Infection Control Today - 01/2002: Instrumental Knowledge

Scoping Out Repairs
An Industry Insider Answers Endoscope Maintenance Questions

Brian Newton, president of The Scope Exchange, an endoscopy repair company based in Greensboro, NC, explains the latest information for keeping delicate equipment functioning effectively.

Q: How often should endoscopes be checked for maintenance? Are there blatant signs when a scope is not working properly and should be checked?

A: Scopes should be leak tested after every procedure/before disinfection. The most effective leak test is to submerse the entire scope and follow OEM instructions. If a leak is detected, the scope needs to be sent in for repair immediately. Scopes should be checked for maintenance on a weekly, monthly, or quarterly basis depending on the number of scopes used and procedures performed.

There are blatant signs that a scope should be checked. One of the most common is when a video scope starts taking pictures by itself, or when it will not take pictures. Usually this is a sign of fluid invasion. The fluid has entered the video switch block controls, and the scope needs to be sent in for repair immediately. Another sign is a cloudy picture. If a picture is cloudy on a video scope, users should look for buildup of gluteraldehyde on the distal lens. If buildup on the lens is detected, clean the lens with an alcohol wipe. If there is no buildup or debris on the lenses, the video scope probably has fluid in the distal end. The scope needs to be sent in for repair immediately.

If a fiber optic scope is cloudy, look for a buildup of gluteraldehyde or debris on the distal lenses. If there is no buildup or debris, look for fluid in the eyepiece and distal lenses. If there is any sign of fluid, send the scope in for repair immediately.

Other signs are clicking and/or sluggishness in the angulation controls, significant movement of the insertion tube when angulating the distal end, poor light transmission, color fluctuations in the video image, blockage or friction when passing a brush through the biopsy and/or suction channel, poor water and/or air flow, poor suction and tears or significant dents in the insertion or light guide tube. Users should call their repair company and/or sales representative for inspection and/or advice.

Another sign is fluid in the water-resistant cap when it is removed after the disinfection process. If fluid is present, redo the leak test. If the leak test is negative, more than likely the water-resistant cap is not so water resistant.

Scopes should also be checked for rough edges, sharp nozzles and cracking/deteriorating glue as all of the above can pose a significant risk to patient safety.

Q: What are the most common repairs made to endoscopes?

A: Air/water nozzle unclog and/or replace; bending rubber replacement; angulation adjustment; biopsy channel replacement; suction channel replacement; minor and major fluid invasion.

Q: What services should endosuite managers be looking for in a company that offers scope repair services?

A: Honesty, quality, and customer service! Scope repair companies should be able to tell you why a repair is necessary. Test your repair company. Tell them you suspect a scope has major fluid invasion, send it in for repair and see what they quote. If you are going to experience the cost savings of using an independent service organization, they must be honest. Quality is equal to honesty. Check out the quality of their replacement parts. Without quality, pricing and turnaround time mean nothing. Last but of equal importance is customer service. Everybody makes a mistake once in a while. How do they honor a warranty? Do they continually look for reasons to charge more money for their mistakes? The following are a couple of good questions to ask:

• Who does the repairs?
• Where do the repair technicians receive their training? It is good practice to know who is actually doing the repairs. This allows endosuite managers to speak directly with technicians in case of immediate need for communication.
• How are the technicians paid? Do they receive a percentage of their billings? What is their turnover?
• What parts are used in the repair process? Specifically, what type of bending rubber glue is used? Some companies use glues that that are cured via ultraviolet light. Some of these glues do not hold up very well. They turn gray quickly and start cracking. Repair companies should use quality glues.
• What type of replacement biopsy channels are used? Some of the biopsy channels being used are high quality but some are of very poor quality. Variations in quality can cause premature kinking and are more susceptible to puncture via biopsy forceps or cleaning brush.
• What type of replacement suction channel is used? Is there a spring wrap at each end of the suction channel to avoid premature kinking? Check out the quality of Teflon^® used in the channel. Variations in quality can cause premature kinking and possibly more susceptible to puncture from a cleaning brush.
• What is the process for repairing the bending section mesh covering the bending section? Is the mesh replaced or is Teflon tape used to bandage the mesh? Teflon tape can affect the movement of the bending section that can cause a variety of problems.
• What type of replacement insertion tubes are used? Is the insertion tube manufactured with a dual opposing flat coil spring? If the insertion tube is overly flexible or flimsy, it may have one flat coil spring. This can cause a variety of mechanical problems as well as physician complaints. Does the coating hold up against cleaning and disinfections? If the insertion tube is not coated/protected properly, the insertion tubes can prematurely leak, split open, and/or buckle. The same questions apply for the light guide tube.
• Does the company support the recoating and/or retubing of insertion tubes? Mechanical components of the insertion tube tend to wear with use. If the insertion tube is recoated toward the end of the insertion tube life cycle, mechanical problems may develop. This defeats the investment of the repair.
• What type of replacement light guide lenses are used? Is the entire assembly replaced or is the top lens replaced or is optical glue used to replace the lens? Poor quality lenses and/or repair can cause the light to spray improperly producing a dark image while inside the patient. This can be construed as a bad video chip.
• Does the company repair video chips? If they repair the video chip, ask about the process and about the warranty.
• Does the company provide loaners? Ask about the availability of loaners.
• Ask to see their repair facility. Meet the technicians. Meet the repair staff. Ask as many questions as possible. A good repair company has nothing to hide!
• Ask about the number of repair technicians and the number of scopes repaired. Ask about the number of customers they have in the market place. Sometimes more means less. Repairs require detail. The larger the volume of scopes being repaired may mean there is less time spent on each scope repair. Sufficient time ensures higher quality.

Q: Are some scopes more fragile than others? Are there any brands known within the industry that generally require more repair than others?

A: Small diameter fiber optic scopes are more fragile than other scopes. Special protection should be used during storage and transport. Each brand of scopes has advantages and disadvantages. Unfortunately, I cannot mention a particular OEM, but managers should look into the warranty and what kind of support they will receive after the purchase. If they are buying used equipment, make sure the company has their own repair facility capable of delivering high quality repair, service, and loaners. Some scopes are made to last and others are what we call resposable scopes. They are not made to be worked on. Once they break they typically require a major overhaul by the OEM. This defeats the purpose of buying a less expensive scope.

Q: If a scope is treated ideally, how long is the expected lifespan? How long should endonurses and technicians expect to be able to trust a scope that has been repaired before worrying about sending it in again?

A: Ideally a scope can last quite a long time but the lifespan depends upon the number of procedures and the number of scopes used to perform those procedures. Obviously an account with a sufficient number of scopes to meet the procedure volume will experience a greater life span. The lifespan also depends upon proper handling, use, care, and maintenance.

A scope is typically not sent in for repair until it develops a problem. Obviously a scope repaired with quality parts and workmanship will last much longer than a scope repaired with low quality parts and/or poor workmanship.

Q: How should scopes be treated to prevent excessive repair bills?

A: Scopes should be treated according to OEM specifications. Most nurses and technicians do an excellent job in the handling of endoscopes. I recommend having dedicated cleaning personnel. This reduces the number of people involved in the handling process. Fewer people involved can reduce excessive repair expenses. Dedicated cleaning personnel can reduce repair bills by routinely performing proper cleaning and disinfection procedures as prescribed by the OEM. Familiarity with the scopes can prevent damage before it occurs. A technician familiar with the scopes can usually notice buckles or kinks in the channels and other signs as listed above that if detected would be a minor repair charge. Leak testing is by far the most important step in reducing repair expenses.

Brian Newton is the president of The Scope Exchange, a leader in the refurbishing of endoscopes and support equipment.