When you work in endoscopy, you know being down even one scope is a huge problem. We have more than 150 endoscopes here at Oregon Health and Science University because we never want to be caught short-handed. And despite our best efforts, there are times when we need a loaner or two. If you can count the number of scopes you have on two hands, the situtation is even more urgent. Here are four tips to keep your scopes functioning optimally and save on repairs.

1. Spread out usage
The biggest challenge may be getting doctors to rotate the scopes. Once a doc decides on a favorite, he'll think that's the only one that can work for him, even though you've got three others that are the same brand, same model, same everything. This is an issue about which you have to put your foot down, especially with the very high-dollar scopes. Simply using a scope means wear, which over time adds up to damage. And every use means you have to manually clean and disinfect or sterilize the scope, which not only adds wear, it increases the number of opportunities for tears: Rough manual cleaning can put holes in delicate lumens, leading to fluid invasion and water damage.

2. Track and sort
One of the best ways to ensure that usage is evenly spread across your scope inventory is to stay on top of scope tracking: usage, reprocessing, inspections, servicing and repairs. That way, if there's ever a problem with a scope, you can better pinpoint where it might have happened and how. You can spot overuse at a glance, or dig down and find other, less-obvious problems.

Our university's endoscope vendor has an online portal that helps us do this. The Web-based program lets me create files for the scopes by serial number, which the company uses to notify me that a scope's been received for service, the problem, the work that's been done and when the scope is being shipped back. When I log in, I can track the maintenance and repair histories for every one of our scopes for the last 120 days. (I can also view scope evaluations online, approve or decline services and generate the purchase order that will be recorded in our files.)

I can import these files into our database and compare what the company is saying is wrong with the scopes to what our physicians, nurses or techs are reporting. Thanks to this thorough tracking and record-keeping, on several occasions we've been able to pinpoint issues with processes that were in place and come up with solutions to better preserve our scopes. One of the best examples of this segues nicely into my favorite damage prevention subject: leak testing.

3. Leak-test correctly, often
We were recently sending out scopes that were failing leak tests, but the company's inspections would turn up nothing. When I looked at the tracking file, I'd be told that the scopes were in perfect working order (and were on their way back to us). We were wasting time and money, and we still hadn't identified the problem. I spent some time observing the cleaning and disinfection processes, because the GI reprocessing techs were the ones reporting the problems.

Turns out that before the leak test, the techs were putting two pumps of soap into the water. That was the issue: The soap bubbles were turning up a false positive. You may think you're doing yourself a service by getting the enzymatic cleaner into the sink early, but you're not. The first thing to remember about leak testing: Perform it in clean, clear water with no solution in it. Second, the scope should be properly submerged to ensure bubbles indicate a true leak and not a gravity leak.

I also suggest that you perform a leak test before cleaning and at the end of cleaning. Even if you're careful during manual cleaning, you could accidentally damage the scope, leading to a fluid invasion after you hook the scope up to the automated reprocessor. Essentially, any time there's the risk a leak was created, you should perform a leak test.

4. Do the little things
Every little bit helps. Some other steps you can take to extend the life of your scopes:

• Don't skip the pre-cleaning at bedside. This eases manual cleaning, and gentler cleaning equals decreased risk for damage.
• Treat scopes with care, making sure they don't come into contact with sharp or protruding objects, and use brushes that are capped and in good shape. Ensuring everyone does this is a constant mission, especially in a big institution where there are a lot of hands on the scopes. Ensure everyone is well-trained to handle the scopes, to spot problems early and to report them immediately.
• Sticky angulation can be one of the first signs of fluid invasion. The bill for even a minor fluid invasion could run the cost of a new scope. Get an angulation guide and use it before reprocessing to determine whether you're getting full flexion, or when a physician complains that the scope isn't working right.
• If a doc complains that the optics don't seem as bright as they used to, don't send the scope out right away. Try cleaning the end of the lens with an eraser - oftentimes, that'll remove the build-up from water or disinfectant causing the problem and improve the optics.

Nipped in the bud
Hopefully, these four tips will help you maintain your endoscopes and catch small problems before they turn into large ones, especially if your facility doesn't have the wherewithal to purchase duplicates of each scope model.