DAY INTERVENTION UNIT – ENDOSCOPY
STUDENT NURSE LEARNING PACK
Day Intervention Unit - Endoscopy Philosophy
Student Nurse Placement
The student nurse will be welcomed into a supporting and nurturing environment.
The student nurse will be respected and valued as an individual and a professional.
The student nurse will have a named mentor; however will have access to the knowledge and experience of the whole team.
The student nurse will be supported through an orientation and self directed learning programme, based on aims and objectives of the placement.
The mentor will facilitate educational visits to other departments associated with Endoscopy procedures.
The student nurse will gain experience in communicating with patients who have undergone an Endoscopic procedure.
The student nurse will gain knowledge of a variety of conditions relating to the GI tract.
The student nurse will always adhere to the NMC code of standards of conduct, performance and ethics.
Endoscopy Unit
Day Intervention Unit
First Week Check List /Geography of Area
Introduction to Staff/Mentor
Fife Points/Exits
Cardiac Arrest Trolley
Call System/Alarms
Off Duty
Breaks
Introduction to Procedures
Nursing Roles
Reporting Sickness
Timetable of Learning
Monday
Tuesday
Wednesday
Thursday
Friday
Endoscopic Procedures
Gastroscopy
This is when a flexible fiberoptic scope is passed down through the mouth or nose to allow direct views of the oesophagus, gastric and duodenum mucosa. It is especially useful when abnormalities, inflammation or infection is suspected.
Name 3 possible reasons why we do a gastroscopy?
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The patient is instructed to fast for at least 6 hours before the examination, they are given a choice of sedation or local anaesthetic throat spray. They are positioned on their left hand side with a plastic mouth guard to protect the scope and assist patient in keeping their mouth open during the procedure, allowing for any fluid or gastric contents to drain without aspiration and suction by the nurse when necessary. As the camera advances it examines the mucosa lining of the oesophagus, gastric and duodenum, taking biopsies where required. The endoscopist will also be observing the gastrointestinal mechanics, checking for any abnormalities. It approximately takes 5 minutes to complete this procedure.
Colonoscopy
This is the study of the large bowel using a similar camera to a gastroscopy, navigating from rectum around to caecum, where the opening to small bowel is situated. This examination can be uncomfortable to the patient at times due to the long, floppy nature of the colon which is expanded with air to allow the camera to pass through and give better views.
Patients fast from the day before and are given 2 x Moviprep, to clear the bowel allowing for view of mucosal lining. They are also asked to drink plenty of clear fluids during this time also. Certain medications may be stopped prior to procedure and also for 72 hours after, this is under medical supervision.
Prior to procedure commencing patients are situated on the left hand side with knees bent, oxygen mask placed on face and sedation and pain relief given intravenously. Patients may be asked to change position to allow the bowel to move, thus assisting the camera to pass safely and quickly through the bowel. On withdrawal of scope, the endoscopist may take some biopsies, or remove polyps where necessary. This test has a variable length of time to complete, varying from 10 to 55 minutes.
Name 3 reasons why this examination may take place for a patient
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Flexible Sigmoidoscopy
Similar to a colonoscopy, although mainly looking at the left hand side of the bowel. Patients can be given moviprep or enema before procedure and this is decided by the Doctor screening this patient for suitability for endoscopy.
Bronchoscopy
It is an examination of the larynx, trachea and bronchi through a bronchoscope. The purpose of this is to determine the location and extent of a pathologic process and obtain samples, either tissue or secretion. Therapeutic bronchoscopy can be done to remove obstructing secretions that the patient cannot move themselves or any foreign bodies.
The scope is passed either through the nasal passage or mouth, due to its flexibility it can be directed down into the segmental bronchi, giving clear views of the respiratory tract. Generally patients are sat upright on their back for this examination and are given a mixture of local anaesthetic spray, lidocaine, along with sedation in order for them to be comfortable during this procedure. It roughly takes around 10-15 minutes to complete.
Can you think of why a patient would need this procedure?
Can you think of any complications that may arise from a bronchoscopy?
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Thoracoscopy
During a thoracoscopy, a small incision is made on a patient’s side, and an endoscope is passed to allow for view of the pleura, lungs and mediastinum during this time it is also possible to also obtain tissue samples for analysis thus aiding diagnosis and treatment plan. This is done in theatre using an aseptic technique.
When the procedure is finished a temporary tube may be put in situ to allow drainage of fluid or air. A suture is used to secure this into place. Patients are more often given sedation and pain relief during the procedure and will be monitored in hospital post procedure.
ERCP (endoscopic retrograde cholangiopancreatography)
Similar to a gastroscopy, although this is done in conjunction with x-ray. The scope has a side view, to give easy view of the ampulla, which is the opening to the common bile, pancreatic and hepatic ducts. ERCP is a therapeutic procedure, and involves the removal of bile duct stones, and obtaining samples of abnormalities.
Can you think of the risks involved with this procedure?
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Other therapeutic procedures
Procedure / Why?Eg. Oesophageal stent insertion / Patients who have narrowing of the gullet have difficulty swallowing food; the stent allows the gullet to expand in diameter allowing food or liquid to pass more easily. This may be due to a tumour in the oesophagus.
Common medications used for endoscopy
Lidocaine / Buscopan / Fentanyl / MidazolamIndications for use
Contraindications
Other medications that endoscopists need to be aware of prior to endoscopy.
Contraindications
Morning Routine - Endoscopy
Unit keys will be collected from the theatre co-ordinator. Controlled drugs in 4 procedure rooms and clean utility will be checked by two registered nurses. Nurse working in the procedure rooms will hold the keys for that room. The Endoscopy co-ordinator will have the key to the CD cupboard in the clean utility on their possession.
Get medical notes and lists from office and prepare lists for morning. Copy of list needed for endoscopy rooms with monitoring form, list for recovery with transport sheet and also for admitting area.
Check where you will be working – work list is written up on board in admission desk.
The co-coordinator will assign an available person to;
Check arrest trolley, BM machines and showers (certain days).
Set up rooms, turn machines on, set up scope, oxygen points, suction available and bed in room.
Admit patients by following checklist.
ENDOSCOPY ROOMS AND STAFF TO BE READY TO START FOR 9am.
Afternoon Routine – Endoscopy
After lunch breaks, co-ordinator will assign persons to;
Patients to be admitted by same routine.
Ensure that rooms are set up with scope, oxygen points, bed and suction available.
Check board where you are working. If in a room make sure you or nurse with you has keys before 1.30pm.
AFTERNOON LIST TO COMMENCE AT 1.30pm.
7.30pm Finish
Assist with day surgery if required.
Ensure grif bins are taken away when full and that all rooms are clean and tidy for morning.
Write up work list onto board for morning.
Make sure specimens have been teletracked for collection.
All keys to be locked away and spanner key given to theatre for overnight.
Kitchen area is clean and dishwasher switched off.
All medical notes in recovery to be returned to office.
Am / PmMonday
Tuesday / ERCP
Wednesday / ERCP/Bronchoscopy/TOE
Thursday / ERCP/ St Andrews / Thoracoscopy
Friday / Bronchoscopy / Emergency List
Saturday
Sunday
· these are dedicated lists, although subject to change. There will be a maximum of 4 lists running in endoscopy along/including the above.
The Role of the Endoscopy Nurse within Procedure Rooms.
Nurse 1 – Assist the Endoscopist
1) Collect, put up and check the scope. Ensure that correct equipment is stocked up and to hand before starting procedure.
2) Draw up sedation for 1 patient at a time.
3) Assist with suction to maintain airway of patient if not assisting endoscopist.
4) Be responsible for ensuring correct labelling of specimens.
5) Clean scope, take to cleaning room hatch and return with clean scope in preparation for next procedure.
6) Clean trolley top, replacing inco pad, foil bowl, suction tubing, syringe, papers, swabs and lubricant jelly.
7) Assist with other nurse in taking patient to recovery, bringing back clean trolley and case notes for next procedure.
8) Take on role of Nurse 2.
9) At end of list, turn room around by changing orange bags, clean trolley top, and change suction liners. At end of day, wipe down used areas, empty water bottles, turn off oxygen, turn off power points, check controlled drugs, stock up any items needed for room and ensure bed is in place for next day. Sign cleaning schedule in room.
Nurse 2 – Patient Nurse
1) Assist patient to the room. Ensure they can get up onto the bed safely and position them for procedure.
2) Attach monitor and oxygen in preparation for sedation. (2 ltrs for Gastroscopy and 4 ltrs for Colonoscopy).
3) Ensure that patient is comfortable during procedure by verbally reassuring. If patient is struggling, ask endoscopist if is possible for patient to have top of medication?!
4) Complete paperwork, register, CD book, specimen book, biopsy card and stickers for pots. Work with Nurse 1 to ensure specimens are correctly labelled. Ensure endoscopist signs relevant paperwork.
5) Check blood pressure, oxygen levels, heart rate and sedation and discomfort score throughout procedure and immediately after remove oxygen if appropriate to ensure the patient is maintaining saturations.
6) Change suction catheter, oxygen mask/sponge for next patient.
7) Take patient to recovery and give handover.
8) Take on the role of Nurse 1.
9) At end of list, turn room around by changing orange bags, clean trolley top, and change suction liners. At end of day, wipe down used areas, empty water bottles, turn off oxygen, turn off power points, check controlled drugs, stock up any items needed for room and ensure bed is in place for next day. Sign cleaning schedule in room.
Discharge/Recovery
When nurses from room arrives with patient post procedure, direct to a bay and receive a handover. Perform a set of observations.
Record patient data on transport sheet and time of sedation. Call patient’s transport and arrange an appropriate time for pick up from department if appropriate.
Refer to policy as regards to appropriate discharge/ recovery.
When discharging patient ensure that have had some diet and fluids (suitable for them), record a final set of observations, blood sugar level checked if needed and remove venflon. Make sure this is recorded on their paperwork.
If endoscopist wants to speak with patient before discharge, arrange this at this point or go over the report with patient and give advice sheet if necessary.
Sign any paperwork and put in final time when patient is leaving department.
When receiving patients from the ward - go over checklist with patient and nurse accompanying to ensure details are correct.
Explain procedure to patient if necessary, nurse can consent (if able), or ensure a consent form is with patient notes for endoscopist.
Put a patient label onto the correct list with bay number so to communicate with others team members that this patient is in the department.
Post procedure – teletrack the patient’s details to arrange a porter and call the ward that you have done so, this way they can send a staff member to come down assist porter.
Useful diagrams