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Insider's Guide to Cleaning Lap Instruments

Deep in the Shaft

The reason most laparoscopic instruments are so hard to clean is that they have hollow shafts.  These instruments have gaskets at the proximal and distal ends that are supposed to keep blood and debris from entering the shaft.  But we've cut open enough instruments in our repair lab to be able to tell you that gaskets can fail.  Despite the gaskets, debris can get lodged in the recesses of the shaft, and at times this can cause an instrument to malfunction.

If soaking in an enzymatic solution is permitted and part of your decontamination protocol, it's advisable to soak instruments vertically rather than laying them horizontally in a sink.  If you soak an instrument horizontally, an air bubble is likely form inside the instrument, similar to the bubble inside a carpenter's level.  On the other hand, soaking an instrument vertically establishes a path for the enzymatic to enter, rise through, and exit the instrument-- as long as the solution is deep enough.  The solution should be deep enough so that the instrument's entire drive rod is submerged.

When you use a cleaning brush to help in the decontamination process, always use a brush that's longer than the shaft of the laparoscopic instrument.  The brush should be long enough to enable all the bristles to exit the far end of the shaft.  Always keep the instrument submerged under water when you perform this task, so that contaminants aren't expelled into the room.

There are several ways you can flush an instrument's shaft.   In facilities that have instruments with cleaning ports, most people attach a luer lock syringe filled with enzymatic solution to the cleaning port and flush out the shaft.   If you use this technique, always keep the distal end of the instrument under water level.

If your facility's instruments don't have cleaning ports, affix a 3-inch piece of tubing over the distal tip.  With the tubing securely in place, attach a syringe to the other end of the 3-inch tube and flush.

If compressed air is available in your decontamination department, it can be an effective tool for flushing.  With a precise nozzle and the ability to control the degree of pressure, air can be forced down the cleaning port.   The air stream can force debris down and out of the shaft.

No matter how good your technique is, always work on improving it.  There are times when instruments are labeled sterile, even though the shaft still contains surgical debris.  The question to ask yourself: Is this surgical debris sterile?

The first time I saw a Medisafe ultrasonic irrigator used to flush cannulated instruments in a hospital setting, I was both amazed and concerned by the results.  A CS director and I hooked the Medisafe machine up to a set of laparoscopic instruments that had already been sterilized.  We opened up the sterile set, hooked the machines tubing over the distal ends of the instruments and turned it on.   Nothing happened for about five minutes.  Then brown stuff started oozing out of the proximal ends.  The irrigator had slowly forced all kinds of old debris out of the instruments.

I was amazed by the machine's cleaning effect.  But I was also concerned because of the risk of cross-contamination due to improperly cleaned instruments.

It might take a person 45 minutes to clean a laparoscopic instrument set.  An ultrasonic irrigator can do the job in 15.  From a justification standpoint, it can actually save money and do a better job of cleaning, while cutting down on possible cross-contamination and instrument failure.  Anything that will force fluid down the shaft will help give you a cleaner instrument.  And it'll help ensure that your instruments function consistently and accurately.

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