Endoscopic Therapy, Assisting
Endoscopic therapy allows visualization of the upper GI tract to help diagnose, control, or prevent bleeding and evacuate blood and clots. During this procedure, the doctor advances a fiber-optic endoscope through the patient’s esophagus and into the stomach and duodenum to help look for a bleeding site. After locating the bleeding site, he may inject a sclerosing agent through an injector needle, which is inserted through a port in the endoscope. The doctor injects the sclerosing agent into the bleeding
vessel or tissue surrounding the vessel; he may also apply a band to stop bleeding.
vessel or tissue surrounding the vessel; he may also apply a band to stop bleeding.
Equipment
Topical anesthetic ▪ oral airway ▪ water-soluble lubricant ▪ oxygen administration equipment ▪ suction apparatus ▪ sterile normal saline solution or sterile water for irrigation ▪ endoscope (rigid or flexible) ▪ endoscopic injector needle (23G to 26G, 2- to 5-mm needle) ▪ three 10-mL syringes filled with prescribed sclerosing agent ▪ tonsil-tip suction device ▪ gloves, gowns, masks, and goggles or face shields ▪ two 30- to 60-mL syringes ▪ cardiac monitor ▪ pulse oximeter ▪ automatic blood pressure cuff ▪ prescribed IV fluid ▪ emergency equipment (cardiac medications, intubation equipment, defibrillator) ▪ Optional: esophageal bands, specimen containers, laboratory biohazard transport bag, laboratory request form.
Preparation of Equipment
Set up the suction apparatus and make sure it’s functioning properly.1 Prepare and label sedatives for administration, as ordered. Gather the emergency equipment and make sure it’s functioning properly.
Implementation
Verify the doctor’s orders.
Confirm that written informed consent was obtained and that the consent is in the patient’s medical record.2
Conduct a preprocedure verification to make sure that all relevant documentation, related information, and equipment are available and correctly identified to the patient’s identifiers.3
Review baseline coagulation studies because abnormal results increase the potential for bleeding.1
Review baseline hematocrit and hemoglobin levels.1
Perform hand hygiene and put on gloves and other personal protective equipment, as appropriate.4,5,6
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.7
Make sure that the patient and his family understand the procedure. Answer any questions to evaluate their understanding of the information provided.
Make sure that the patient has had nothing by mouth for at least 4 hours before the procedure or according to your facility’s policy.1
Remove the patient’s dentures, if appropriate.
Verify that the patient has an adequate-sized, patent IV catheter (an 18G catheter is preferred) to administer sedation and any emergency medications or IV fluid, if necessary. If an adequate catheter isn’t in place, insert one. (See “IV catheter insertion and removal,” page 421.) Begin an IV infusion, as prescribed.
Provide goggles or a waterproof covering for the patient’s eyes to protect him against accidental exposure to blood or sclerosing agents.8
Attach the patient to the cardiac monitor, pulse oximeter, and automatic blood pressure cuff for continuous monitoring during the procedure.
Obtain baseline vital signs and pulse oximetry and assess the patient’s neurologic, cardiac, and respiratory status.
Determine the patient’s sedation score based on vital signs, level of consciousness (LOC), and respiratory status using a scoring system according to your facility’s policy.
Position the patient in a left lateral position. This position is the position of choice to prevent aspiration and allows predictable views of the stomach as the scope is advanced. This position also allows secretions to collect in the dependent areas of the mouth for easy suctioning.1
Administer analgesia, sedation, or both as ordered, following safe medication administration practices, before endoscope insertion to facilitate the insertion process.
Double-Checking High-Alert Medications10
When administering high-alert medications such as moderate sedation agents, another nurse must perform an independent double-check of your preparation of the drug to ensure safe administration. The second nurse must:
verify the patient’s identity7
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
