OLYMPUS
EVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE
EVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE Instructions
178 Pages
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INSTRUCTIONS
EVIS EXERA II ULTRASONIC BRONCHOFIBERVIDEOSCOPE
OLYMPUS BF TYPE UC180F
CAUTION : Balloons Used with This Product Contain Natural Rubber Latex, Which May Cause Allergic Reactions.
Contents
Contents Symbols...
1
Important Information - Please Read Before Use...
3
Intended use ...
3
Applicability of endoscopy and endoscopic treatment ...
3
Instruction manual...
4
User qualifications ...
4
Instrument compatibility ...
5
Reprocessing before the first use/reprocessing and storage after use ...
5
Spare equipment ...
5
Maintenance management...
6
Prohibition of improper repair and modification ...
6
Signal words ...
6
Warnings and cautions...
7
Examples of inappropriate handling...
12
Chapter 1
Checking the Package Contents...
13
1.1
Standard components...
13
1.2
Ultrasonic cable ...
14
1.3
Optional Components ...
15
Instrument Nomenclature and Specifications ...
16
2.1
Nomenclature...
16
2.2
Endoscope functions...
18
2.3
Specifications...
19
2.4
Attaching the cap chain (MAJ-1723)...
23
Preparation and Inspection ...
27
3.1
Preparation of the equipment...
28
3.2
Inspection of the endoscope ...
29
3.3
Preparation and inspection of accessories ...
33
3.4
Attaching accessories to the endoscope ...
39
3.5
Inspection and connection of ancillary equipment ...
43
3.6
Inspection of the endoscopic system ...
51
3.7
Preparation and inspection of the balloon...
56
Operation ...
63
4.1
Insertion ...
65
4.2
Observation of the ultrasonic image ...
70
Chapter 2
Chapter 3
Chapter 4
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Contents
4.3
Using EndoTherapy accessories ...
71
4.4
Withdrawal of the endoscope...
74
4.5
Removal of the balloon ...
75
4.6
Transportation of the endoscope ...
77
Reprocessing: General Policy...
79
5.1
Instructions...
79
5.2
Importance of cleaning, disinfection, and sterilization...
79
5.3
Precautions ...
80
Chapter 5
Chapter 6
Compatible Reprocessing Methods and Chemical Agents ...83
6.1
Compatibility summary...
83
6.2
Water (for reprocessing) ...
85
6.3
Detergent solution ...
85
6.4
Disinfectant solution ...
86
6.5
Rinsing water ...
86
6.6
Ethylene oxide gas sterilization...
86
6.7
Steam sterilization (autoclaving) of accessories ...
89
Chapter 7
Cleaning, Disinfection, and Sterilization Procedures 91
7.1
Required reprocessing equipment ...
92
7.2
Cleaning, disinfection, and sterilization procedures ...
97
7.3
Precleaning ...
98
7.4
Leakage testing...
103
7.5
Manual cleaning ...
109
7.6
High-level disinfection ...
119
7.7
Rinsing after high-level disinfection...
122
7.8
Sterilization ...
125
7.9
Cleaning, disinfection, and sterilization procedures for reusable parts and cleaning equipment ... 126
7.10 Care of the ultrasonic cable (MAJ-1597, MAJ-1722) ...
135
Chapter 8
Cleaning and Disinfection Equipment ... 137
Chapter 9
Storage and Disposal ... 139
9.1
Storage of the endoscope ...
139
9.2
Storage of reusable parts and reprocessing equipment ...
140
9.3
Storage of ultrasonic cable ...
140
9.4
Disposal ...
140
Chapter 10 Troubleshooting ... 141 10.1 Troubleshooting guide ...
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
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Contents
10.2 Withdrawal of the endoscope with an abnormality...
145
10.3 Returning the endoscope for repair ...
146
Appendix ... 147 System chart ...
147
Inspection of the endoscope after cleaning, disinfection or sterilization in accordance with IEC 60601-2-37...
151
EMC information ...
153
Acoustic output table...
159
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Contents
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Symbols
Symbols The meaning(s) of the symbol(s) shown on the package, the back cover of this instruction manual and/or this instrument are as follows: Refer to instructions. Caution
TYPE BF applied part
Serial number IPX7
Ingress protection rating (except for connectors) Ultrasonic endoscope
Single use only
Do not resterilize
Use by (expiration date)
Sterilized using ethylene oxide
Sterilization lot number
Lot number
Keep away from sunlight
Keep dry
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Symbols
Do not use if package is damaged
Contains or Presence of Natural Rubber Latex
Lock the ultrasonic cable connector
Release the ultrasonic cable connector
Manufacturer
Authorized representative in the European Community
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Important Information - Please Read Before Use
Important Information - Please Read Before Use Intended use This instrument has been designed to be used with an Olympus compact endoscopic ultrasound center or an Olympus universal endoscopic ultrasound center or a diagnostic ultrasound system (Hitachi, Ltd or FUJIFILM Healthcare Corporation.), video system center, light source, documentation equipment, monitor, EndoTherapy accessories and other ancillary equipment. This instrument is designed for endoscopic real-time ultrasonic imaging, ultrasound guided needle aspiration and other endoscopic procedures within the airways, trancheobronchial tree, esophagus and surrounding organs. Do not use this instrument for any purpose other than its intended use.
Applicability of endoscopy and endoscopic treatment If there is an official standard on the applicability of endoscopy and endoscopic treatment that is defined by the hospital’s administration or other official institutions such as academic societies on endoscopy, follow that standard. Before starting endoscopy and endoscopic treatment, thoroughly evaluate its properties, purposes, effects, and possible risk (their natures, 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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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. 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 Elastography: Mode for displaying the relative elasticity information of a tissue using color images. For more details, refer to the instruction manual for the ultrasound instrument for which elastography is available.
User qualifications If there is an official standard on user qualifications to perform endoscopy and endoscopic treatment that is defined by the medical administration or other official institutions such as academic societies on endoscopy or pulmonology, follow that standard. If there is no official qualification standard, 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 by following guidelines set by academic societies on endoscopy, etc., and considering the difficulty of endoscopy and endoscopic treatment.
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Important Information - Please Read Before Use
Instrument compatibility Refer to the “System chart” in the Appendix to confirm that this instrument is compatible with the ancillary equipment being used. Using incompatible equipment can result in patient injury and/or equipment damage. This instrument complies with the EMC standard for medical electrical equipment, edition 4 (IEC 60601-1-2: 2014). When connecting to an instrument that complies with a previous edition of the EMC standard for medical electrical equipment edition, the EMC characteristics could be vulnerable.
Reprocessing before the first use/reprocessing and storage after use This instrument was not cleaned, disinfected, or sterilized before shipment. Before using this instrument for the first time, reprocess it according to the instructions given in Chapter 7, “Cleaning, Disinfection, and Sterilization Procedures”. After using this instrument, reprocess and store it according to the instructions given in Chapters 5, “Reprocessing: General Policy” through 9, “Storage and Disposal”. Improper and/or incomplete reprocessing or storage can present an infection-control risk, cause equipment damage or reduce performance. The balloons are disposable, and are intended for a single use only; a new one must be used for each patient. Do not attempt to reuse or resterilize a balloon.
Spare equipment Be sure to prepare another endoscope to avoid an interruption of the examination due to equipment failure or malfunction.
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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 a observed irregularity should not be used, but should be inspected by following Section 10.1, “Troubleshooting guide” on page 142. If the irregularity is still suspected 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 can 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:
Indicates a potentially hazardous situation which, if not avoided, could result in death or serious injury.
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.
Indicates additional helpful information.
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Important Information - Please Read Before Use
Warnings and cautions Follow the warnings and cautions given below when handling this instrument. This information is to be supplemented by the warnings and cautions given in each chapter.
•
This endoscope has a “forward oblique” view. There is a difference between the direction of view and the insertion direction of the endoscope. The insertion direction appears in the lower portion of the endoscopic view, and the visible area in that direction is limited. Always view the endoscopic image carefully, and insert the endoscope prudently. Otherwise, patient injury may occur.
•
Never perform angulation control, perform suction, insert or withdraw the endoscope’s insertion tube without viewing the endoscopic image. Patient injury can result.
•
Do not touch the light guide of the endoscope connector immediately after removing it from the light source because it is extremely hot. Operator or patient injury can result.
•
Before each use or after a change of viewing modes/settings, check to ensure the view observed through the endoscope provides a live image (rather than a stored one) and has the correct image orientation. Otherwise, patient injury, bleeding, and/or perforation could result.
•
Regardless of the flexibility of the endoscope’s insertion tube, do not attempt to bend it with excessive force. Otherwise, patient injury could result.
•
This endoscope is not intended for fetal use.
•
Clean and disinfect or sterilize the endoscope as described in Chapter 5 through 8 of this manual, before use.
•
Never perform high-suction continuously. Patient injury can result.
•
Never tie the elastic opening of both sides of the balloon with a thread. This may cause the balloon to rupture or come off the distal end of the endoscope when inflating it excessively. This can result in patient injury.
•
Never inflate the balloon to a diameter of more than 20 mm when using the endoscope in the trachea. This could result in suffocation of the patient.
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Important Information - Please Read Before Use
•
Never withdraw the endoscope while the balloon is still inflated. Otherwise, the balloon may burst or come off the distal end of the endoscope. If the balloon cannot be deflated, insert the channel cleaning brush (BW-7B) into the irrigation port. Using slow, short strokes, carefully feed the brush to remove debris.
•
When withdrawing the endoscope, make sure that the balloon is completely deflated, using the ultrasonic image and endoscopic field of view. Withdrawing the endoscope while the balloon is inflated could result in patient injury.
•
The shape and size of the nasal cavity and its suitability for transnasal insertion may vary from patient to patient. No endoscope, including this one, can always be inserted transnasally into all patients. Before proceeding, always be sure to confirm that transnasal insertion is possible with the patient. Otherwise, patient injury can result or the endoscope could become lodged and be difficult to withdraw.
•
Transnasal insertion is accompanied by the risk of inflammation of the nasal cavity. If this happens, the nasal passage will be constricted, making it more difficult to withdraw the endoscope. In this case, do not use force to withdraw the endoscope because patient injury such as bleeding or perforation may result.
•
Elastography*1 uses the pulsation of a living body. Intentional pressurization is not necessary. Compression onto the tissue by operating the bending section, inserting or withdrawing the endoscope may cause tissue damage, bleeding or perforation. ∗1 Elastography is not available with the diagnostic ultrasound system (Hitachi, Ltd or FUJIFILM Healthcare Corporation.) in Canada.
•
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Transnasal insertion is accompanied by the risk of bleeding in the nasal cavity. Be sure to be prepared to deal with any bleeding. When withdrawing the endoscope, observe the inside of the nasal cavity to ensure that there is no bleeding. Even when the endoscope has been withdrawn without bleeding, do not allow the patient to blow his or her nose strongly because this could cause it to start bleeding.
ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Important Information - Please Read Before Use
•
Before transnasal insertion, apply the appropriate pretreatment and lubrication to the patient to enlarge the nasal cavity. Otherwise, patient injury can result or the endoscope could become lodged and be difficult to withdraw. Otherwise, the treatment will have no effect. The effects of the pretreatment agent and lubricant will decrease the longer the procedure lasts. Apply the pretreatment agent or lubricant as required during the procedure – for example, when withdrawal seems to be difficult.
•
Transnasal insertion of the endoscope should be performed carefully. If resistance to insertion is felt, or the patient reports pain, stop insertion immediately. Otherwise, operator and/or patient injury can result or the endoscope could become lodged and be difficult to withdraw.
•
If it becomes impossible to withdraw the transnasally inserted endoscope, detach the ultrasonic cable from the ultrasonic cable connector, pull its distal end out of the mouth, cut the flexible tube using wire cutters and, after ensuring that the cut section will not injure the body cavity or nasal cavity of the patient, withdraw the endoscope carefully. Therefore, always prepare wire cutters in advance.
•
If any irregularity in the ultrasound image is observed, turn the ultrasound center OFF immediately. Continued ultrasound radiation will cause the distal end to become hot and could cause operator and/or patient burns.
•
Be sure that this instrument is not used adjacent to or stacked with other equipment (other than the components of this instrument or system) to avoid electromagnetic interference.
•
Electromagnetic interference may occur on this instrument 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 instrument, or shielding the location.
ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
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Important Information - Please Read Before Use
10
•
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 not be visible.
•
Do not coil the insertion tube, universal cord or ultrasonic cable into a diameter of less than 12 cm. Equipment damage can result and/or the ultrasonic image will be abnormal.
•
Do not apply shock to the distal end of the insertion tube, particularly the ultrasonic transducer and 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 leaks.
•
The cover of the irrigation port part cannot be removed. Equipment damage can result.
•
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.
•
Do not attempt to bend the endoscope’s insertion tube with excessive force. Otherwise, the insertion tube may be damaged.
•
Do not touch the electrical contacts in the ultrasonic cable connector. Equipment damage can result.
•
Do not pull, twist or tightly coil the ultrasonic cable. Noise can develop in the ultrasonic image.
•
To prevent unnecessary patient exposure to ultrasonic radiation, follow the “as-low-as-reasonably achievable” (ALARA) principle when using Olympus ultrasonic equipment. Freeze the image whenever you are not actively viewing the “live” ultrasonic image. When the equipment is in the FREEZE mode, no ultrasonic energy is emitted.
ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Important Information - Please Read Before Use
•
It is highly desirable that a backup ultrasonic cable be available to continue clinical procedures in case of a malfunction.
•
This endoscope contains a memory chip that stores information about the endoscope and communicates this information to the video system center CV-160 and CV-180.
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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 given below. •
Using improperly or incompletely reprocessed or stored instruments may cause patient cross-contamination and infection.
•
Applying prolonged suction with the distal end in contact with the mucosal surface with higher suction pressure than required or with prolonged suction time may cause bleeding or suction lesions.
•
The endoscope has not been designed for use in retroflexed observation. 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. In case the patient moves due to coughing and other reasons while the endoscope is angulated in the narrow lumen, the bending section of the endoscope may be pushed into the lumen and be retroflexed. Pretreatment to control patient’s coughing reflex and other possible unexpected moves is the responsibility of trained specialists. Retroflexed observation should be performed only when the usefulness of doing so is determined to be greater than the risk that is posed to the patient.
•
Inserting, withdrawing and using EndoTherapy accessories without a clear endoscopic image may cause patient injury.
•
Patient injury may be caused by: − inserting or withdrawing the endoscope or applying suction without a clear endoscopic image − forcefully pulling or rotating the angulated bending section
Natural rubber latex medical alert Balloons used with this instrument contain natural rubber latex that may cause allergic reactions in some patients. Do not use this instrument on a latex-sensitive patient.
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Chapter 1 Checking the Package Contents
Chapter 1 Checking the Package Contents 1.1
Standard components Match all items in the package with the components shown below. Inspect each item for damage. If the instrument is damaged, a component is missing or you have any questions, do not use the instrument; immediately contact Olympus. This instrument was not disinfected or sterilized before shipment. Before using this instrument for the first time, reprocess it according to the instructions given in Chapter 7, “Cleaning, Disinfection, and Sterilization Procedures”.
Endoscope
Water-resistant cap (MH-553, 2 pcs)
Single-use adapter biopsy valve (MAJ-1414, 10 pcs, sterile)
Channel-opening cleaning brush (MH-507)
Suction cleaning adapter (MAJ-222)
Channel cleaning brush (BW-7B, 2 pieces∗1) or single use single-ended cleaning brush (BW-400B, 3 pcs∗1)
Channel cleaning brush (BW-15B)
Balloon (MAJ-1351, 20 pieces, sterile)
Cap chain (MAJ-1723)
Single-use suction valve (MAJ-209, 20 pcs, sterile) or suction valve (MAJ-207, 10 pcs)
Balloon applicator (MAJ-1352)
Instruction manual
∗1 These products may not be available in some areas. ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
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Chapter 1 Checking the Package Contents
1.2
Ultrasonic cable The ultrasonic cable (MAJ-1722, MAJ-1597, optional) is necessary to use this endoscope (BF-UC180F) and may be purchased from Olympus.
For the Olympus compact endoscopic ultrasound center
Endoscope-side connector Ultrasonic connector
Ultrasonic cable (MAJ-1722)
For the diagnostic ultrasound system (Hitachi, ltd or FUJIFILM Healthcare Corporation.) and the Olympus universal endoscopic ultrasound center
Endoscope-side connector
Ultrasonic connector Ultrasonic cable (MAJ-1597)
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ULTRASONIC BRONCHOFIBERVIDEOSCOPE BF-UC180F
Chapter 1 Checking the Package Contents
1.3
Optional Components The items listed below are optional, and can be purchased from Olympus.
Biopsy valve For Europe
Single-use biopsy valve (MAJ-210)
For countries other than Europe
Cap
Main body Biopsy valve (MD-495)
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