EJECTION BIOPSY FORCEPS

Abstract

Purpose: Unnecessary exposure to sharps must be avoided at all costs. Instruments for IV catheter introduction and other medical devices have been designed accordingly in order to protect the staff from transmission of infection due to needle-sticks. When an endoscopic biopsy is performed, it is often necessary for the assistant to use a sharp in order to extricate the specimen. Biopsies obtained to rule out H. Pylori are placed on a slide for testing at the bedside, and to that end sharps are used even more often. In some centers needles have been replaced by toothpicks, providing but a crude solution. The problem was brought to our attention when one of the nurses at our institution was injured by a needle while trying to extricate a specimen of an AIDS/HCV patient. Shortly thereafter, Lindsay Sattler, ex-president of the SGNA related a similar experience in an article published in the SGNA Journal. Methods: These events prompted the creation of two types of ejection biopsy forceps with and without spike, invented and designed by Naomi Nakao and manufactured by MedSource Technologies. The non-spike ejector is designed whereby the tissue sample ejecting means comprises a small prong extension on the cup hinge. Located outside of, and displaced from the cups while they are closed to sever the tissue sample, the prongs pivotally move to pass through openings in the central section in the cups to contact and dislodge the specimen when the cups are moved to a fully opened position. The sample ejecting mechanism is remotely activated by control means in the handle assembly. The spike ejector comprises a movable needle attached to a wire linking member and thereby to a control handle located at the proximal end of the forceps. As the wire is withdrawn proximally, the needle is likewise withdrawn to bring the specimen/s into contact with the contacting surface, thereby causing specimen ejection. Results: We compared our devices to the Olympus forceps during 35 procedures and a total of 50 biopsies and have found specimen size, maneuverability and function to be comparable. While the Olympus forceps required 3–5 shakes in the preservative, the use of a sharp in 11% of the non-spike forceps, and 38% of the spiked forceps, our devices required 1–2 shakes, and no need for sharps to extricate the specimen. Conclusions: A biopsy forceps designed to avoid the use of sharps should be a requirement to the manufacturers of these devices. Our designs addressing this requirement are simple, functional, do not add cost to manufacturing, and have proved efficacious.