EFHSS Questions and Answers - Question Q00563

Dear,

ENT Theatre have a new Surgeon who has a preference for using "Bismuth Subgallate with Adrenaline paste" when performing tonsillectomies. This is proving to be a problem here in SSD as it is very difficult to clean these instruments. It isn't helped by OR staff who try to clean the instruments with wet swabs during the case which only lends to the spreading of the paste over the rest of the instruments!! My own feeling is that the temperature in the washer/disinfector is causing the paste to melt and thus dry onto the instruments. We prewash all these instruments and soak them in the sink for 10 mins in an Enzomatic solution but still have problems. If anyone has encountered this problem before or knows of any method to reduce the problem I would appreciate their help.

Regards, Tony

Ask the ones who sell the paste. They have to come forward with a solution.

Dear,

It took me sometime to find the chemical properties of Bismuth...
You have problems because bismuth does not dissolve in water, so soaking instruments coated with bismuth paste does not help very much. Bismuth readily dissolves in nitric acid, aqua regia, and hot sulfuric acid, and tardily in hot hydrochloric acid. I am not sure whether these acids are available in hospital, or what damage will nitric and sulfuric acid inflict upon the instruments.

Yaffa Raz

Dear Anthony,
In our sterilization department we use "Solvitan" (Voco) to remove all kinds of materials e.g. pastes and cements especially from dental instruments. Maybe it can also be useful to you.
Information on it and other cleaning materials you find on the VOCO website: www.voco.com, follow products, overview, cleaning material.

Good luck,
Wim Renders

p.s. The leaflet of Solvitan says: "Please let us have further suggestions for the practical use of Solvitan. Interesting ideas will be awarded with a bonus."
You never know.