Endoscope Repair

Maintaining properly functioning endoscopes is an absolute necessity in every facility or suite in which endoscopic procedures are performed. In the interest of patient and clinician safety, and of establishing optimal efficiency, scopes must be kept in excellent condition at all times. In order to explore the nuances of scope repair and maintenance, we posed a series of questions on these topics to a group of experts.

The Panel:

Harvey Buxbaum, president of H.M.B.Endoscopy Products (HB)

Eddie Garces, vice president, endoscopy service at Olympus America Inc. (EG)

Dean Ider, vice president of sales at Surgical Repairs International (DI)

Brad Jensen, director, technical operations at The Scope Exchange (BJ)

Scott Kabanek, vice president, repair services division at Instrument Specialists Inc. (SK)

Robert Purtell, product manager, flexible endoscope repair division of Mobile Instrument Service & Repair Inc. (RP)

Dan Scalzo, executive director,production operations and systems for endoscopy service at Olympus America Inc.(DS)

Lynne A. Thomas, BSN, RN, CGRN, vice president of education at Integrated Medical Systems and Les Faucher, flexible technical coordinator at Integrated Medical Systems (LF/LT)

Ideally, how often should a scope be repaired or refurbished?

“A scope needs to be repaired as soon as any component, or system, malfunctions. It is also imperative that it get repaired as soon as it fails a leak test. However, if the user is fortunate enough not to have had any problems with the scope for an extended period of time, it is a good idea to have it sent to a repair company, or to the manufacturer, for preventive maintenance. This should be done at least once every six months or once every year depending upon the number of uses the scope gets.” — HB

“It is difficult to provide a definitive answer to this question since there are so many variables that can contribute to the frequency of endoscope repairs. These factors include frequency of use, reprocessing, care and handling, quality of maintenance and service. However, most repairs are preventable.” — EG

“There is no set time table for routine repair or refurbishment. We recommend inspection of functions prior to each patient exam and following trauma to the scope, and leak testing after each utilization, trauma to the scope, and/or return from repair. A more thorough top-to-bottom inspection of all scopes in inventory should be quarterly. Repairs should be performed as problems arise.” — LF/LT

“There is no right or wrong answer to this question. How often a scope requires repair/refurbishment is really dependent upon factors such as the workload, care and handling conditions within a facility. I would recommend each scope being inspected periodically (preventive maintenance) for the overall condition of the scope. Often, small subtle changes in the working condition of the scope may go unnoticed and these can be corrected before they become a problem by having an established preventive maintenance program within a facility.” — BJ

What are some indications/signs that a scope may be in need of a repair?

“A proactive inspection of the condition of the instrument may significantly reduce the frequency and extent of repairs. Some indications that a scope may be in need of repair could include reduced angulation, reduced suction capacity, images that are darker than normal, or difficulty in passing biopsy forceps through channels. Proper care, handling, and reprocessing in conjunction with the original equipment manufacturer-provided instructions, such as leak testing after every procedure, will maximize the uptime of endoscopes.” — DS

“Anytime the doctor notices a change in the working characteristics of a scope or if the cleaning technicians start to notice problems like a restriction when passing a cleaning brush or degradation of the tubing, the scope should be sent in for inspection and/or repair.” — BJ

“Anytime a scope leaks during a leak test, no matter how small the leak, it needs to be repaired. Other signs to look for are chemical damage or buckling of the insertion tube, poor angulation deflections, restrictions in the channels, and decreased image quality. There are many ways a scope can be damaged, but these are some obvious signs to look for.” — RP

“The main indications that a scope is in need of repair are poor quality image, failure of the leak test, blocked channels, and difficult or rough angulation of the bending section.” — HB

Are there circumstances that can lead to accelerated damage/breakdown of scopes?

“Scopes can be damaged in several different ways and many of them are preventable. An endoscope should never be used if it fails a leak test. Scopes that fail leak tests or worse — have fluid invasion — are more susceptible to accelerated damage. Problems that could occur as a result of fluid invasion include corrosion, broken fibers (reduction of light/’pepper’ dots in image), stiff angulation movement, and/or video problems. Most leaks can be resolved with a minor repair, preventing more costly repairs later! Endoscopes also have a minimum radius that they can be put in without causing damage to the insertion tube or its internal components including biopsy channels, air/water channels, or fiberoptic bundles. You can refer to the owner’s manual for specific information about what radius is acceptable. ‘Forcing’ instruments and brushes in a scope will create further damaged and turning angulation knobs past the point of resistance will snap angulation wires and create more damage. So, most damage can be avoided with just a little care.” — SK

“Leak testing the scope prior to reprocessing will provide the greatest opportunity to prevent fluid invasion into the scope. Undetected fluid invasion is the fastest way to accelerate damage and reduce the functionality of an endoscope.” — DS

“Improper care and handling are the leading causes of damage. Always follow the manufacturer’s guidelines for handling, cleaning, disinfecting and sterilizing endoscopy equipment. This not only applies to the instrument manufacturer but also the manufacturer of the cleaning/disinfecting agents as well. For example, follow their dilution recommendations and soak times. Also follow the Society of Gastroenterology Nurses and Associates (SGNA) guidelines for care and handling of the equipment.” — BJ

What are some things to keep in mind in terms of maintaining a “healthy” scope?

“Leak test, leak test, leak test! Also, utilize only designated, trained individuals to reprocess endoscopes; utilize applicable soaking or ETO caps when reprocessing; avoid stacking endoscopes on top of one another; avoid placing sharp instruments next to or with endoscopes; allow sufficient time for endoscopes to cool down after reprocessing; pre-clean endoscopes promptly following each procedure; utilize proper transportation and storage methods; have enough endoscopes to accommodate the number of procedures; and utilize a quality-oriented repair company.” — DI

“Educating your staff on the proper care and handling of scopes is the primary goal. From transporting a scope safely in a facility, to properly cleaning and disinfecting each scope after use, it’s important for the nurses and technicians to follow protocol. It’s also important to make sure the scopes are stored safely. Ideally, scopes should hang in a scope cabinet, or at least in an area where they can’t come in contact with other equipment.” — RP

“The best way to maintain a healthy scope is to follow the recommendations for use by the scope’s manufacturer coupled with the consistent application of all label directions that are listed on the chemicals used to clean or reprocess scopes, as well as the guidelines of the automated endoscope reprocessor. Having enough scopes, by model and physician preference, in inventory that correspond to the number and types of cases performed also allows the facility to balance wear and tear on scopes.” — LF/LT

“Immediate bedside cleaning reduces the possibility of damage to the scope due to such things as clogged nozzles, while it also helps to reduce the amount of time needed to clean the unit during reprocessing. Leak testing after every procedure will also go a long way toward detecting problems early. Another important concern is proper storage in places where scopes are protected from contact with liquids, high temperature and humidity, and direct sunlight. In general, be conscious of any surface that a scope comes in contact with, as it can be a potential source of insertion tube punctures and damage. An inspection of the functional aspects of the scope prior to each procedure will help to ensure that the scope is ready to be safely used.” — DS

What are some common misconceptions about scope maintenance/upkeep/repair?

“One of the leading misconceptions is that only the OEM can perform quality repairs. The truth is that there are a number of repair companies that are capable of providing quality repairs at cost-effective prices.” — DI

“There’s a misconception that scopes will break and leak, regardless of how much care is taken with them. However, 80 percent of the repairs we see are preventable. There are many things that can be done to substantially reduce the chance that a scope will break and leak. Other misconceptions are that scopes do not need to be leak tested after every procedure and that the condition of the water-resistant cap is always good. Another misconception is that all repair parts are interchangeable among models and brands. Make sure that the parts used to repair your endoscope are designed specifically for that scope, because scopes are designed as a unit with components that are expected to work interdependently to provide optimum clinical performance. An additional misconception is that the FDA regulates all endoscope service providers. The fact is that the FDA only has regulatory authority over OEMs.” — EG

“Probably one of the most common misconceptions regarding scope repair is that the scope must be returned to the manufacturer. This is simply not true. Secondly, many believe flex scopes are tough instruments. As mentioned earlier, the scopes are made up of small, delicate parts and need to be handled with care. Proper storage is also important to the health of the endoscope. Never store a scope in its case. Always hang them with the insertion tube straight. And finally, many believe a leak test is too time consuming and not important. Just the opposite is true — a thorough leak test will prevent very costly damages to a flexible scope.” — SK

“Misconceptions of upkeep, repair and maintenance stem from not understanding the cause and effect of the repetitive types of repairs experienced in a facility and not taking proactive measures to change practices and protocols to reduce repair needs.” — LF/LT

What are some potential hazards in using a damaged or poorly repaired scope?

“Patient safety can be compromised by using a damaged scope. For instance, if the scope has significant light bundle damage, the physician may not be able to properly see the field of view. Poor angulation deflection can affect the physician’s ability to navigate, and may cause patient discomfort. If the forceps channel is restricted, then the necessary instruments will not pass safely through the channel.” — RP

“The greatest potential hazard in using a damaged or poorly repaired scope is that the high costs of the more complex repairs that will be needed to bring the scope back to proper working condition. If minor repairs are taken care of promptly, large, complex and expensive repairs will not be needed.” — HB

“A damaged or poorly repaired scope will simply not function properly. For instance, a scope with a small hole in the insertion tube will have fluid enter the scope and create severe, and sometimes fatal, damage to the interior components. A scope with a damaged biopsy channel will not allow biopsies to be performed properly. And of course, a poorly repaired scope will cost the facility more time and money to correct. That’s why it’s very important to catch problems early and to send the scope to a reputable service provider for repair. Finally, there may not be a dollar amount attached, but the costs of damaged scopes result in patient discomfort, patient rescheduling, longer procedures than normal, frustration for the surgeon and staff, and overall disruption for endoscopic procedures.” — SK

“At a minimum, a damaged or poorly repaired scope will cause the cancellation of procedures and the delay of patient treatment. Using a poorly repaired scope with reduced functionality can cause increased procedure time, decreased patient comfort, and can require the use of more medication. More serious potential hazards can include the failure of an endoscope during a procedure, compromising patient safety and increasing liabilities.” — EG