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Figure 9 – Anatomy of a Flexible Endoscope

With its panoramic view and wide range of distal tip deflection, the flexible endoscope is useful for variety of surgical procedures. Flexible endoscopes are used to view the following structures and organs: throat and respiratory structures (nasopharyngoscope, bronchoscope, laryngoscope), stomach and upper small intestine (gastroscope), the large intestine (colonoscope and sigmoid scope), the urinary bladder (cystoscope), the kidneys (nephroscope), the ureters (ureteroscope), and the heart (angioscope). Handling and Cleaning Flexible Endoscopes To correctly handle a flexible endoscope, hold the control body of the flexible endoscope with one hand and the distal tip with the other hand while maintaining a slight bend in the flexible insertion tube. The tip and control body can be secured using one hand but be careful not to severely bend the endoscope. Extreme bending of the flexible insertion tube can compromise the fibers inside the flexible tubing. It is important to protect the distal lens tip, as the lens can be broken if the distal tip is left to dangle and subsequently hits a hard surface during transfer and use. Flexible endoscopes are more complex to clean because of the construction and length of the instrument and there are more reported problems associated with cleaning them. These endoscopes are usually cleaned using only a manual cleaning process, which requires an effective set-up and supplies to clean the endoscope according to the manufacturer’s instructions. As detailed in the “Multisociety Guidelines on Reprocessing Flexible GI Endoscopes” (2016), of the reported cases infection related to GI endoscopes, all of them were directly linked to the failures to follow the manufacturer’s instructions related to proper cleaning. Evidence-based guidelines for processing flexible endoscopes can be reviewed in the Guidelines for Perioperative Practice published by the Association of PeriOperative Registered Nurses (AORN). This section will detail a manual process, also will include an automatic process as well as an automatic process using a machine like an Automatic Endoscopic Reprocessor (AER) or Endoscope Cleaning and Reprocessing (ECR), etc. These machines provide a level of quality that is difficult to replicate using only a manual process cleaning and disinfecting. The machine can deliver consistent process steps as well as measure report on the steps taken to reprocess the endoscope; these reports can be used for quality documentation.

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