EBME Forums Forums Management Medical Equipment Management Philips TOE probes

After searching the Philips manual, contacting Tristel, i am still none the wiser about how to decontaminate his item.
The manual says that the probe should not be submerged, which means that AER is out of the question.
However this is a critical peice of equipment which comes into contct with mucous membranes and so requires high level disinfecting....namely AER sterilisation.
At present we do what is recommended, we use the sheaths, and then the tristel wipes between patients.
Have any of you any experience of this?
Can any one shed any light or know someone who might know the answer.
I am worried to death about this.
Also, apart from the visual inspection, how do you check that the probe is intact with no areas of degeneration or rips?
Thanks in advance,
Quinny

Hi Quinny,

I work for a competitor to Philips as a Service Engineer on Ultrasound equipment. Although i cannot advise whether the following would be recommended by Philips it is a general "rule of thumb" for such devices. Alot of my customers use such cleaning agents as Virkon which is similar to Tristal for alot of their Transvaginal and Transrectal probes. If i were you i would contact Philips Service and ask what they would advise to clean their TOE Probes over the phone. I have a customer who uses several TOE type probes and sends theirs away after each use to an independent sterilising company in Edinburgh, if you wish i can find out further details for you on this. My company supply an insulation resistance meter with each TOE type probe sold, which we advise to test before each use. We have had a few failures over the years, so safety testing of the insulation is imperative. If you don't get such meters supplied by Philips i would advise safety testing the probes on the machine regularly. If you require further details on this proceedure please let me know.

Quinny,
Some scope washers have additional TOE facilities. It is only the plug and controls that should not be immerced in fluid. These have a compartment where these parts are stored while the patient part of the probe is washed and disinfected.
To electrical safety test it, consider it as an applied part when connect to the machine. In the past I have used a tube of saline to make electrical contact with it. Theen perform a normal safety test with which ever tester you have. It is easier to test it as part of the system than as a stand alone object - you would not test ECG leads on their own.
Obviously part of any electrical safety test is a visual inspection for damage.
In my experience they fail safety tests unless they have the "condom" on and as this is the recomended normal operating condition there is nothing wrong with this.
Regards
Robert

Our Echo staff have a disinfecting bath. As Robert says, the probe area can be immersed, but not the controls or cable etc. As for electrical safety test, there is a section in the Sonos manual that describes the test setup. Essentially the test invloves dipping the probe into 1% saline and measuring the leakage current via a return electrode also dipped in the saline solution. The leakage current is compared to the earth leakage current. The transducer leakage current should be less than 80% of the earth leakage current.

Quinny Hi,

I agree that the current range of documentation in this area is not good at telling you waht you should do.

We here have been using TOE for a number of years. To start with things where fine. For addressing all of the issues you ask above we used a device supplied by HP but made by a German company Schuster, this device was designed for the cleaning disinfecting and electrical testing of TOE probes. This was a wonderful bit of kit that used a cidex based cleaning agent and all that you had to do was keep the cleaning and wash tanks topped up and empty the waste tank once a day or every few days depending on your usage figure.

However when HP pulled out of the medical market and sold everything to Philips was when the the problems began. Suffice it to say that support for this device (which was - granted - from to time very lady like in operation) become more and more difficult - If my memory serves me right the device from Schuster was good at its job but not a big seller I think the the most every in the UK was 4 or 5. So that in the end despite everyones best efforts it had to go to the great disposal land in the sky.

At that point we tried a number of differing systems to effect cleaning and disinfection here - as Robert says it is the control handle and connector etc that you must not immerse, the distal tip and sheath are fine - however we began to notice a high rate of damage to the distal tip with alternative machines and this combined with other damage to the probe length caused we think by poor design of the disinfectors loading baskets moved us away to a manual process. This process uses Tristel wipes and if you want the in and outs of what we do - which I stress has not shown any problems or infection issues then mail me and I'll let you have the contact deatils for our CSSD wizard.

As to EST for these device The ultimate referance is the method explained by Bill. However we here also use the fluke biomedical TOE probe testing kit which provides a quick and effective indication of the electrical condition of the probe. This method is very popular in the States and where Uncle Sam goes so we follow. A quick call to Tony at Ultramedic should get him over to give you a demo. We use this method which I stress at least 1 supplier belives should be done by the end user - on a 6 monthly basis and once very couple of years or so we do the full job as Bill does this - in addition we would also do the full job if we had any major doubts. This approach works well for us. The other thing we use in TOE prob testing is a high powered magnifier so we can check for any sheath damage and a plished perspex block thatwe can use to check that all transducer elements are there.

Hope this helps.

I would offer the following in relation to TOE decontamination.

Recently (last week) had a demo of the Scope-Vault product from 'Neocare.'
We, like others, have some issues to resolve around decontamination of these devices and our AP steered us towards this one option from the above company.
Our demo went well and the device is CE marked (certificated etc) so it's looking hopeful.
A web search should bring up the contact details of the company but any issues, let me know and i will post (assuming that's ok)

By the way i have no affiliation to the company, just looking at their offered solution currently !

cheers
Steve

Thanks guys,
BUT unfortunately this brings me more headaches and many more questions for you all!
Firstly, i am a nurse not a biomed so "electrically testing" goes whoosh right over my head.
BUT, am i right in surmising that:
1) It is safe to submerge the distal end and the sheath (in a company recommended detergent) and to do this there are "bath" type facilities available? (you have given me some great contacts for these, many thanks, i shall enquire asap)
2) the probe should be electrically tested every 6 months or so. (A piece of kit directly adjacent to the myocardium needs to be safe...yes!)
3) The electrical test should take place with the whole shebang. So is this part of the service or should our EBME guys be doing this?
4)There is no definitive way of assessing the integrity of the sheath unless using a high powered magnifying instrument between patients?
5) can any one elaborate on what a "installation resistance meter" is please, is it similar to the leak tester that we use on our bronch?
and finally, The service contract on the TOE is £12k (!!!!!)
Can any one tell me what we will get for our £12k?
What do you get when your machines are serviced?
Once again, many many thanks for your replies, this has defo helped me loads.
Kind regards,
Quinny

Steve, ive just done a google search of neocare and i am just getting loads of babycare type products. Do you have a web page link that i could access please?

Here it is:-
www.neocare.org.uk (Steve Ladley is the contact)

I would have tried it myself............. but guess what..... the site is being blocked by the Trust websense filter !

Steve

Quinny,

Lets see if we can answer some of your questions.

Point 1 - depending on your cleaning solution - yes, but I suggest you mail me and I'll let you have the contact details for our CSSD wizz who can give you some spot on advice

Point 2 - yes for the reasions you suggest

Point 3 - yes and no - you can test the probe away from the scanner if you want and some suppliers are quite happy for someone such as yourself to do that - ideally no less than once every couple of years or so the whole shebang should be tested using the methods other respondants have suggested. In a perfect world your supplier should do this as part of their PPM routine - the same as they should do other things like image resolution, transmission power and so on, but I bet they don't. Yes your EBME guys can do this for you no problem.

Point 4 - There are really only two ways to check one is by a simple electrical test the early part of para 3 above (this can also help with your point 4) and the second which we have found is actually quicker and easier is by eyesight and touch. Running your fingers along the whole of the probe sheath from the distal tip to the control handle you should be able to feel for any abnormailities like nicks or bite marks or damage due to dragging over the mouth guard usually when the probe is being withdrawn from the patient. For needle type holes which do occur then a magnifier is excellent. There is a 3rd which I have seen done but won't explain too much as it needs a couple of screwdrivers to dismantle the control handle, a soft air line and a bowl of water the effect is like checking a bike tyre for punctures - PLEASE don't as they say try this at home unless you know exactly what you are doing, suffice it to say that we don't do this!

Point 5 - The analogy in the terms of a TOE probe is a good one. Combined with a saline bath such a meter would check the abilities of the sheath to resist electrical current flow, i.e. leakage - when you test a bronch you do the same except it is the probes ability to hold air prssue that is being checked.

The 12K payment is I assume just for the TOE probe alone not the complete system and more than likely as part of some shared risk contract? Shared risks means that if the probe needs replacing then you don't pay the full repalcement price. If so then this is quite resonable as I have paid much more than that in the past! You can get better quotes / deals by shifting to 3rd party provision. I'll leave it to others to answer the question what you get when your machines are serviced as I have no desire to open that can of worms.

If you want any more detail then feel free to mail me.