The Challenge of Long Endoscopy Procedures
Around 1-1.5% of the population requires an upper or lower endoscopic investigation of the gastrointestinal tract each year. Gastrointestinal endoscopic procedures are used as diagnostic, as well as interventional. And everyday, long and complex endoscopic procedures are performed in more patients, who are also presenting with more complex co-morbidities. Sedation is routinely used in endoscopy to assist patients in tolerating these procedures.
Current state of practice
A joint position statement endorsed by the British Society of Gastroenterology (BSG), Joint Advisory Group (JAG) and Royal College of Anaesthetists (RCoA) on deep sedation and anaesthesia in complex gastrointestinal endoscopy found that:
- Higher Complications
- Increased by factor of 4
- Failed procedure rate
- up to 30%
- Over-sedation
- 33% received more than 5.5mg midazolam
- 8% required flumazenil
The role of nurses in keeping patients safe
1. Adequate knowledge and skills
Not having appropriate knowledge and skills to care for patients under sedation has been reported as one of the most important aspects. Undergoing formal training gives nurses the tools they need to prepare a patient for sedation, adequately choosing medication and doses, monitoring appropriately and intervening when complications occur. The British Society of Gastroenterology endorses the Academy of Medical Royal Colleges guidelines on safe sedation practice and recommends formal training that follows the core curriculum for safe sedation.
2. Preparing the Environment
Making sure the environment has been prepared and is safe ahead of the procedure is essential in endoscopy sedation. This involves having sedative drugs, emergency drugs and oxygen supply. Monitoring equipment also needs to be available for routine monitoring, including blood pressure, pulse oximetry, capnography and ECG. Equipment to manage complications, specifically airway problems, respiratory compromise and cardiovascular failure is also required.
3. Keeping Patients Safe
The clinical objectives of administering sedation for endoscopy are to relieve patient anxiety and discomfort, improve the outcome of the examination, and diminish the patient’s memory of the event.
In order to keep patients safe, adequate pre assessment highlights possible risk factors and patient suitability to receive sedation. Choosing the level of sedation depend on patient and procedure determinants, and doses must be titrated to achieve the desired effect.
Routine patient monitoring is a key component of safety in endoscopy sedation It allows nurses to detect changes in pulse, blood pressure, breathing and ventilatory parameters, cardiac activity and level of sedation. Identifying changes in these parameters early, allows for intervention.
