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Preparation Of The Patient For Peroral Endoscopy
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Care Of Instruments
Category: ANATOMY OF LARYNX, TRACHEA, BRONCHI AND ESOPHAGUS, ENDOSCOPICALLY CONSIDERED
Source: A Manual Of Peroral Endoscopy And Laryngeal Surgery
The endoscopist must either personally care
for his instruments, or have an instrument nurse in his own employ,
for if they are intrusted to the general operating room routine he
will find that small parts will be lost; blades of forceps bent,
broken, or rusted; tubes dinged; drainage canals choked with blood or
secretions which have been coagulated by boiling, and electric
attachments rendered unstable or unservicable, by boiling, etc. The
tubes should be cleansed by forcing cold water through the drainage
canals with the aspirating syringe, then dried by forcing
pipe-cleaning worsted-covered wire through the light and drainage
canals. Gauze on a sponge carrier is used to clean the main canal.
Forceps stylets should be removed from their cannulae, and the
cannulae cleansed with cold water, then dried and oiled with the
pipe-cleaning material. The stylet should have any rough places
smoothed with fine emery cloth and its blades carefully inspected; the
parts are then oiled and reassembled. Nickle plating on the tubes is
apt to peel and these scales have sharp, cutting edges which may
injure the mucosa. All tubes, therefore, should be unplated. Rough
places on the tubes should be smoothed with the finest emery cloth,
or, better, on a buffing wheel. The dry cells in the battery should be
renewed about every 4 months whether used or not. Lamps, light
carriers, and cords, after cleansing, are wiped with 95 per cent
alcohol, and the light-carriers with the lamps in place are kept in a
continuous sterilization box containing formaldehyde pastilles. It is
of the utmost importance that instruments be always put away in
perfect order. Not only are cleaning and oiling imperative, but any
needed repairs should be attended to at once. Otherwise it will be
inevitable that when gotten out in an emergency they will fail. In
general surgery, a spoon will serve for a retractor and good work can
be done with makeshifts; but in endoscopy, especially in the small,
delicate, natural passages of children, the handicap of a defective or
insufficient armamentarium may make all the difference between a
success and a fatal failure.
A bronchoscopic clinic should at all times be in the same state of
preparedness for emergency as is everywhere required of a fire-engine
[PLATE I--A WORKING SET OF THE AUTHOR'S ENDOSCOPIC TUBES FOR LARYNGOSCOPY,
BRONCHOSCOPY, ESOPHAGOSCOPY, AND GASTROSCOPY:
A, Adult's laryngoscope; B, child's laryngoscope; C, anterior
commissure laryngoscope; D, esophageal speculum, child's size; E,
esophageal speculum, adult's size; F, bronchoscope, infant's size, 4
mm. X 30 cm.; G, bronchoscope, child's size, 5 mm. X 30 cm.; H,
aspirating bronchoscope for adults, 7 mm. X 40 cm.; I, bronchoscope,
adolescent's size, 7 mm. x 40 cm., used also for the deeper bronchi of
adults; J, bronchoscope, adult size, g mm. x 40 cm.; K, child's size
esophagoscope, 7 mm. X 45 cm.; L, adult's size esophagoscope, full
lumen construction, 9 mm. x 45 cm.; M, adult's size gastroscope. C,
I, and E are also hypopharyngoscopes. C is an excellent esophageal
speculum for children, and a longer model is made for adults.
If the utmost economy must be practised D, E, and M may be omitted.
The balance of the instruments are indispensable if adults and
children are to be dealt with. The instruments are made by Charles J.
Pilling & Sons, Philadelphia.]
Next: Anatomy Of Larynx Trachea Bronchi And Esophagus Endoscopically Considered
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