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How to Maintain and Repair Surgical Instruments

Surgical instruments are a necessary expenditure of hospitals and health centers around the world must make to run a successful healthcare organization. Without them, they would not be able to function. Whether it is a specialized instrument like an endoscope, or a more general tool like a clamp, surgical instruments are a necessity that cannot be overlooked. Because of this, and because of the large price tag that is often associated with such instruments, utmost care has to be devoted to their maintenance. In doing so, not only will their useful lifespan extend, but the safety of the patients exposed to them will also improve.

How to Maintain Surgical Instruments

When surgical instruments are properly maintained, the doctors using them know with certainty that any procedure they perform will encounter less complications in the operating room. For example, imagine using an endoscope that was previously damaged. The damage was minimal, but it was damaged nonetheless. And because proper maintenance protocols were not established or adhered to, the damage went undetected. Without going into detail about what could happen if the endoscope is used in surgery—suffice to say that it could include a surgical site infection and a hefty lawsuit—everything could have been avoided with a proper inspection followed by a trip to get endoscope repair services from organizations like Surgical Solutions.

With that in mind, maintaining surgical instruments can be broken down into three manageable steps:
  1. Cleaning, disinfection and/or sterilization
  2. Inspecting
  3. Testing

 

Cleaning and Sterilizing

The first step in surgical instrument maintenance, cleaning and sterilizing, takes place immediately after they were last used, which is called point-of-use cleaning. This includes an initial cleaning to remove any and all leftover surgical debris like blood, body fluids and tissues, followed by rigorous sterilizing to ensure that all microorganisms like bacteria have been eliminated. Sterilization is achieved through a variety of methods that include:
  • Autoclave sterilization
  • Ethylene oxide sterilization
  • Dry heat sterilization
  • Microwave sterilization
  • Etc.
Professionally speaking, this process—cleaning and sterilizing—is called surgical instrument reprocessing and includes many tasks that work together to prevent contamination in the operating room.

 

Inspecting

Like we touched on earlier, thorough inspections ensure that everything is caught before it can evolve into something much worse. This is why regular inspections are a must—any damage today can become a lawsuit tomorrow. To prevent this from happening, inspections should be introduced directly after cleaning. Keep in mind that an inspection goes above and beyond a cursory glance, and includes checking for things like:
  • Cleanliness
  • Corrosion
  • Damage or defects
  • Missing or loose parts
  • Proper alignment and functioning mechanisms

 

Testing

After an inspection comes testing to catch anything that might have been overlooked, and to make sure that the surgical instrument is indeed ready for use. Because of the large breadth of surgical instruments that are used day in and day out, this step and the testing protocols that go with it will vary from instrument to instrument and according to the manufacturer’s instructions for use. For instance, here are specific protocols for some general use surgical instruments:
  • Scissors
    • Hold the scissors as a surgeon would.
    • Open the scissors half-way and close on the test material or glove. The cut should be smooth and even to the tip, without snagging.
    • Open the scissors and gently drop one handle. The scissors should engage with tension at ½ to ⅓ of the closure point.
  • Rongeurs
    • Cut a 3×5 index card, business card or material of similar weight. Two-thirds of the cutting edge of a bone rongeur must cut the test material smoothly, without tearing. The bite should be clean without snagging or tearing (except Pituitary Rongeurs).
      • Pituitary Rongeurs should make an even, uniform impression on the test material.
  • Osteotomes
    • Using a plastic testing rod or dowel, or a plastic syringe barrel, place osteotome at a 45° angle. The cutting edge should not “slip,” but will engage evenly on the rod.
  • Needle Holders
    • The jaws of the needle holder should come together at the tips, without having to apply closing pressure on the first ratchet.
    • Close the jaw to one ratchet and assure that light cannot be seen through the jaws.
    • Close the jaw to one ratchet onto test material (e.g.  aluminum foil). Check for the outline of the jaw and impressions of serrations (if present).
    • Open the needle holder and drop one side of the handle gently. It should be ½ to ⅓ closed.
  • Clamps
    • Close the clamp on the first ratchet and hold it up to the light while continuing to close the ratchet. No light should be seen passing through the jaws, with the exception of vascular clamps.
    • As with the needle holder, drop one side of the handle gently. It should be ½ to ⅓ closed.
  • Vascular Clamps
    • To test the atraumatic “teeth”, fill a zip lock bag with water.
    • Close the clamp at one corner of the bag to test if the liquid is protected from flowing into the clamped corner.
    • Remove the clamp and check that there are no holes or perforations.
  • Forceps
    • Toothed forceps should engage evenly when being closed. The teeth should be sharp and equally sized.
    • When closing or opening thumb forceps with a guide pin, the pin must slide centrally into the guide hole and the pin must not jam or rub.
    • Most ratcheted instruments should open completely and hold test material at each step of the ratchet (with the exception of vascular clamps).
  • Curettes
    • Test sharpness on a plastic rod or dowel or syringe barrel, as with the osteotome.
    • Assure the cutting edge is clean, smooth and intact.

 

How to Repair Surgical Instruments

Even if you have been doing everything correctly in terms of maintenance, you will eventually have to deal with surgical instrument repair. After all, the more you use an instrument—the more wear and tear that accumulates—the more you will have to do to maintain them until you reach a point where maintenance is not enough. This is where surgical instrument repair comes into play.

 

For the best results, avoid doing any repair work yourself. This is what we touched on earlier with our example of the damaged endoscope and the scope repair services that followed. Surgical instruments are expensive and anything done in-house has a higher likelihood of leading to an extra repair job than if things were taken care of by an expert with the right tools and replacement parts.

 

Final Thoughts

Ensuring patient safety extends beyond what happens in the operating room and includes properly maintaining the instruments that will serve as tools during a procedure. It is imperative for every medical center to have access to instruments that are always in perfect working order and can function to their fullest capacity. For this to happen, any inefficiencies need to be taken care of. As we learned today, this can be accomplished by setting and always adhering to maintenance and repair protocols.

Author: Raynetta Stansil

Raynetta earned her BA in Healthcare Administration from University of Phoenix in 2016. In 2019, she will be completing her Master’s in Healthcare Administration from Ohio University. When not immersed in some form of healthcare education, Raynetta enjoys spending time with her husband and two sons in their hometown of Gary, IN.

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How to Maintain and Repair Surgical Instruments
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How to Maintain and Repair Surgical Instruments
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Surgical instruments are a necessary expenditure of hospitals and health centers around the world must make to run a successful healthcare organization. Without them, they would not be able to function.
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Raynetta Stansil
Raynetta earned her BA in Healthcare Administration from University of Phoenix in 2016. In 2019, she will be completing her Master’s in Healthcare Administration from Ohio University. When not immersed in some form of healthcare education, Raynetta enjoys spending time with her husband and two sons in their hometown of Gary, IN.