Training Centres

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in Laparoscopic Surgery

Proper care and Maintenance of Instruments

Mr. Bagga

With this publication, we intend to provide some information on the correct handling of instruments, some of the options available for their sterilization, so to say, about the care of the instruments. In short, understanding the value of the instruments, not in terms of rupees and paise but in terms of its usage value and the importance of keeping it in good working condition.

Procedures involved:

  • Preparation for disinfection and cleaning
  • Manual disinfection and cleaning
  • Machine disinfection and cleaning
  • Ultrasonic cleaning
  • Care/Maintenance
  • Inspection
  • Sterilization

Preparation for disinfection and cleaning helps not only in preserving the instruments but also the person responsible for their cleaning, care and maintenance as well as their transportation to the "disinfecting station". The instruments should be cleaned immediately after use. Any soiling left to dry will make cleaning more difficult. More important, it can also result in irrepairable damage to the instruments.

Occasionally corrosive agents such as silver nitrate, iodine components and mercury components are used in surgery. Remnants of these products be removed immediately. Also, under no circumstances should instruments be preserved in physiologically saline solutions as prolonged contact can cause pitting.

Caution: Instruments should never be left overnight before cleaning as the chances of causing permanent damage increases with the duration of time between last usage and cleaning.

Handles and cables for HF surgery have to be prepared like normal surgical procedures. Rigid instruments for Endoscopy have to be dismantled prior to cleaning as per the manufacturer's instructions. Optical instruments and telescopes have to be kept in separate containers for disinfection.

Manual Disinfection and Cleaning:

For manual disinfection, instruments have to be immersed in a combined disinfectant and cleaning solution which has a proven disinfectant effect. As far as possible, use fresh disinfectant solution. The following problems may occur due to using the same solution for too long:

  • Risk of corrosion due to soiling.
  • Risk of corrosion due to increasing concentration because of evaporation.
  • Decrease in disinfecting effect due to excessive dirt concentration

After chemical disinfection and cleaning, instruments should always be cleaned well under running water. Any residue should be removed manually (No metal brushes or scouring agents). Finally, they have to be dried immediately. Rigid endoscopy equipments have cavities and channels, which are difficult to clean. Careful preparation of these instruments would involve removing the seals/washers, removing stopcocks, dismantling etc. When immersing the endoscopy instruments in the disinfecting solution, ensure that all air bubbles escape by moving the instruments to and fro thus ensuring proper wetting of the instruments. For telescopes, use a wooden applicator with cotton wool soaked in alcohol to gently rub off dirt from the glass surfaces. Otherwise, use a neutral detergent.

Ultrasonic Cleaning:

Delicate instruments are best cleaned by ultrasonic treatment. Ultrasonic treatment is the method of choice for effectively removing encrustations. In order to achieve maximum efficiency, please ensure that the ultrasonic bath is filled up to the marks indicated and add a suitable cleaning and/or disinfectant solution to it. Temperatures above 40°C promote degassing and cleaning. Instruments have to be completely immersed. Uncovered instruments will not be cleaned. Hinged instruments should be kept in an open position.

Caution: Telescopes must never be subjected to ultrasonic treatment.

Care and Maintenance:

Instruments with joints and ratchets have to be treated with special lubricating agents during the cleaning process. These lubricants prevent the friction of metal on metal and preserve the smooth functioning of the instruments by avoiding corrosion by friction.

Inspection:

After each cleaning, the instruments have to be macroscopically clean i.e. free of any protein remnants or other contaminants. Worn out or damaged instruments should be removed for repairs or replacement. Corroded instruments should be discarded immediately as these can cause contact corrosion. Loops should be free from encrustation. Take care that the insulations should be in a good condition. Check light cables for optical fiber breaks. Check telescopes for fogginess. If foggy, try and clean with a wooden applicator having cotton swab dipped in alcohol. If this does not correct the problem, then send to the manufacturer for repairs or replacement.

Sterilization:

In general, follow the sterilization instructions of the manufacturer but also remember, Sterilization is no substitute for cleanliness.

Autoclaving:

Normally autoclaving is carried out with saturated steam at a temperature of 134°C. In special cases, a temperature of 121°C can be used for a longer time. Steam used for autoclaving should be free from contaminants. Due to heating and cooling, a surgical instrument with ratchet can suffer from tension stress, which can result in a compromised working efficiency or even damage to the instruments. Such instruments should be autoclaved with the ratchet open or closed at the first tooth. Telescopes suitable for autoclaving should be treated at 134°C instead of 121°C because of shorter thermal stress.

Gas Sterilization:

Gas sterilization should be used when other methods are not available. Optical systems of rigid endoscopes may be sterilized. However, adhere to the instructions of the manufacturers. Goods sterilized with ethylene oxide need sufficient airing time before being used again.

Chemical Disinfections and Sterilization: Follow the instructions of the provided disinfectant and the manufacturer.

Brand new instruments:

They are to be treated in no different fashion. Cleaning, rinsing, lubrication, inspection and sterilization have to be carried out as previously described.

Cameras, Light Sources and Insufflators for endoscopic surgery:

The following points should be remembered :

  • Always ensure a stabilized power supply before connecting
  • Always accompany a tool kit along with fuses of different ratings
  • Always store spare power cords and extension boards
  • Check all connections before use
  • Keep camera head away from sharp objects
  • It is advisable not to switch on the CCU of the camera without connecting the camera head
  • Prefer to use high-resolution monitor
  • White balance, if there is any change in the components of the optical system
  • Proper earth connections

Always keep the CO2 cylinder upright or else liquid CO2 may enter into the insufflators and cause damage.

We hope that these few tips will help you in taking better care of your instruments thereby prolonging their life and usage.