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Insider's Guide to Cleaning Lap Instruments

Insulation Inspection

Among reusable laparoscopic instruments, there are basically two types: insulated and non insulated.  The first thing to know about the insulation on laparoscopic instruments is that it's temporary.  It's got to be monitored for nicks and cuts, and many times it's got to be replaced.  Checking that insulation is part of your job in central service.

There are safeguards tin the operating room to reduce electrical risks.  But when the insulation gets scratched of nicked so that metal shows through, the electricity that's transmitted to the distal end of an instrument can arc to the neighboring tissue or organs during a procedure and cause surgical complications.  And there are risks to surgeons as well.  There are reports that insulation failures in an instrument's handle rings can enable electrical charges to reach a surgeon's glove.

Teach your staff how to inspect for flaws in the insulation.  The technique is to begin by inspecting the distal tip.  Look at the first three inches very closely for insulation failure.  Those few inches are where you'll most often find insulation failure.

When inspecting insulation, you need a 360-degree view of the instrument.  Start at the distal tip and slowly rotate the instrument, examining it all the way down to the rings.  The rings are another place where you may find cracks in the insulation.  you may even find that the insulation is completely missing.

When you discover insulation failures, communicate your findings to the appropriate clinical authority.  Such communication is a way to market your department as a center of quality control.

Nicks and scratches aren't the only problems you have to monitor.  Many times the insulation, which manufacturers heat-shrink onto an instrument, can loosen and pull away from the distal end.  Make sure the insulation hasn't become loose and able to slide.  For quality assurance, hold on to the shaft of the instrument and pull back on the insulation.

If it slides, schedule that instrument to be repaired. Sliding insulation allows more metal to be exposed than should be.  Another negative effect: insulation that slides can conceal surgical debris.  Once again, communicate such discoveries to your clinical customers in the surgery department.

Shaft reinsulation is not a complicated repair and shouldn't take more than 24 hours.  The cost: $25 to $60.  Handle reinsulation, however, is a more complicated repair.  It can take seven to ten days and cost $100 to $250.

Reinsulation is just one of the many types of repairs that can be done to laparoscopic instruments.  When a vendor tells you that you have an instrument that can't be repaired, always get a second opinion.  Usually, the only cost involved in getting a second opinion is that of shipping, which can be as low as $2 to $4.  Savings on a misdiagnosed instrument can easily be $400 to $600.  It can be tedious to find a high-quality repair vendor in your market to provide a second opinion, but the savings can be tremendous.

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