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COPYRIGHT 2004 Jannetti Publications, Inc.
Periodically, a look at the past helps health care professionals see how much practice has changed as well as how some concepts and practices remain similar to the original rationales and techniques. Two chapters from a 1911 textbook on cystoscopy have been reprinted that describe catheter and instrument care and preprocedure requirements for cystoscopy performed in the hospital, office, or home. Sterilization methods and instruments for cystoscopy have improved in the century since this book was written but the rationale for the procedure and concepts guiding the instrumentation have some similarity with the practices performed nearly 100 years ago. Some comments also provide a bit of comic relief. One example, "this undoubtedly shortens the life of the catheter, but it lengthens the life of the patient" appears in the discussion about catheter cleaning after use in a pus case.
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CARE OF THE INSTRUMENTS
Sterilization
Everything which is to be used in a cystoscopic examination must be absolutely sterile. Unless this can be accomplished, and unless an examination can be conducted under aseptic conditions, it should never be attempted.
All metal and rubber instruments are first thoroughly cleansed mechanically with soap and water, great care being taken to remove all traces of foreign material. Rubber catheters and hollow instruments should have water under pressure forced through their lumen, and in the case of hollow metal tubes, when the caliber is large enough, they should be mechanically cleansed with stilets carrying pled-gets of cotton.
The smaller catheter tubes which in the modern instruments are open for most of their extent may be cleansed by passing "pipe-stem cleaners" through them.
That part of the instrument which contains the lamp and lens should be treated as follows:
1. Thorough mechanical cleansing with soap and water, using a stiff brush, preferably a tooth-brush.
2. Washing off with a 5 per cent solution of carbolic acid.
3. Injection of any enclosed tubes with 5 per cent carbolic acid solution or 10 per cent formalin solution, followed by alcohol.
4. Drying of all the parts with a clean towel. If there are any enclosed tubes, these should also be dried.
5. With all the parts separated, they should be placed in a formalin sterilizer (see Figure 62), be exposed to the heated formalin vapor for two hours, and be allowed to remain in the sterilizer until used.
If it is necessary to use the instrument repeatedly without long enough interval for sterilization by formalin gas, the safest method is as follows:
1. Thorough scrubbing with soap and water, and mechanical cleansing inside and out.
2. All metal parts excepting those containing lens systems and lamp to be boiled three minutes.
3. Telescope containing lens system to be immersed...
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