ESWL (Extracorporeal Shock Wave Lithotripsy)

Q: Is there a safe limit to the number of ESWL procedures that can be done in a day?  Some facilities have an ESWL machine brought in for procedures, and the operator/driver of the machine can only work so many hours and be driving for so many hours without being considered unsafe. Are there any small facilities that have run into this dilemma? The surgeons always want to schedule as many as they can, then they take longer than expected, and it can lead to a very long day for the operator/driver.

A: We are a small facility and do up to five per day. We have not run into any issues.

A: No issues here with “over service” hours.

A: I have never had that problem and we did ESWLs one day per week and all the urologists were scheduled on that day so we did more than five.

Hardware Deposition

Q: Is it acceptable for patients to bring home hardware removed from their bodies?  If so, the hardware needs to be decontaminated, but does it need to be sterilized?

A: We send everything to pathology. If the patient desires to get the hardware, we let pathology know and we have the patient contact them. We do not give the patient anything.

A: We give patients their hardware after we wash and sterile with a quick flash cycle.

A: Patients could have it, but the doctor needs to give it to the patient.

A: Our policy is that the device must first go to pathology and then can be decontaminated. The physician must write an order requesting the device be given to the patient. This creates an evidentiary trail if anything comes of it. Since the patient paid to have the device put in, legally the device belongs to the patient. The patient must sign a waiver if the device goes to anyone else, such as the representative or someone doing research.

Central Sterile Processing

Q: I have just added Central Sterile Processing to my group to develop an orientation and competency program. Does anyone have Central Sterile Processing material they can share?

A: No, but that’s something that would be very valuable to share!

A: I am in the process or re-doing ours so I would be very interested in others’ input as well.

A: I would also be interested in any orientation and competency information anyone can share.

A: AAMI is a great place to start.