Care Of Instruments


Categories: ANATOMY OF LARYNX, TRACHEA, BRONCHI AND ESOPHAGUS, ENDOSCOPICALLY CONSIDERED
Sources: 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

house.



[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.]





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