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by James W. Gunter and Russel Hornbeek
In the surgeon's office, surgery center, and the operating room, technicians and nursesare responsible for overall instrument functionality. These facilities are busier thanever, and with the advent of centralized services, more inventories are being neglected.Surgeons are not able to perform procedures with the necessary precision. Patient recoverytime 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 canfix this problem. They are relatively simple steps, but they can provide tremendous timeand 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 aredull or not functioning properly or that they are aesthetically blemished. A basic visualinspection after each sterilization can help identify the problems before instruments arere-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 instrumentsscored, discolored, and with loose mechanisms. Cleaning with a soft brush and milddetergent can eliminate this damage. Be certain that all areas are scrubbed free ofdebris. Thorough cleaning can get rid of the binding and clicking joints and will promotethe smooth operation of the instrument. The use of acceptable lubricating agents, such asinstrument milk, between the sterilization process is another method of care. Lubricatingagents will coat the areas of wear and provide smooth operation. The lubricating processis not necessary after every use. Follow the manufacturer's suggestions for proper use ofthe product to ensure optimal performance and to maintain the aesthetic appearance of theinstruments.
Special attention should be given to the visual inspection of all needle holders andforceps. The textured surfaces of these instruments can make it difficult to spot apotential problem. Many times the warning signs are seen too late, and the instrument isdamaged beyond repair. The result is cost of replacement, and the loss of time forreplacement. Loose or cracked tungsten carbide (TC) inserts can be detected easily throughvisual 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 orrecently refurbished instruments should be noted for proper alignment and functionality.Compare the instruments to those that have been in service for some time. Forceps areespecially critical for this inspection. When the jaws of these instruments are out ofalignment, service them with qualified technicians. When inspecting sharps--such aschisels, osteotomes, rongeurs, and scissors--cutting surfaces should be smooth and glossyin appearance. There should be no visible burrs or nicks on the cutting edge. Manyprofessionals 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 ofthese 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. Thesesurfaces can be abrasive and compromise the edges. When testing scissors, there should beno skips in the cut and no torn or tattered patterns. There should be no gritty noisesduring the cut. Noise is the telltale sign of dull scissors. They should be removed fromservice and sharpened by a professional immediately. The better the instruments aremaintained, the longer they last. Proper care and maintenance can extend the life of ageneral 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 ventholes. Always protect sharp edges by placing them in peel packs or by wrapping them intowels. Consistent technique is key in avoiding possible injury during set up in the OR.Manufacturer's instructions for the recommended time and concentration of sterilizationsolutions should be followed carefully. Specialty instruments, such as rigid telescopesand flexible endoscopes, should be tested for proper function after each procedure. Rigidscopes should be visibly inspected for clarity of view, fiber-optic light output, andaesthetic presentation. Flexible endoscopes should be pressure tested after each use andchecked for channel blockage. After preliminary cleaning, they should also be tested forproper up, down, right, and left angulation. Little or no play should be noticed duringtesting 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 outpatientcenters, physician's offices, and in the OR. This equipment is highly specialized andrequires more frequent preventive maintenance to reduce costly repairs. Preventivemaintenance service on this equipment must be performed by a qualified repair facility.The facility must recognize stringent quality control and have the ability to replacecomponents within original equipment manufacturer (OEM) specifications. All powerequipment functions at a high tolerance and must maintain that tolerance to performproperly.
Once it has been determined that an instrument is in need of repair, it should be sentto a qualified repair facility. How do you identify a qualified repair facility? Severalthings should be considered when seeking a repair facility. Is the company recognized inthe industry? Repair facilities around the country are forming alliances with OEMs. OEMsare reevaluating their current repair programs and their responsibility to providing moreefficient service. This will bring the qualified repair facility closer, limiting thechances of problems in shipping and tracking. Build a relationship with a qualifiedvendor. This relationship enables you to control the number of technicians and techniquesthat the instruments encounter. When a qualified technician evaluates the instruments,they are able to give valuable information as to the condition of the surgicalinstruments, a suggestion for better care, or a better technique in the process ofsterilization. The key to a good relationship is to start with good communication. Doesthe company offer a tracking system for serialized instruments? Does the company haveafter hours customer service or weekend hours? It's good to know that when you need theinstrument 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 atInstrument Repair Network (Los Alamitos, Calif).
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