Instrument Functional Testing

June 1, 2000

Instrumental Knowledge

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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