1. Section Editor(s): Huber, Deb A. MSN, RN, ARNP, CGRN

Article Content

As I was reviewing the Society of Gastroenterology Nurses and Associates (SGNA) discussion forum, I came across several discussions of reusable items versus disposable items. Several different items were mentioned in the forum, ranging from disposable versus reusable biopsy forceps to single-use items, to items not labeled as single use but for which there were questions regarding whether they should be reused or not. These are frustrating times for many endoscopy units. Cutting costs seems to be an important element to all. Managers are asked to do this by doing more procedures with fewer staff positions. Equipment and repair costs seem to continue to mount. We all try to cut corners but still provide safe and quality care to our patients. I would like to review a few of the topics from the forum in this column.


Initial Cost

There is always a debate about disposable versus reusable biopsy forceps. Initial costs need to be considered. How many times can a forceps be used before it is no longer sharp or badly bent? Do you have certain physicians who are notorious for forcing forceps down scopes and potentially damaging the forceps or the scope? Do you think many of your scope repairs are secondary to channel damage from bad forceps? Are there concerns regarding cleaning and disinfection? Is your staff large enough or knowledgeable enough to properly clean and maintain these accessories? There seems to be a lot of questions, but who has the answers for your situation?


Reimbursement Issues

When there is an endoscopy procedure performed, many pieces of equipment are used. Each comes with a price tag and a concern for safety and reliability. Does the patient pay for each item individually, or are these combined as an endoscopy unit fee? Some of the items in the discussion forum discussed tubing, such as nasal cannula extension tubing and suction tubing. Other items included such things as suction canisters or liners. I'm aware the discussion forum does not reflect an equal representation of all members; however, on these topics, the numbers of members on both sides seemed fairly equal in responses regard discarding or reusing.


Potential for Infection

The respondents often noted no problems with infections. However, keep in mind that once those patients (primarily the outpatients) are discharged from your unit, how do you know what infections they acquire unless it can be directly traced back to you (not an easy process)? It is thought that because suction tubing is pulling potentially infected organisms away from the patient to the canister, such tubing cannot infect another. With the same theory, the oxygen cannula is propelling fresh oxygen through the cannula toward the infected patient. Is it possible for microorganisms to pass through the extension tubing?


What are the thoughts about the suction canister? Can microorganisms get out of a canister or not? Many argue that it simply looks bad and have offered suggestions to camouflage it. Again, has the patient paid for this article, or is it a unit charge? What if you must "fish for polyps" after polypectomy and unsuccessful retrieval? Do you assume all pieces of tissue belong to the current patient who is in the room or is there a possibility some tissue may belong to another?


Single-Use Items

What about items labeled "single use"? According to the SGNA position statement regarding reprocessing of endoscopic accessories (adopted May 2002), critical items labeled for single use should not be reprocessed or reused. However, there are many practitioners who are reusing these items. Some will clean and maintain them themselves, whereas others will send them to a third party reprocessing company. How do you decide when it is no longer safe to use these items? How do you validate the cleaning process because there are no manufacturer recommendations for cleaning these items? Who has paid for the cost of the forceps? Is it initially incurred by the first person to use the piece of equipment, with the next patients not incurring a charge; or is each subsequent patient receiving a full charge? Or is the cost divided among the number of patients expected to use it?


Need for Evidence

I am not trying to convey a right or wrong answer to these questions. As I review the discussion forum, I realize there are many unanswered questions plaguing our profession with regard to these topics. As Cuba Gooding Jr. said to Tom Cruise in the film Jerry McGuire, "Show me the money," I say to you, "Show me the research." SGNA is striving to be a forerunner in gastrointestinal nursing by using evidence-based practice. SGNA continues to support research, so please consider some of these topics as a basis for a research project, especially if these problems are affecting your practice setting. I really appreciate the people in the discussion forum who identify themselves and often their working setting. It's harder to ask questions or refute claims that are made by someone listed as anonymous.


When something goes wrong, the courts look at the current standards of practice to compare your practice to a similar practice to help determine wrongdoing. It is up to you to keep abreast of current changes and ideas in the field and studies being undertaken. If there is a question, try to validate your information and not simply take the word of another. You may have asked your child in the past when he has done something wrong, "Why did you do that?" When he said to you, "Tommy did it," does that make it right for your child? Probably not, unless Tommy is a known expert in that area!!


As I reviewed the discussion forum on these topics, I was filled with more questions than answers. The most frequent concerns regarding these topics included cost containment (including staff to clean and reprocess equipment), infection control, safety, and convenience.


Ask yourself: "When it is time for my endoscopy procedure, do I feel good about the way these things are handled in the unit I am going to use?" When you get your bill for those services, are you going to be upset by the charges that your insurance (with your mounting premiums) had to pay, or will you feel it is money well spent? The answers to these questions are important for you and your patients.