Before purchasing nasoendoscopic equipment to use with the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) clinical procedure, take the time to personally research online the various hardware and software options available. Below is a guide to buying FEES equipment.
1) Portable vs Stationary Location:
The ability to easily carry or roll the FEES unit to the patient bedside is very important. Larger, stationary systems are generally made to remain in a permanent location. They may be moved with considerable effort. These units are suitable for office practices or in outpatient settings. Smaller, lighter, and more portable units provide a significant advantage when patients cannot be transported. These units are frequently used in hospitals, nursing homes, home care, and mobile FEES companies.
2) Fiberoptic vs Digital Technology:
Reflective glass-rod bundles, or fiberoptics, to view the body cavity revolutionized medical evaluations and procedures beginning in the 1950s. However, low structure illumination, pixelated images, low image reflectivity, and picture size, color, and light irregularities detract from the image quality. Images are viewed through an eyepiece lens, or through a separate attachable video camera. Endoscope and camera calibration are necessary to obtain the best picture quality. One medical technology goal is to generate high-quality images with correct color tint and hue, line definition, contract, image clarity, depth of field, and brightness. The miniature “chip-on-the-tip” digital endoscope cameras vastly improve the images needed for laryngeal/pharyngeal examination and to follow the biomechanical dynamics of swallowing functions. The viewing lens is replaced with images projected directly to a laptop computer or a large viewing screen. While the costs may be a bit higher, digital endoscopes come highly recommended over the older technology of fiberoptics. It pays off when reviewing, analyzing, and scoring FEES studies.
3) Fully-dedicated FEES Equipment vs ENT/GI Shared Equipment:
- Shared equipment means lack of availability when needed.
- FEES equipment requires video AND audio recording capture capability at 30 frames per second. Program software must allow for immediate playback, slow-motion playback, frame-by-frame playback, stop-action, and screen capture of select images for later analyses.
- Software for viewing and recording FEES is standard on dedicated FEES systems but not on standard ENT or GI endoscopic systems. DO NOT attempt to cut corners and buy the FEES software and install it on your hospital or personal computers. Incompatibilities result in frustration and downtime. Further, manufacturers will not provide a warranty on mixed equipment.
- DO NOT ALLOW your FEES equipment system to be selected and purchased without your input. FEES equipment while similar is not identical to other endoscopic systems in a hospital. Some hospitals contract with large equipment companies and buy endoscopic equipment only if it is on the contract list. Most will not be FEES equipment. Further, ENTs should not select your equipment for you.
- When considering any equipment, ensure it is fully approved by the FDA before purchasing. If any component is not fully approved, JCAHO could cite your facility for this costly issue during an inspection.
- FEES systems have one endoscope included with the purchase. For most clinical practices, this is insufficient. Always buy a minimum of two (2) endoscopes. Why? After completing a FEES study, that scope must be cleaned. If sent to Sterile Processing, hours or days will pass before it is returned. Thus, your FEES capability ceases. A second scope allows for continued patient care. Secondly, endoscope damage most often occurs during sterile processing. The endoscope cannot be used until repaired. A second scope allows continuing your FEES practice.
4) In-person Equipment Demonstration before Buying:
Always require a sales representative to come and visit before selecting a FEES unit. If the unit cannot be brought to your location, arrange to go see it. It is important that you see the equipment you are going to purchase. Hold the endoscope in your hand. How does it feel? Is it comfortable to hold for 10 minutes? Can you reach and manipulate the tip toggle lever and the on-off and video buttons? Go through the video capture and playback options on the computer. Are they easy to manipulate? Have the rep “scope” him or herself. Yes, do a real insertion and view it. Look at the image size, brightness, clarity, color, line definition, and contrast. Does it meet your location/portability requirements? Best advice: do your homework. Don’t ask another SLP for their opinions until later.
5) Scope Cleaning:
Before finalizing the purchase of a FEES unit, have the sales representative fully explain to you and the cleaning department the exact process required to clean the endoscope. For hospital-based FEES programs, scopes have to be sterilized, and only certain cleaning processes are approved for any specific make of endoscope. Make sure your hospital owns the correct equipment to clean the scope. Damage most often occurs to an endoscope in the Sterile Processing Department. For those programs allowed to use high-level disinfectant solutions, all endoscopes are pre-approved to be cleaned by most standard disinfecting solutions. It is important to read and follow the IFU (Instruction For Use) document that comes with every endoscope regarding use, cleaning, and storage. Information in this document must be included in your department/company Policies and Procedures.
This is a guide to buying FEES equipment. This process includes other considerations including budget limitations, a clear understanding of infection control requirements and products, and the required training to learn the FEES procedures and protocols, scoring, analyses, interpretation, and reporting. For more information on training see the SASS training page.
Recommended FEES Equipment
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Karl Storz Endoscopy-America, Inc.
March 5, 2021