ENDOSCOPY
Fig 3: Endoscope tip protector
discouraging any microbial proliferation (see figures 2,3,4 and 5). An endoscope’s insertion tube length and diameter varies greatly by model and is dependent upon the anatomy viewed. It is hollow and provides protection for the delicate internal components. The shell is covered with a thin- walled flexible tube called the bending section rubber. The bending section is the most fragile portion of the flexible endoscope and must also be protected from impact. Impact to the distal tip potentially damages all the inner components. Therefore, it is imperative that an endoscope tip protector can cope with the varying different sizes of different scopes. It should have minimal contact points to allow
for aeration and most importantly not require too much force to remove it from the scope – otherwise there is the possibility of causing damage itself.
Esther McBurney, a senior sister and unit manager at the endoscopy units of both the King George’s Hospital and Queen Elizabeth Hospital in London, UK, recently clinically evaluated one of these new protection devices. The endoscopy departments at the London hospitals perform around 5000-6000 procedures a year using seven gastroscopes, five colonscopes with two PCF paediatric/slim diameter colonoscopes – as well as a number of bronchoscopes and other specialist endoscopes. “We see a variety of damage to our scopes ranging from water damage and leaks, to angulation of the scopes being too tight or loose. We also see channel blockages and electrical faults, such as no graphics on the screen or lines on the image. Of course, we have also seen a number of distal tip damages, such as cracked lenses, leaks at the distal tip and damaged air/water nozzles,” McBurney explained. “Most of this damage occurs during
Esther McBurney
transportation or storage of the scope. Therefore, to protect the scope we try to minimise the movement as much as possible. We keep the scope in a tray for transportation and it is also placed in a tray during reprocessing. This is placed either in a sealed bag for use or in our drying cabinet
for longer term storage. We now also provide extra tip protection with the use of the Protech tip protection device.” McBurney decided to undertake a retrospective search on all scope repairs within the last six months and then compared this to the next six months using the Protech. Presented at the prestigious European Society of Gastroenterology and Endoscopy Nurses and Associates (ESGENA) meeting in Barcelona, her findings showed that the use of the Protech scope tip protection device resulted in a 53.8% decrease in overall repairs and a 66.7% reduction in loan scopes required.15
Over an extended nine-month
evaluation period endoscope tip damage was also reduced by 66.7%.
Fig 4 and 5: New purpose designed scope tip protectors are now available NOVEMBER 2020
“Studies have shown that scopes can have scratches and dents that could harbour blood, tissue and bacteria – despite rigorous cleaning. The Protech stops more than just tip damage, however. I believe it acts like a visual cue for staff who handle the scope to take more care in general. Other tip protectors have been solid and caused tips to remain wet which can cause bacteria to grow. The Protech allows for breathability,” McBurney explained. She reported that staff also found it very easy to use and scope uptime increased. In addition, after introducing the device, the hospitals’ use of loan scopes decreased by two thirds as the need for repairs was reduced. “Some Hospital Trusts won’t allow loan scopes to be used, as the decontamination history of the scope is unknown. My Trust isn’t one of these, but using less loan scopes makes everyone feel easier,” McBurney commented. “By using Protech, the staff have seen how much smoother the lists run and the need for loan scopes has decreased, which in turn decreases spend. The decontamination staff have less work to do in having to send the scope away for repair and setting up the loan scopes to the endoscopic washer disinfectors. This all means other
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