University of Alberta Edmonton, AB, Canada
Correspondence to: Peter G. Brindley, MD, Assistant Professor of Critical Care Medicine, 4H1.22, W.C. Mackenzie Health Sciences Centre, 8440 112th St, Edmonton, AB, Canada, T6G 2R7; e-mail: firstname.lastname@example.org
We experienced an unusual complication with two flexible bronchoscopes within a week. The following letter is meant to alert others, and is intended for both education and cost savings.
The flexible A-rubber sheath on the distal portion of the bronchoscope “ballooned,” and in one bronchoscope ruptured, during the sterilization process. As the repairs cost roughly $1,000 (Canadian dollars) per bronchoscope and this had never happened in our institution before, we set out to uncover the problem.
The following two simultaneous conditions were believed to be responsible: a failing check valve in the sterilizer; and the fact that the bronchoscopes had been placed into the sterilizer with a slight positive internal pressure following leak testing. A failing check valve can add as much as 6 to 7.6 lb per square inch of vacuum to the exterior surface of the bronchoscope. Any positive pressure that is left in the bronchoscope from the leak test procedure could add as much as 3.5 lb per square inch of pressure.1 Together, the additional pressure could cause dilation and/or rupture of the rubber sheath.
To prevent a repeat, we have emphasized the need for maintenance on any sterilizing equipment at least twice per year. As part of our own ongoing quality assurance efforts, a check step to the leak test procedure has been added to ensure that no positive pressure remains prior to sterilization. By briefly installing a venting cap onto the bronchoscope following leak testing, all remaining positive pressure is removed. To facilitate this, an ethylene oxide cap was chained to the leak tester.
Although not a common problem, the cost of repair mandates an extra effort. We think that this simple step, which requires minimal time, no extra training, and the negligible cost of a venting cap, will prevent future damage. We encourage readers to consider their own bronchoscope-venting procedures.
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