Chest
Volume 98, Issue 2, August 1990, Pages 448-454
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bronchoscopy
The High Price off Bronchoscopy: Maintenance and Repair off the Flexible Fiberoptic Bronchoscope

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IMPROPER HANDLING

The objective lens and the delicate quartz filaments of the FFB are particularly susceptible to trauma during routine use. Care must be taken not to allow the distal end of the instrument to strike a hard surface or this may fracture the objective lens. Forced angulation of the instrument along its flexible portion (Fig 1) or twisting the body of the scope (Fig 2) may damage its quartz filaments,10 resulting in the appearance of black spots in the field of vision and reducing the quality of the

PROCEDURAL

The working channel of the FFB is lined by delicate plastic tubing. Although a thin tube allows maximal flexibility, the tubing is extremely vulnerable to trauma from the use of flexible endoscopic instruments. If this plastic tubing is perforated, fractured, or lacerated, liquids may seep into the flexible quartz bundles, fogging the field of vision and making further examination impossible (Fig 5). In our experience, this is a major drawback with the use of the immersible bronchoscope as its

PATIENT-RELATED DAMAGE

Patient cooperation is essential to minimize the possibility of injury to the FFB. Although the examination can be performed facing the sitting patient, the supine position provides greater patient relaxation and lessens the likelihood of a vaso-vagal attack, which might lead to grabbing or pulling the fiberscope by the patient. While the most common method of insertion is the transnasal approach, it may be necessary to use the transoral approach or to perform the procedure through the

CLEANING AND MAINTENANCE

Strict adherence to the recommended procedures for cleaning, disinfection, and sterilization must be employed as these instruments have limited tolerance for trauma, heat, and chemical agents. Care must be taken to immerse only appropriate parts in the cleaning solution. The proximal control unit, eye piece, or fight connector of nonsubmersible FFBs should never be immersed in the cleaning solutions.8 For disinfection, use of the recommended agents for the suggested contact time will decrease

FINANCIAL IMPACT OF FIBEROPTIC DAMAGE

To evaluate cost factors for a busy bronchoscopy service, we have reviewed our bronchoscopy repair records specifically for the rate of occurrence of preventable and unpreventable repairs over a 4 1/2-year period (January 1985 through June 1989) (Table 2). Preventable repairs were defined as repairs that involved some type of human error. Unpreventable repairs were classified as mechanical failure alone. Approximately $20,000 per year (total $89,863.11) was spent over this period to repair

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