Training

A surgeon throwing an instrument across a room is not the most effective way to determine if it needs to be sharpened or repair. Taking a proactive approach to instrument repair can help eliminate stress on medical staff and give your patients the greatest chance of a successful procedure. To help you become more proactive we have created an instrument inspection guide intended to help you and your staff identify damaged or broken instruments.

How to inspect your instrument
Our guide below instructs how to inspect some of the most commonly used surgical instruments. Problems such as misaligned jaws, dull cutting edges, stains from bio-burden or rust, pitting, missing screws and broken springs can occur to nearly every instrument and most of the concepts can be carried over. This guide does not guarantee you will be able to recognize every broken instrument, but it will give you a high level of understanding on how to inspect surgical instruments.

Even if your instrument is not listed in the below picture examples you can use the following examples as indicators that your instrument needs repair. Our services are not inclusive to the pictures below, we can repair nearly any surgical instrument.

Some general issues that would cause any surgical instrument to need repair are

If you find any of the above issues, just click the Request Service Link and we will send you more info about how begin the Bramstedt Surgical instrument repair process.

Laparoscopic Instruments

1. Cracked or Shrunken Insulation: Cracked insulation on laparoscopic instruments creates a wide range of potential hazards for the doctor, patient and your instruments. Fortunately, there are a number of ways to test your instruments and eliminate these risks. Simply doing a visual inspection can reveal major cracks and if the insulation has shrunk it can be seen at the tip or by the handle of the instrument. Using disposable wands to sweep the instrument is a commonly used way to check for cracks to small to be seen. Similar to a wand, an arch tester will find these tiny cracks, but it is not a limited use tester. If any of these indicate there is a crack in the insulation the instrument should be sent in immediately.
2. Cracked Handle Insulation: Testing the handle’s insulation of laparoscopic instruments can be very difficult. Due to this it is often over looked or ignored, but presents as many problems as cracked insulation on the shaft of the instrument. Disposable wands cannot test the handle, so the best way to check laparoscopic handles is with an arch tester. If there is a crack the tester will quickly identify it and can be used to quickly test the rest of the instrument.
3. Loose Screws or Pins: Like rongeurs the screws and pins dictate the action of the instrument. If screws or pins become loose or missing the instrument will not function and must be replaced. An examination of the instrument should expose any missing components and if there are loose screws or pins the cutting or grasping end will not close properly. If this occurs, send in the instruments and all components, even if they are broken, to have it repaired and parts replaced.
4. Cutting or Grasping End: There is a diverse range laparoscopic instruments from laparoscopic scissors to needle holders; each of which requiring different inspection techniques. To learn how to inspect each of these instruments please refer to the earlier inspection techniques for forceps, needle holders and scissors.

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Rongeurs

1. Loose or Missing Screws/Pins: Rongeurs have many screws and pins, each of which must be secured for the instrument to function properly. To test the screw connecting the handle to the body is secure; gently push the handles back and forth. If the front handle rattles the instrument needs to be repaired. The top shaft of the rongeur is secured to the body by a driving pin. If this pin or other components within the rongeur are not secure the top shaft cannot be driven forward properly to apply the cutting edge. In either case the instrument should be sent in for repair. If the instrument is missing any of these screws or pins the instrument will not work or will be in multiple pieces. In this case, send all of the components, even if they are broken, in to be repaired or replaced.
2. Worn Out or Broken Spring: When a spring is working well there should be pressure when closing the instrument and it should return abruptly to its original position. When the spring is worn out the instrument will not have a firm feel. It may also stick when returning to its original position (sticking can be caused by other issues as well. See #4). More commonly, the spring will break before it is worn out. Whether the spring wears out or breaks the instrument should be sent out for repair or replacement parts.
3. Dull Cutting Edge: Like a scissors, a dull cutting edge is the most common reason a rongeur is sent in for repair. The cutting edge can be tested by taking a business card and trying to cut it with the top 1/3 of the rongeur’s cutting edge. If the rongeur is sharp applying firm pressure should make a clean cut, taking a small sample out of the business card. If the rongeur cannot make a clean cut and does not remove a small sample it needs to be sent in for repair.
4. Sticking Top Shaft: As mentioned earlier a sticking top shaft can be caused by a worn out spring, but more commonly it is due to build up between the top shaft and guide. During each procedure small amounts of “debris” can get lodged within the shaft of the instrument. This build up is not only unsanitary, but can cause your instrument to bulge and break. To test for this simply close the instrument and let it open back up. If it feels as if the instrument is getting stuck, catching on something or sticking when it is opening back up it should be sent in for repair.

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Forceps:

1. Cracks in the Box Lock: Cracks in the box lock develop due to continuous stress on the instrument and are often unavoidable. These small cracks significantly reduce the structure integrity of the instrument and usually occur in one of three places indicated below. Cracks should be apparent if looked at closely, but can often be missed without proper inspection. Instrument with a cracked box lock usually can be repaired and should be sent in immediately.
2. Jaw Alignment: One of the most common reasons a forceps needs repair is misalignment of the jaws. For a standard forceps or hemostat inspecting the jaws with the instrument securely closed should reveal if it is improperly aligned. For forceps with teeth, open and close the instrument to feel if the teeth are snagging rubbing each other.
3. Loose Box Lock: A loose box lock is another common problem which occurs from normal wear and tear. To check if the box lock is to loose open the instrument, grab one ring handle in each hand and gently push one handle up and down. There should be some play in the instrument, but if it feels “sloppy” it should be repaired.
   
   
4. Worn Serrations or Broken Teeth: Visually inspecting the jaws of an instrument should quickly reveal if there are worn serrations or broken teeth. If there is any indication this has occurred send in the instrument immediately. There is a greater chance this can be repaired the earlier the problem is addressed.
5. Ratchet Fit: When the jaws are closed there should be 1/16” to 1/8” of space between the ratchets to maintain proper tension. The instrument should also stay tightly locked and properly aligned when secured in the first ratchet position.

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Surgical Scissors

1. Nicks, Pitting or Cracks: Doing a visual inspection of a scissor cutting edge can expose small nicks or “holes” from pitting which if unattended will cause significant performance problems and ruin your instrument. The earlier a scissors with these problem is repaired the longer useful life it will have. Scissors with vertical cracks through the cutting edge are very dangerous and should not be used. In most cases a scissors with this type of damage is beyond repair.
2. Bent or Broken Tips: The tips of a scissors see the most use and will sometimes bend or break. Bent tips are not always easy to see, but opening and closing the instrument should reveal an uncomfortable rubbing at the tip. A scissors with a bent tip can be repaired, but when the tip is completely broken off it is beyond repair.
3. Loose or Worn Screw: A loose or worn screw in a scissors is similar to a loose box lock on a forceps or needle holder. The scissors will feel “sloppy” and the cutting edges will not pass together properly. Opening and closing the scissors should indicate if it has the proper “like new” feel. It is also possible for a small crack to develop close to the screw. In each case the instrument needs to be repaired.
4. Dull Cutting Edge: A dull cutting edge is the most common reason a scissors is sent in for repair. To test if a scissors is dull cut either a surgical glove, latex free Thera-Band or an equivalent with the front 1/3 of the blades. These mimic skin and the scissors should pass through them with very little effort. If you must push to cut the material or the tips get caught it is in need of sharpening.

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Needle Holder

1. Cracks in the Jaws or Box Lock: Although needle holders were designed to have the insert fail and crack before the jaw there are situations where the jaw itself will crack. If this occurs there will be a distinct bend in the jaw with a clear break behind the insert. This type of break can be repaired, but the chances of a successful repair are small. Like a forceps, cracks in a box lock are generally small, but compromise the integrity of the instrument. Any instrument with a cracked box lock should be sent in for repair immediately.
2. Cracks or Wear on the Inserts: Because the tip of a needle holder’s jaws are generally the only part of the instrument used the majority of insert damage will occur there. Visible cracks in the insert are easy to identify and if seen the insert needs to be replaced. Inserts also wear down and if the tip of an insert looks and feels significantly less coarse than the rest of the insert it should be replaced. Another good test is to close the instrument, hold it up to a light and look to see if light is passing between the inserted portion of the jaws. If so the instrument needs to be repaired.
3. Loose Box Lock: A loose box lock is another common problem which occurs from normal wear and tear. To check if the box lock is to loose open the instrument, grab one ring handle in each hand and gently push one handle up and down. There should be some play in the instrument, but if it feels “sloppy” it should be repaired.
4. Ratchet Fit: When the jaws are closed there should be 1/16” to 1/8” of space between the ratchets to maintain proper tension. The instrument should also stay tightly locked and properly aligned when secured in the first ratchet position.

–> Did you find an issue? If so click this link to get started: Request Service Link