Instrument Functional Testing
by James W. Gunter and Russel Hornbeek
In the surgeon's office, surgery center, and the operating room, technicians and nurses are responsible for overall instrument functionality. These facilities are busier than ever, and with the advent of centralized services, more inventories are being neglected. Surgeons are not able to perform procedures with the necessary precision. Patient recovery time can be lengthened due to additional surgery time and trauma to the procedure area. All this can result from dull or non-functioning instruments. A number of solutions can fix this problem. They are relatively simple steps, but they can provide tremendous time and cost of replacement savings to the facility as well as to the patient.
The two most frequent complaints surgeons make about their instruments is that they are dull or not functioning properly or that they are aesthetically blemished. A basic visual inspection after each sterilization can help identify the problems before instruments are re-introduced into a surgical procedure. An overview of the instrument for rust, cracks, and debris can be the first and easiest step to keeping instruments in peak condition. More damage to instruments comes from debris in the lock box area, leaving the instruments scored, discolored, and with loose mechanisms. Cleaning with a soft brush and mild detergent can eliminate this damage. Be certain that all areas are scrubbed free of debris. Thorough cleaning can get rid of the binding and clicking joints and will promote the smooth operation of the instrument. The use of acceptable lubricating agents, such as instrument milk, between the sterilization process is another method of care. Lubricating agents will coat the areas of wear and provide smooth operation. The lubricating process is not necessary after every use. Follow the manufacturer's suggestions for proper use of the product to ensure optimal performance and to maintain the aesthetic appearance of the instruments.
Special attention should be given to the visual inspection of all needle holders and forceps. The textured surfaces of these instruments can make it difficult to spot a potential problem. Many times the warning signs are seen too late, and the instrument is damaged beyond repair. The result is cost of replacement, and the loss of time for replacement. Loose or cracked tungsten carbide (TC) inserts can be detected easily through visual inspection and should be removed from service and repaired as soon as possible. Correctly aligning the instrument's jaw is most important for proper function. New or recently refurbished instruments should be noted for proper alignment and functionality. Compare the instruments to those that have been in service for some time. Forceps are especially critical for this inspection. When the jaws of these instruments are out of alignment, service them with qualified technicians. When inspecting sharps--such as chisels, osteotomes, rongeurs, and scissors--cutting surfaces should be smooth and glossy in appearance. There should be no visible burrs or nicks on the cutting edge. Many professionals have different opinions on how to test scissors. These delicate instruments, used on human tissue, should be tested on tissue paper or latex gloves. The surface of these items will keep the edge in good working condition and not cause damage to the edge. They should never be tested on peel pouches, table covers, drapes, or gowns. These surfaces can be abrasive and compromise the edges. When testing scissors, there should be no skips in the cut and no torn or tattered patterns. There should be no gritty noises during the cut. Noise is the telltale sign of dull scissors. They should be removed from service and sharpened by a professional immediately. The better the instruments are maintained, the longer they last. Proper care and maintenance can extend the life of a general instrument up to seven to ten years.
Overloaded sterilization trays can cause instruments to be compromised and damaged. Instrument trays should be lined with towels to protect the instruments from tray vent holes. Always protect sharp edges by placing them in peel packs or by wrapping them in towels. Consistent technique is key in avoiding possible injury during set up in the OR. Manufacturer's instructions for the recommended time and concentration of sterilization solutions should be followed carefully. Specialty instruments, such as rigid telescopes and flexible endoscopes, should be tested for proper function after each procedure. Rigid scopes should be visibly inspected for clarity of view, fiber-optic light output, and aesthetic presentation. Flexible endoscopes should be pressure tested after each use and checked for channel blockage. After preliminary cleaning, they should also be tested for proper up, down, right, and left angulation. Little or no play should be noticed during testing of angulation. Always refer to the manufacturer's user manual for maintenance.
The use of power equipment, both pneumatic and electric, is on the rise in outpatient centers, physician's offices, and in the OR. This equipment is highly specialized and requires more frequent preventive maintenance to reduce costly repairs. Preventive maintenance service on this equipment must be performed by a qualified repair facility. The facility must recognize stringent quality control and have the ability to replace components within original equipment manufacturer (OEM) specifications. All power equipment functions at a high tolerance and must maintain that tolerance to perform properly.
Once it has been determined that an instrument is in need of repair, it should be sent to a qualified repair facility. How do you identify a qualified repair facility? Several things should be considered when seeking a repair facility. Is the company recognized in the industry? Repair facilities around the country are forming alliances with OEMs. OEMs are reevaluating their current repair programs and their responsibility to providing more efficient service. This will bring the qualified repair facility closer, limiting the chances of problems in shipping and tracking. Build a relationship with a qualified vendor. This relationship enables you to control the number of technicians and techniques that the instruments encounter. When a qualified technician evaluates the instruments, they are able to give valuable information as to the condition of the surgical instruments, a suggestion for better care, or a better technique in the process of sterilization. The key to a good relationship is to start with good communication. Does the company offer a tracking system for serialized instruments? Does the company have after hours customer service or weekend hours? It's good to know that when you need the instrument for Monday morning at 0700 you can receive confirmation that it will be there.
James W. Gunter is the service manager and Russel Hornbeek is the president at Instrument Repair Network (Los Alamitos, Calif).
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