Rather than read a book on the challenges of cleaning and sterilizing cannulated instruments, here's a page of practical tips on reprocessing rigid endoscopes, minimally invasive surgery instruments (such as graspers and forceps) and general-purpose surgery devices (such as pool-tip suction).

1. Submerge ASAP. Soak anything with a lumen in an enzymatic detergent as soon as possible after it's done being used for a procedure - and before it's returned to central sterile processing. Doing this right away can help keep any debris and bioburden from coagulating and drying in the lumens, which will make it difficult to clean later.

2. Flush with enzymatic cleaner. Force-flushing devices that have clean-out ports with a lumen cleaner will further break up any debris. Either connect a syringe to the port, or use a water pistol or lumen cleaner on cannulated devices (with and without special clean-out ports). I've found the latter to be more effective than syringes.

3. Brush with care. Up next: manually cleaning with brushes. The manufacturer's instructions will often tell you what size brush you need at this stage. If you don't have this material, measure the lumen diameter. Either way, you should probably stock somewhere between 12 and 15 different-sized brushes in central sterile for this purpose. It's absolutely necessary to use the appropriately sized brush - the diameter of the brush is critical to letting bristles create friction against the walls of the lumen. If you use one that's too big, the bristles will bend back and won't scrub debris away, and you risk scratching the inside of the cannula. Too small, and you won't create any (or at least not enough) friction between the bristles and the inner walls.

Be sure to keep the instrument completely under the waterline when you brush. Never brush outside the water, as you want anything you pull out to stay under the water.

Proper manual cleaning done with the proper brushes is the most important step in reprocessing these instruments. Want proof? I did an unscientific experiment with nine Yanker suckers in which I soaked them in cream of mushroom soup and let them dry. I let three soak in enzymatic detergent, then an ultrasonic cleaner, then an automated instrument washer. I cleaned the other three with enzymatic cleaner and an appropriate-diameter and length brush, then did the ultrasonic cleaner and instrument washer steps. Afterward, I examined all of them by dipping a pipe cleaner in water and passing a new one through each. It was amazing how much dried soup gunk was left in those instruments that I hadn't brushed.

4. Rinse, rinse again. Force-flush the lumen using the device you used in step two, only this time using copious amounts of water to rinse the cannulas, flushing them of debris and enzymatic solution.

5. Wash further. Next, submerge compatible instruments in a mechanical ultrasonic washer to help ensure the outside is completely clean, and to potentially loosen any remaining debris inside. After this is done, run the instruments through your general mechanical washer.

6. Inspect carefully. As a last step before you package cannulated devices for the autoclave, low-temperature gas plasma sterilizer or ozone sterilizer, require staff to recheck the lumen by passing an appropriately sized moistened pipe cleaner or brush to test that the lumen is clean. If it is, go ahead and wrap and sterilize. If not, send it back to square one.