Flexible endoscopes are fragile, complicated and expensive - they cost upwards of $20,000, and more serious repairs can run you $5,000 to $10,000. How you handle, reprocess and inspect your scope can mean several years added to or subtracted from the life of your flexible endoscope.

"The life of an endoscope is very variable," says David Barlow, PhD, the director of technology assessment for Olympus America, Inc., in Melville, N.Y. "If endoscopes are carefully maintained, they can be in use well over 10 years. On the other hand, facilities that have a high turnover in personnel, centers which inadequately train their staff, and high-volume teaching centers where physicians are just learning how to use endoscopy equipment may find their instruments require a major repair every few years."

We talked to experts from scope manufacturers and repair firms to find out what you can do to avoid costly repairs while extending the life of your endoscope. Here are the 11 most common - and preventable - mistakes healthcare workers make:

Using too much enzymatic solution.
This is a case where more is not necessarily better, says Brian Newton, the president of the Scope Exchange in Greensboro, N.C. Not properly diluting your enzymatic solution for cleaning makes it difficult to wash the solution off before the endoscope is put in the automatic endoscope reprocessor (AER). In addition, enzymatic cleaners are harsh - that's why they should be diluted - and can wear down parts of the scope.

Not attaching the soaking cap.
Place the water-resistant cap over the video connector before the en-doscope is submerged in liquid.

"Fluid [in the scope] could be from not putting on a soaking cap," says Keith Nelson, the director of technical services for Pentax. "It's most likely not putting the soaking cap on [that allows fluid invasion]."

Once fluid finds an opening, you've set yourself up for scope trouble.

"Preventing fluid is the most important care precaution for flexible endoscopes," says Bernie DeLacy, the operations manager for Total Scope in Boothwyn, Pa. "Fluid can go wherever it wants once it's inside of the scope."

Fluid can damage a scope's light fibers, video chip and angulation system, cause corrosion and impede flexibility.

Not letting the scope cool properly.
After running the scope through your AER, it is important to not handle the scope; allow it time to cool, since the scope is in a "soft" state and susceptible to damage.

"The scope needs to cool about five to seven minutes [after it's been through your disinfection unit]," says Mr. Nelson. "Handling it could add to separation [between the bending rubber and mesh]."

In addition, says Mr. DeLacy, "In they drying cabinet, it gets up to 115 degrees, and as the fluid gets dried out of the scope, the fiber optic bundle can get brittle. Any physical trauma to scope at this point could be rough on the fiber bundle."

Squeezing too tightly when wiping.
Be gentle when you wipe down the insertion tube.

"You don't want to squeeze too tight when wiping down the scope, especially the bending section," says Mr. Nelson. "It could bunch."

Bunching the bending rubber can cause creases, small tears or holes; bunching the insertion tube can cause kinks or holes in the biopsy/suction/air/water channels or buckling, dents or peeling in the insertion tube.

Brushing the channels too roughly.
Some endoscope-cleaning brushes have ball tips; others can have sharper tips - be especially careful to inspect the distal end of the cleaning brush, especially reusable brushes.

"Too often channels become scratched or grooved by rough brushing," says Mr. Newton. These can lead to premature wear in the in the scope's channels and suction cylinder.

Mr. Newton recommends disposable brushes with soft bristles and a bristle diameter of 5mm (large-diameter scopes) or 3mm (small-diameter scopes). Short strokes should be used to gradually introduce the brush to your scope's channels, instead of simply "cramming the brush through the channels." If you feel significant resistance, proceed from the other direction to remove debris, but don't force a brush through a blocked channel: that could cause more damage. If you can't easily pass the brush through the channels, send the scope out for repair.

Not carefully clearing work channel.
Steadily pull instrumentation back through the work/biopsy channel so the end of the biopsy forceps, for example, does not hit the channel's lumen.

"Needle irrigators and forceps are sharp and can damage internal channels," says Charlie Neff of Fujinon. "They could cause a perforated channel inside the scope. ' It could be months between the cause and the true effect [major fluid damage]."

9 Steps to Endoscope Cleaning We asked Brian Newton, the president of the Scope Exchange in Greensboro, N.C., for his keys to thorough and proper reprocessing of flexible endoscopes. Preclean in the procedure room, if possible. Suction up some enzymatic cleaner into the endoscope. You should do it within 10 minutes of finishing a procedure to prevent bio-buildup in the nozzle and channels. Alternate suctioning solution and air to remove debris. Test for leaks. You can't get a true leak test unless you remove trapped air from the channels and make sure the valves of the scope are removed. Also make sure the basin you're doing the leak test in is big enough that the scope is not coiled too tightly. If you do find a leak, discontinue with reprocessing and send the instrument out for repair. Get the air out. When you remove the scope from the leak tester, let all the air escape from the scope. Trapped air can inflate your bending rubber, causing stretching and premature wear. Brush the channels. Clean the channels with disposable brushes, which seem to cause the least damage. Use short strokes. Clean the channels. Suction enzymatic cleaner through the channels. Note: Don't increase the concentration of enzymatic solution over what the manufacturer recommends. It's tough to wash off, and you don't want excess enzymatic solution combining with disinfection or sterilization solution. Wash. Thoroughly wash all enzymatic cleaner from the scope. Use a separate basin full of fresh water or drain the sink completely and refill with fresh water. Disinfect or sterilize. Properly seal the cap on the endoscope and properly align the EtO port groove and pin. Your endoscope may leak test negative, but if they are not in alignment, you may unknowingly flood your scope. Run the scope through your AER. Check the cap. When the disinfection cycle is complete, remove the cap and look for fluid inside the cap. If you see fluid on the interior of the cap, it's possible that there's fluid invasion. If this is the case, you may need to send the cap and the scope out for repair. Flush with alcohol, dry and hang. If your disinfecting unit doesn't provide an alcohol flush, do one, and make sure the scope is dry before hanging it up. Store in a well-designed cabinet. Make sure scopes (especially small-diameter scopes) are dry inside and out before they are placed on travel or emergency carts. - Stephanie Wasek

Storing/transporting the scope carelessly.
At all costs, avoid banging or dropping the distal tip of the endoscope; when this happens, the video chip can be damaged, cracks may occur in the lens or the bending rubber may be punctured.

"The bending rubber is often damaged by contact with the control handle, which has a lot of sharp edges," says Les Faucher, an endoscopy technical specialist for IMS in Acworth, Ga. "Or sometimes the scope gets wadded up."

Mr. Newton recommends transporting your scope in a tray or on a table (preferably covered) by itself.

Even if the scope makes it to the cleaning room unscathed, it may be damaged in storage, says Mr. Nelson. Scopes should be hung away from each other - coiled so the bending section and light guide connector are separate from the rest of the scope - and should be easy to store and remove.

"Don't let the insertion tube swing," says Mr. Nelson. "You have to check your cabinets, because [exposed] screws or nails on the cabinet could scratch."

Reprocessing with other instruments.
This is a common-sense tip: Reprocess your scope by itself. Putting a scope through reprocessing with other instruments, especially sharp ones like forceps, only spells trouble for your scope's bending rubber and insertion tube.

Waiting too long to irrigate.
During a procedure, blood, feces and mucous get into the scope through the air/water and suction/biopsy nozzles, and may build up in the channels.

"If bio-burden is left behind, it can dry up," says Mr. DeLacy. "The potential is there for it to clog."

Don't wait too long to irrigate the scope after a procedure, says Mr. Neff: "As soon as it's out of the patient, run water to try to get started cleaning [the scope]."

Not adequately testing for leaks.
If you remember only one thing, remember this: leak test, leak test, leak test.

"The pressure test is most important thing that the end user can do," says Mr. DeLacy. "Understanding that leak test can prevent fluid invasion."

There are several components of the leak test: properly hooking up the air source, attaching the soaking cap, making sure the scope isn't too tightly coiled, letting trapped air escape from the channels. Take every precaution to ensure that the leak test will signal a problem. If you do notice a problem, immediately send the scope off for repair.

Not removing jewelry.
Jewelry, especially rings, poses a hazard to the integrity of your scope.

"Make sure you don't have rings on your fingers or sharp fingernails," says Mr. Newton. While cleaning a scope, you may unwittingly damage it.

Care for your scope
If something goes wrong, you can always have your scope sent out for repairs (see "Should You Use Third-Party Repairs?" on page 58). But it's most efficient, in the long run, to do the little things now and save the big bucks later.