Tools In the Suite

Part II

Advances in technology have made what once was impossible easily within reach. The versatility of today’s video and monitoring equipment not only enhances diagnostic capabilities, but also helps manage case information, increasing efficiency and production.

The Olympus CV-160 offers leadingedge video processing technology in a compact video system. “Development of the miniature CCD (Charge Coupled Device) for the CV-160 video processor helped overcome the final hurdle in video endoscopy,” says Ken Wolcott, senior product manager for Olympus. “With new smaller chip technology, we can now make video-scopes as small as 3.8 millimeters outer diameter with a working channel, and we’ve made prototypes that are even smaller.”

The CV-160 has unique enhancement circuitry that uses frequencies specifically suited to endoscopic images, allowing the user to boost both the high and low frequency components of the video signal while reducing the noise. The result: details in the image that you normally might not see — tissue textures and color variations on the mucous membrane.

Both a video processor and a light source are needed for endoscopy; Olympus uses two separate units. “This is a nice design feature for the cost-conscious user. As you upgrade, you can retain your old light source,” says Wolcott. “It can be more cost-effective over time.” Compared with the earlier Olympus system, the CLV-160 light source generates 30 percent more light intensity. “That’s important when you’re viewing areas like the fundus of the stomach, or the cecum,” Wolcott explains. “Sometimes you can only advance the scope so far, but you still need to view in the distance. This gives you nice, bright illumination, even in those typically difficult- to-see areas.”

Medical Measurement Systems manufactures video manometry equipment that facilitates diagnosis in swallow, esophageal and defecation disorders. The MMS Solar system features a computerized database with the ability to tie into a hospital’s existing network system. Digitized single images or cine-loops in real time are synchronized with the pressure recordings. During analysis, images and pressure recordings are displayed simultaneously on the computer screen, and cine-loops can be played back at full-speed or slow motion.

The system and extensive database are very simple to use, says Jeff Sawyer, director of sales and marketing for MMS. “You can set it up to track by patient, which most hospitals do. If you’re in a research environment, you can track by symptom and diagnosis. You can also do data sort and data querying to find out: of 100 patients, how many ended up presenting with abnormal esophageal sphincter pressure readings? It keeps it all in one profile. A patient can come in and have a manometry, then a pH study, then a urodynamic study, then an anorectal study. It’s all tracked under the same patient name. Once you highlight their name in the database, every study that has ever been performed on that patient using our equipment is tracked.”

EndoSoft, by Utech Products, is an easy-to-use software suite designed specifically for endoscopy procedures. Endosoft automates the procedure reporting and image management of an endoscopic procedure. “Essentially what we’re doing is replacing dictation with a pointand- click interface,” says Utech western regional sales manager Tom Baumgartner. “As the physicians develop a database, they store procedures and templates, and essentially a case that once took five minutes to dictate is dropped down to a minute or two, tops. Our software is connected to the endoscopy system during the procedure so the physician can capture either still images or streaming video of the procedure, and they are stored in our SQLcompliant database.”

In addition, EndoSoft provides a true electronic medical record including automatically scheduling a patient, generating consent letters, endoscopy and pathology reports, letters to referring physicians as well as generating and submitting claims. The software will interface with any hospital information system through an HL-7 or Dicom interface.

Another feature, Nurse’s Notes, contains patient history, allows nurses to enter pre-, intra- and post-procedure notes, automatically captures vital signs and track patient teachings. An inventory management feature facilitates tracking of materials within the department, for billing and/or reorder purposes and maintaining scope repair records.

“What we’ve tried to do is look at the entire environment and provide a software solution that reflects the requirements of that environment,” says Baumgartner, who adds that EndoSoft was designed by a team of gastroenterologists.

The System 83 by Custom Ultrasonics is the only washer/disinfector for flexible endoscopes cleared by the Food and Drug Administration (FDA), says product manager George Raudenbush, RCPT. Custom Ultrasonics’ complete line of systems, products and processes are designed to meet or exceed reprocessing guidelines set forth by the Society of Gastroenterology Nurses and Associates (SGNA), the Association of periOperative Registered Nurses (AORN), Association for Professionals in Infection Controland Epidemiology (APIC), American Society for Gastrointestinal Endoscopy (ASGE) and the Centers for Disease Control and Prevention (CDC).

The System 83 is available with a single chamber (designed to accommodate one or two scopes), dual chamber, (which accommodates one or two scopes in each of two independently operated units), or triple chamber (one or two scopes in each of three independently operated units), and models that also combine pre-processing sinks for scopes and accessories.

“The way we connect is a unique feature,” says Raudenbush. “We connect one bulkhead from the machine to each scope channel — we don’t bifurcate lines halfway down tubes. Therefore, we can guarantee that each channel gets adequate flushing, rinsing, and chemical immersion.”

The System 83 also monitors the temperature of the fluid running through the scopes. “If the fluid drops below a certain temperature during processing, the heaters on the processing base side come back on,” says Raudenbush. “An optional temperature control module heats the chemical reservoir and maintains the temperature, and also will abort in the event of an overheat, which will cut off the electrical power to the heater. Also, in the event of a computer failure, it has a thermal break in the circuitry.”

The Endobath endoscopic cleaning system by Next Step Medical Technologies, LLC, was created as a solution to reducing harmful fume inhalation, says company president Tom Hight. “The idea was that if you wanted to decrease the fume production, you had to reduce the surface area,” he says. “I realized that it would be easy to decrease the rate of evaporation by limiting the size of the area of the liquid that’s in contact with the air.”

“The deeper I got into it, the more I realized we could increase safety in a number of ways,” says Hight. “We can decrease the risk of splashing because you can’t drop the entire scope into the basin; you thread it into the basin one part at a time. You’re going to have a smaller splash.”

Splashing also occurs when emptying the basin. “Somebody has to lift up this two-to three-gallon basin — usually it’s a five-foot-two female nurse — and pour it out. It’s fairly unstable to carry something like this to the sink and pour it out.” The Endobath is connected to the sink by a hose, and a valve control is used to discard used biocide.

Hight cites safety advantages to both the clinician and the patient. “The advantage for the patient is that it is not a cold soak, it’s temperature controlled. The biocide recommendations are 25 degrees C, (77 degreesF). Some of the more fastidious organisms may not be killed at the cooler temperature. The problem with the cold soak is, in the basin, evaporation is continuously cooling. The evaporation process absorbs heat, so the glutaraldehyde sitting in the basin with the large surface area is always cooling itself. The Endobath is temperature-controlled; the temperature is always being monitored and adjusted.”

The SYSTEM 1 Sterile Processing System by STERIS Corporation, first sold in 1988, was the first peracetic acid-based, low temperature liquid sterilization system. Utilizing a single-use peracetic acid-based sterilant chemistry (S-20), the SYSTEM 1 process was designed for immersible, temperature-sensitive medical devices, including flexible and rigid endoscopes.

“The SYSTEM 1 process is both environmentally friendly and efficacious in a short period of time,” says Drew Lindsey, senior product manager for the SYSTEM 1 product line. “We’re able to provide a process that uses peracetic acid, which has the efficacy customers and need and is also environmentally friendly from a disposal standpoint. The final byproducts of the peracetic acid reaction in water are water and oxygen.”

One of the challenges in scope cleaning is the complexity and diversity of different endoscope and device models. The SYSTEM 1 processor accommodates the needs of many different scopes. “There are very specific ways that each scope is to be connected,” says Lindsey. When working with staff on in-services, we focus on stressing the importance of verifying that they’re using the proper scope with the proper flow unit. Our flow units are labeled, so they have a reference right there they can look at when they’re hooking it up. We made that as easy as possible.”

Lindsey adds that no special venting is required for the SYSTEM 1 processor; it’s an enclosed, safe system that reduces environmental hazards. During normal use of the processor, the healthcare worker never comes into contact with the use ddilution, which has an almost neutral pH. Failsafe measures are in place to monitor the temperature of the solution, and the single-use “cup” eliminates the chances of an inaccurate use-dilution of sterilant. Additionally, a documented printout of each cycle ensures that the critical sterilization parameters have been met. An optional barcode reader allows the user to identify bar codes correlated to specific scopes, which can be included in the documentation that prints out at the end of each cycle for permanent record keeping.

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