EVIS EXERA lll COLONOVIDEOSCOPE Operation Manual

Contents

Contents Symbols ... 1 Important Information - Please Read Before Use ... 2 Intended use ... 2 Applicability of endoscopy and endoscopic treatment ... 2 Instruction manual ... 3 User qualifications ... 4 Instrument compatibility ... 4 Reprocessing before the first use/reprocessing and storage after use ... 4 Spare equipment ... 4 Maintenance management ... 5 Prohibition of improper repair and modification ... 5 Signal words ... 5 Warnings and cautions ... 6 Precaution of disappeared or frozen endoscopic image ... 10 Examples of inappropriate handling ... 11

Chapter 1 Checking the Package Contents ... 13 1.1

Checking the package contents list ... 13 Packaged items for North America, Europe, Australasia, Middle East, and Africa ... 14 Packaged items for countries other than North America, Europe, Australasia, Middle East, and Africa ... 15

Chapter 2 Instrument Nomenclature and Specifications ... 17 2.1

Nomenclature and functions ... 17 Control section, insertion section ... 18 Endoscope connector ... 22

2.2

Specifications ... 24 Environment ... 24 Function list ... 24 Specifications ... 25

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Contents

Chapter 3 Preparation and Inspection ... 27 3.1

The workflow of preparation and inspection ... 27

3.2

Preparation of the equipment ... 29

3.3

Inspection of the endoscope ... 30 Inspection of the endoscope ... 30 Inspection of the passive bending section ... 32 Inspection of the flexibility adjustment mechanism ... 33 Inspection of the bending mechanisms ... 34

3.4

Inspection of accessories ... 38 Inspection of the air/water and suction valves ... 38 Inspection of the biopsy valve (MB-358) ... 39 Inspection of the single use biopsy valve (MAJ-1555) ... 40 Inspection of the auxiliary water inlet cap (MAJ-215) ... 40 Inspection of the auxiliary water tube (MAJ-855) ... 41

3.5

Attaching accessories to the endoscope ... 41 Attaching the suction valve ... 41 Attaching the air/water valve ... 43 Attaching the biopsy valve ... 44 Attaching the auxiliary water inlet cap ... 44

3.6

Inspection of ancillary equipment ... 45

3.7

Connection of the endoscope and ancillary equipment ... 46 Connection to the light source ... 46 Connection of the water container ... 47 Connection of the suction tube ... 48 Connection of the auxiliary water tube ... 48

3.8

Inspection of the endoscopic system ... 49 Inspection summary ... 49 Inspection of the endoscopic image ... 50 Inspection of the focus switching function ... 52 Inspection of the remote switches ... 54 Inspection of the air-feeding function ... 55 Inspection of the objective lens cleaning function ... 56 Inspection of the suction function ... 58 Inspection of the instrument channel ... 60 Inspection of the auxiliary water feeding function ... 60 Inspection of the endoscope position detecting function ... 62

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Contents

Chapter 4 Operation ... 63 4.1

Precautions ... 63

4.2

Insertion ... 66 Holding and manipulating the endoscope ... 66 Insertion of the endoscope ... 67 Observation of the endoscopic image ... 68 Focus switching ... 69 Angulation of the distal end ... 70 Flexibility adjustment ... 71 Insertion of the endoscope using the endoscope position detecting unit ... 72 Air/water feeding and suction ... 72

4.3

Using EndoTherapy accessories ... 77 Insertion of EndoTherapy accessories into the endoscope ... 79 Operation of EndoTherapy accessories ... 80 Withdrawal of EndoTherapy accessories ... 81 Use of nonflammable gases ... 81 High-frequency cauterization treatment ... 82

4.4

Withdrawal of the endoscope ... 83

4.5

Transportation of the endoscope ... 85 Transporting within the hospital ... 85 Transporting outside the hospital ... 86

Chapter 5 Troubleshooting ... 87 5.1

Troubleshooting ... 87

5.2

Troubleshooting guide ... 88 Angulation ... 88 Air/water feeding ... 89 Suction ... 90 Image quality or brightness ... 90 Flexibility adjustment ... 91 Auxiliary water feeding ... 92 EndoTherapy accessories ... 92 Endoscope position detecting ... 92 Other ... 92

5.3

Withdrawal of the endoscope with an irregularity ... 93 Withdrawal when the WLI and NBI endoscopic images appear on the monitor ... 94 Withdrawal when either the WLI or the NBI endoscopic image does not appear on the monitor ... 96 Withdrawal when no endoscopic image appears on the monitor or a frozen image cannot be restored ... 96 Withdrawal when the focus setting cannot be switched ... 98

5.4

Returning the endoscope for repair ... 99

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Contents

Appendix ... 101 Combination equipment ... 101 System chart ... 101 Reprocessing equipment ... 104 Compatible video system center ... 105 Compatible light source ... 105 Compatible accessories ... 105 Compatible EndoTherapy accessories ... 106 Compatible electrosurgical accessories ... 110

EMC information ... 112

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CF-HQ190L/I OPERATION MANUAL

Symbols

Symbols The meaning(s) of the symbol(s) shown on the component packaging, the back cover of the instruction manual, and/or the instrument are as follows: Symbol

Description Refer to instructions.

Endoscope

TYPE BF applied part

Single use only

Lot number

Manufacturer

Authorized representative in the European Community

Serial number

CF-HQ190L/I OPERATION MANUAL

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Important Information - Please Read Before Use

Important Information - Please Read Before Use

 Intended use This instrument is intended to be used with an Olympus video system center, endoscope position detecting unit, light source, documentation equipment, monitor, EndoTherapy accessories (such as a biopsy forceps), and other ancillary equipment for endoscopy and endoscopic surgery. The EVIS EXERA III COLONOVIDEOSCOPE CF-HQ190L/I is indicated for use within the lower digestive tract (including the anus, rectum, sigmoid colon, colon, and ileocecal valve). Do not use this instrument for any purpose other than its intended use. Select the endoscope to be used according to the objective of the intended procedure based on the full understanding of the endoscope’s specifications and functionality as described in this instruction manual.

 Applicability of endoscopy and endoscopic treatment If there are official standards on the applicability of endoscopy and endoscopic treatment that are defined by the hospital’s administrators or other official institutions, such as academic societies on endoscopy, follow those standards. Before starting endoscopy and endoscopic treatment, thoroughly evaluate its properties, purposes, effects, and possible risks (their nature, extent and probability). Perform endoscopy and endoscopic treatment only when its potential benefits are greater than its risks. Fully explain to the patient the potential benefits and risks of the endoscopy and endoscopic treatment as well as any examination/treatment methods that can be performed in its place, and perform the endoscopy and endoscopic treatment only after obtaining the consent of the patient. Even after starting the endoscopy and endoscopic treatment, continue to evaluate the potential benefits and risks, and immediately stop the endoscopy/treatment and take proper measures if the risks to the patient become greater than the potential benefits.

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CF-HQ190L/I OPERATION MANUAL

Important Information - Please Read Before Use

 Instruction manual This instruction manual contains essential information on using this instrument safely and effectively. Before use, thoroughly review this manual and the manuals of all equipment that will be used during the procedure and use the equipment as instructed. Note that the complete instruction manual set for this endoscope consists of this manual and the “REPROCESSING MANUAL” with your endoscope model listed on the cover. It also accompanied the endoscope at shipment. Keep this and all related instruction manuals in a safe, accessible location. If you have any questions or comments about any information in this manual, please contact Olympus.

 Terms used in this manual NBI (Narrow Band Imaging) observation: This is optical-digital observation using narrowband light.

Normal light observation (or WLI (White Light Imaging) observation): This is observation using white light.

Normal focus mode: In this observation mode, the focusing position of the endoscope is optically shifted to a normal position. At this position, a wider focusing depth can be obtained.

Near focus mode: In this observation mode, the focusing position of the endoscope is optically shifted to a near position. At this position, a magnified image can be obtained.

Focus switching: This is an action to switch the focusing position between the normal focus mode and the near focus mode.

Image sensor: The image sensor is a device that converts light into electrical signals.

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Important Information - Please Read Before Use

 User qualifications If there are official standards for user qualifications to perform endoscopy and endoscopic treatment that are defined by the hospital’s medical administrators or other official institutions, such as academic societies on endoscopy, follow those standards. If there are no official qualification standards, the operator of this instrument must be a physician approved by the medical safety manager of the hospital or person in charge of the department (department of internal medicine, etc.). The physician should be capable of safely performing the planned endoscopy and endoscopic treatment following guidelines set by the academic societies on endoscopy, etc., and considering the difficulty of endoscopy and endoscopic treatment. This manual does not explain or discuss endoscopic procedures.

 Instrument compatibility Refer to “Combination equipment” on page 101 to confirm that this instrument is compatible with the ancillary equipment being used. Using incompatible equipment can result in patient or operator injury and/or equipment damage. This instrument complies with the EMC standard for medical electrical equipment, edition 2 (IEC 60601-1-2: 2001) and edition 3 (IEC 60601-1-2: 2007). However, when connected with an instrument that complies with the EMC standard for medical electrical equipment, edition 1 (IEC 60601-1-2: 1993), the whole system complies with edition 1.

 Reprocessing before the first use/reprocessing and storage after use This instrument was not reprocessed before shipment. Before using this instrument for the first time, reprocess it according to the instructions given in the endoscope’s companion “REPROCESSING MANUAL” with your endoscope model listed on the cover. After using this instrument, reprocess and store it according to the instructions given in the endoscope’s companion reprocessing manual. Improper and/or incomplete reprocessing or storage can pose an infection control risk, cause equipment damage, or reduce performance.

 Spare equipment Be sure to prepare another endoscope to avoid interruption of the examination due to equipment failure or malfunction.

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CF-HQ190L/I OPERATION MANUAL

Important Information - Please Read Before Use

 Maintenance management The probability of failure of the endoscope and ancillary equipment increases as the number of procedures performed and/or the total operating hours increase. In addition to the inspection before each procedure, the person in charge of medical equipment maintenance in each hospital should inspect the items specified in this manual periodically. An endoscope with an observed irregularity should not be used, but should be inspected by following Section 5.2, “Troubleshooting guide”. If the irregularity is still observed after inspection, contact Olympus.

 Prohibition of improper repair and modification This instrument does not contain any user-serviceable parts. Do not disassemble, modify, or attempt to repair it; patient or operator injury and/or equipment damage may result. Equipment that has been disassembled, repaired, altered, changed, or modified by persons other than Olympus’ own authorized service personnel is excluded from Olympus’ limited warranty and is not warranted by Olympus in any manner.

 Signal words The following signal words are used throughout this manual:

WARNING

Indicates a potentially hazardous situation which, if not avoided, could result in death or serious injury.

CAUTION

Indicates a potentially hazardous situation which, if not avoided, may result in minor or moderate injury. It may also be used to alert against unsafe practices or potential equipment damage.

NOTE

Indicates additional helpful information.

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Important Information - Please Read Before Use

 Warnings and cautions Follow the warnings and cautions given below when handling this endoscope. This information is to be supplemented by the warnings and cautions given in each chapter.

WARNING • After using this endoscope, reprocess and store it according to the instructions given in the endoscope’s companion “REPROCESSING MANUAL” with your endoscope model listed on the cover. Using improperly or incompletely reprocessed or stored instruments may cause patient cross-contamination and/or infection. • Before endoscopy, remove any metallic objects (watch, glasses, necklace, etc.) from the patient. Performing high-frequency cauterization treatment while the patient is wearing metallic objects may cause burns on the patient in areas around the metallic objects. • Do not strike, hit, or drop the endoscope’s distal end, insertion tube, bending section, control section, universal cord, or endoscope connector. Also, do not bend, pull, or twist the endoscope’s distal end, insertion tube, bending section, control section, universal cord, or endoscope connector with excessive force. The endoscope may be damaged and could cause patient injury, burns, bleeding, and/or perforations. It could also cause parts of the endoscope to fall off inside the patient. • Never perform angulation control forcibly or abruptly. Never forcefully pull, twist, or rotate the angulated bending section. Patient injury, bleeding, and/or perforation may result due to unintended retroflexion of the bending section. It may also become impossible to straighten the bending section during an examination. • Never insert or withdraw the endoscope’s insertion section while the bending section is locked in position. Patient injury, bleeding, and/or perforation may result. • Never perform flexibility adjustment, operate the bending section, feed air or perform suction, insert or withdraw the endoscope’s insertion section, or use EndoTherapy accessories without viewing the endoscopic image or while the endoscopic image is frozen. Patient injury, bleeding, and/or perforation may result. • Regardless of the flexibility of the endoscope’s insertion tube, never insert or withdraw the insertion section abruptly or with excessive force. Patient injury, bleeding, and/or perforation may result. • If it is difficult to insert the endoscope, do not forcibly insert the endoscope; stop the endoscopy. Forcible insertion can result in patient injury, bleeding, and/or perforation. • When using the electronic zoom function of the video system center, never insert or withdraw the endoscope’s insertion section or use EndoTherapy accessories while the image is magnified. Patient injury, bleeding, and/or perforation can result.

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CF-HQ190L/I OPERATION MANUAL

Important Information - Please Read Before Use

WARNING • Never insert or withdraw the endoscope’s insertion section while the focus setting is set to the near focus mode. Patient injury, bleeding, and/or perforation can result. • Do not touch the light guide on the endoscope connector immediately after removing it from the light source because it is extremely hot. Operator or patient burns can result. • If the endoscopic image becomes dimmer during the procedure, it may indicate that blood or mucus is adhering to the light guide lens on the distal end of the endoscope. Immediately withdraw the endoscope from the patient, remove blood or mucus, and confirm that the light guide lens has no irregularities to use it again. If you continue to use the endoscope with the obstructed light guide lens, the temperature at the distal end may rise, which may cause patient injury or operator and/or patient burns. • When the endoscopic image does not appear on the monitor, the image sensor may have been damaged. Turn the video system center OFF immediately. Continued power supply in such a case will cause the distal end to become hot and could cause operator and/or patient burns. • Do not rely on the NBI observation mode alone for primary detection of lesions or to make a decision regarding any potential diagnostic or therapeutic intervention. • The endoscope position detecting unit (UPD-3) is designed only to assist the insertion of an endoscope. Never insert the endoscope into the patient’s body by observing only the endoscope position display on the endoscope position detecting unit. Be sure to observe the endoscopic image and insert the endoscope while confirming the safety. If the endoscope is inserted without observing the endoscopic image, patient injury, bleeding, and/or perforation can result. • The endoscope position detecting unit (UPD-3) generates AC magnetic fields. To prevent critical effects on patients, be sure to adhere to the following:  Never use the endoscope position detecting unit on a patient with a pacemaker. The AC magnetic fields generated by the endoscope position detecting unit may cause malfunction or damage to the pacemaker, exerting critical effects to the cardiac function of the patient.  Never use the endoscope position detecting unit on pregnant women or women observed of being pregnant. Never use the endoscope position detecting unit close to pregnant women or women observed of being pregnant. The effects of the AC magnetic field generated by the endoscope position detecting unit on the unborn baby have not yet been determined. • Be sure to check that the passive bending section bends smoothly by touching it with your hands before inserting the endoscope into the patient. If any irregularity is observed on the distal end motion of the endoscope, immediately stop using the endoscope and withdraw it from the patient. Patient injury, bleeding, and/or perforation may result. CF-HQ190L/I OPERATION MANUAL

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Important Information - Please Read Before Use

WARNING • When combining the endoscope with a splinting tube, there is a risk of perforation or bleeding due to entanglement of the mucous membrane, or of the tube separating from the endoscope and remaining in the body. Before use, be sure to read the instruction manual for the splinting tube to fully understand its characteristics. • During endoscopic treatment, keep the insertion section and the bending section as straight as possible. If there is a loop or a bend on the insertion section or the bending section, the operation cannot be performed as intended, and patient injury, bleeding, and/or perforation can result.

CAUTION • Do not pull the universal cord during an examination. The endoscope connector will be pulled out from the output socket of the light source and the endoscopic image will disappear. • Do not coil the insertion tube or universal cord with a diameter of less than 12 cm. Equipment damage may result. • Do not attempt to bend the endoscope’s insertion section with excessive force regardless of its flexibility. The insertion section may be damaged. • Do not apply shock to the distal end of the insertion section, in particular the objective lens surface at the distal end. Visual abnormalities may result. • Do not twist or bend the bending section with your hands. Equipment damage may result. • Do not squeeze the bending section forcefully. The covering of the bending section may stretch or break and cause water leakage. • Turn the video system center ON only when the endoscope connector is connected to the light source. In particular, confirm that the video system center is OFF before connecting or disconnecting the endoscope connector. Failure to do so can result in equipment damage, including destruction of the image sensor. • The endoscope’s remote switches cannot be removed from the control section. Pressing, pulling, or twisting them with excessive force can break the switches and/or cause water leaks. • If remote switch 1 does not return to the OFF position after being pressed strongly from the side, gently pull the switch upwards to return it to the OFF position. • Do not hit or bend the electrical contacts on the endoscope connector. The connection to the light source may be impaired and faulty contact can result. • If endoscope’s suction is insufficient, select another suction system without using the endoscope and use it according to the directions given in its instruction manual. Otherwise, a proper endoscopic image may not appear on the monitor.

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CF-HQ190L/I OPERATION MANUAL

Important Information - Please Read Before Use

CAUTION • Electromagnetic interference may occur on this endoscope near equipment marked with the following symbol or other portable and mobile RF (Radio Frequency) communications equipment, such as cellular phones. If electromagnetic interference occurs, mitigation measures may be necessary, such as reorienting or relocating this endoscope, or shielding the location.

• To check the electromagnetic interference from other equipment (any equipment other than this endoscope or the components that constitute this system), the system should be observed to verify its normal operation in the configuration in which it will be used.

NOTE This endoscope contains a memory chip that stores information about the endoscope and communicates this information to the video system center CV-190.

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Important Information - Please Read Before Use

 Precaution of disappeared or frozen endoscopic image WARNING • If the endoscopic image disappears unexpectedly or the frozen image cannot be restored during an examination, immediately stop using the endoscope and withdraw it from the patient as described in Section 5.3, “Withdrawal of the endoscope with an irregularity”. Inserting or withdrawing the endoscope, using EndoTherapy accessories, performing flexibility adjustment, performing suction, feeding air, or performing angulation control under these conditions could result in patient injury, bleeding, and/or perforation. • Follow the precautions given below. Otherwise, the endoscopic image may disappear unexpectedly or the frozen image may not be restored during the examination.  Connect the endoscope connector to the light source completely by pushing the video connector until it clicks. Otherwise, a faulty contact can result.  Do not bend, hit, pull, or twist the insertion section, bending section, control section, universal cord, and endoscope connector. The endoscope may be damaged, and water leaks and/or breakage of internal parts like the cable can result.  Before connecting the endoscope connector to the light source, confirm that the endoscope connector, including the electrical contacts, is completely dry and clean. If the endoscope is used with the electrical contacts wet and/or dirty, the endoscope and light source may malfunction.  If air bubbles emerge from the endoscope continuously during the leakage test, do not use the endoscope. Water may enter the endoscope and cause a short circuit. This may result in image sensor damage.

CAUTION • Turn the video system center ON only when the endoscope connector is connected to the light source. In particular, confirm that the video system center is OFF before connecting or disconnecting the endoscope connector. Failure to do so can result in equipment damage, including destruction of the image sensor. • Do not hit or bend the electrical contacts on the endoscope connector. The connection to the light source may be impaired and faulty contact can result.

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CF-HQ190L/I OPERATION MANUAL

Important Information - Please Read Before Use

 Examples of inappropriate handling Details on clinical endoscopic technique are the responsibility of trained specialists. Patient safety in endoscopic examinations and endoscopic treatment can be ensured through appropriate handling by the physician and the medical facility. Examples of inappropriate handling are described below.

WARNING • Over-insufflating the lumen may cause patient pain, injury, bleeding, and/or perforation. • Applying suction with the distal end in prolonged contact with the mucosal surface, with higher suction pressure than required, or with prolonged suction time may cause bleeding and/or lesions. • The endoscope has not been designed for use in retroflexed observation in parts of the body. Performing retroflexed observation in a narrow lumen may make it impossible to straighten the angle of the bending section and/or withdraw the endoscope from the patient. Retroflexed observation in parts of the body should be performed only when its usefulness is determined to be greater than the risk that is posed to the patient. Also, do not operate the endoscope forcibly in retroflexed observation. • Inserting, withdrawing, and using EndoTherapy accessories without a clear endoscopic image may cause patient injury, burns, bleeding, and/or perforation. • Inserting or withdrawing the endoscope, feeding air, applying suction, or operating the bending section without a clear endoscopic image may cause patient injury, bleeding, and/or perforation. • For reasons described below, do not rely on the NBI*1 observation mode alone for primary detection of lesions or to make a decision regarding any potential diagnostic or therapeutic intervention.  NBI has not been demonstrated to increase the yield or sensitivity of finding any specific mucosal lesion, including colonic polyps or Barrett’s esophagus. *1

Narrow Band Imaging. For more details, refer to the instruction manual for the video system center CV-190.

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Important Information - Please Read Before Use

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CF-HQ190L/I OPERATION MANUAL

1.1 Checking the package contents list

Chapter 1

1.1

Checking the Package Contents Ch.1

Checking the package contents list

Match all items in the package with the components shown below. Inspect each item for damage. If the endoscope is damaged, a component is missing, or you have any questions, do not use the items; immediately contact Olympus.

 Endoscope

CF-HQ190L/I

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1.1 Checking the package contents list

 Packaged items for North America, Europe, Australasia, Middle East, and Africa

Ch.1 Single use combination cleaning brush (BW-412T, 3 pcs)

Injection tube (MH-946)

Channel plug (MH-944)

AW channel cleaning adapter (MH-948)

Suction cleaning adapter (MH-856)

ETO cap (MB-156)

Auxiliary water tube (MAJ-855)

Single use biopsy valve (MAJ-1555, 10 pcs)

Instruction manual for MAJ-1555

Instructions (leaflet type)

Operation manual

Reprocessing manual

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CF-HQ190L/I OPERATION MANUAL

1.1 Checking the package contents list

 Packaged items for countries other than North America, Europe, Australasia, Middle East, and Africa

Ch.1 Channel cleaning brush (BW-20T)

Injection tube (MH-946)

Channel plug (MH-944)

Channel-opening cleaning brush (MH-507)

AW channel cleaning adapter (MH-948)

Suction cleaning adapter (MH-856)

ETO cap (MB-156)

Biopsy valve (MB-358, 10 pcs)

Auxiliary water tube (MAJ-855)

Instructions (leaflet type)

Operation manual

Reprocessing manual

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