allow adequate time for the air to leave the endoscope during the leak testing process to minimize to potential of damage to the endoscope. The bending rubber is much like a balloon when it is inflated during the leak testing process the material thins and is more susceptible to damage if not deflated completely.
PVE Connector (Fluid Invasion/ Corrosion)
Fluid invasion can enter the PVE connector and cause corrosion in several ways. When leak testing, the leak tester connector should always be connected to the endoscope while the PVE connector is dry and outside of the sink. The PVE connector should never be placed into the sink until the leakage tester has been inflated and should never be removed from the endoscope until the PVE connector is removed from the sink and the air removed from the endoscope. Improper connection and disconnection of your leakage tester will allow fluid to enter the PVE connector and cause corrosion to the internal circuit boards. Additionally, improper storage of the leakage tester where the endoscope distal connector falls into the sink will allow water to enter the leakage tester connector and tubing and will end up in the PVE connector of the next endoscope leak tested. Anytime this occurs, the water must be removed from the leakage tester prior to further use. If water cannot be removed, the leak tester it should be discarded, and a new unit put in its place. Finally, fluid invasion has also been found when an AER – Automated Endoscope Reprocessor has a leak test feature, the leak test connector is connected to the PVE connector and the leak test feature is not turned on in the AER. Periodic checks should take place with your AER manufacturer to ensure this feature remains activated if it is being utilized.
Distal Body Damage (Cracks and Crushes)
The Distal body of the endoscope is the most expensive area due to the Camera (CCD or CMOS – Image Sensor), Glass objective lenses and air/ water nozzles. This area of the endoscope should always be protected when transporting, cleaning and hanging the instrument.
Cracks in the Distal Body and lenses usually occur due to improper transportation, the distal end is not properly held in the persons hand and can contact metal door frames and carts during transportation. Additionally, when a staff member pulls the insertion tube through their hands during manual cleaning instead of moving their hands around the insertion tube, the distal end of the endoscope can strike the inside of the metal sink and do damage to the endoscope. These issues can be corrected through observation of the staff and re-training for proper care and handling of the endoscopes.
Crushes usually occur during raising and lowering of bed rails, moving of procedure carts and improper loading of an AER – Automated Endoscope Reprocessor. In all cases, damage can be avoided by understanding where the Distal body of the endoscope is at all times and then repositioning it to a safe place prior to completing the above tasks.
Ultrasound Cable Damage (Perforations and Crushes)
Ultrasound cable perforations and crushes occur in a couple of ways. Improper setup of the procedure room where the Ultrasound cable is lying on the floor and susceptible to being run over by the ultrasound processor or procedure cart is the most frequent finding. When setting up the room, careful consideration of where the ultrasound cable is lying and an attempt to keep it off the ground is important. Other sources of perforations are raising and lowering of bed rails and improper loading of an AER – Automated Endoscope Reprocessor.
Ultrasound Connector Damage (Fluid Invasion)
Fluid invasion in the ultrasound connector is usually associated with the soaking cap that is connected to the ultrasound connector during leak testing, cleaning and disinfection. There are 3 items to inspect to correct this issue and eliminate further fluid invasion. First, ensure that the soaking cap is always being utilized during all phases of the reprocessing process. If the soaking cap is always utilized, inspect the cap to make sure there are no cracks in the plastic. If there are no cracks, check to ensure the O-ring seal is properly seated in the cap and is not damaged in any way. If the soaking cap is cracked or the O-ring is damaged, discard the soaking cap and replace it with a new one.