Gastrointestinal endoscopic procedures

Around 1-1.5% of the population requires an upper or lower endoscopic investigation of the gastrointestinal tract each year.1 Gastrointestinal endoscopic procedures are used as diagnostic, as well as interventional. It includes gastroscopies where the scope is placed inside the oesophagus, stomach and first part of the small bowel; and colonoscopies where the scope is inserted in the large bowel. Nurse’s play an important role in these procedures. In this article we highlight the role of nurses in gastrointestinal endoscopy.

Patients may require a gastrointestinal endoscopy for several reasons:2

  • Indigestion
  • Heartburn
  • Repeated vomiting
  • Vomiting blood
  • Difficulty swallowing
  • Long term abdominal pain
  • Weight loss
  • Anaemia
  • Gastric ulcers
  • Coeliac disease
  • Barrett’s oesophagus
  • Foreign bodies or blockages
  • Persistent diarrhoea
  • Changes in bowel movements
  • Rectal bleeding
  • Crohn’s disease
  • Polyps

Gastrointestinal Endoscopy Nurses

The European Society of Gastroenterology and Endoscopy Nurses and Associates has established a core curriculum for nurses working in these settings.3 Taking that more and more procedures are being performed in endoscopic rooms, in replacement of open surgery, nurses are also required to keep their knowledge and skills up to date after initial training.

Overall, nurses working in gastrointestinal endoscopy have two main roles: assisting the endoscopist during procedures and specialised patient care before, during and after the procedure.4,5

Advanced Roles in Endoscopy Nursing

Nurses have been developing two main advanced roles in endoscopy: as nurse endoscopists and as nurse sedationists.

The role of nurse endoscopists has been developed in several EU countries and studies have shown nurses are at least as good as doctors when performing these procedures.5 Since the role became operational, the average time patients on the waiting list reduced from 4 to 5 months to 3 to 4 weeks.1 Training lasts usually 1 year in most EU countries and is university based.

For most endoscopic procedures, moderate sedation is the standard method of sedation.6 The role of nurses in endoscopy sedation has evolved over time and is different in each country. It ranges from nurses administering single drugs, to combinations of benzodiazepines and opioids, and in some countries nurse-led propofol administration.

Irrespective of the type of sedation used, quality management requires pharmacologically appropriate training for all clinical staff involved in sedation practice. European and national societies have developed evidence-based and consensus-based guidelines for sedation and monitoring in gastro-intestinal endoscopy that give a comprehensive outline of structural requirements, medication options, patient monitoring and discharge, and the role of endoscopy staff.7

Guidelines for Sedation in GI endoscopy have been developed in 2018.8

These guidelines highlight the important of patient monitoring during sedated endoscopy. Mandatory monitoring includes:8

  • Heart rate
  • Blood pressure
  • Pulse oximetry
  • Level of consciousness
  • Ventilatory status
  • Continuous electrocardiogram for patients with cardiovascular disease or dysrhythmia

The guideline does not include capnography in mandatory monitoring of endoscopy procedures. However, capnography has been recommended by the Association of Anaesthetists of Great Britain and Ireland. The association recommends that continuous waveform capnography should be used to monitor adequacy of ventilation for all patients undergoing moderate or deep sedation, and should be available wherever any patients undergoing moderate or deep sedation are recovered and additionally where multiple drugs/anaesthetic drug techniques are used, and pre-assessment highlights increased clinical risk.9

Adverse events and complications  

Sedation adverse events and complications are known to occur. These are more likely depending on the type, dose and mode of administration of sedative drugs, patient’s age and underlying chronic conditions Medication side effects, like hypotension, desaturation, bradycardia, hypertension, arrhythmia, aspiration, respiratory depression, vomiting, cardiac arrest, respiratory arrest, angina, hypoglycaemia, and/or allergic reaction, have been reported.6 Nurses involved in sedation practice must have adequate training to administer sedative medications, monitor the patient throughout the procedure and recover from possible complications.

About the author

My name is Andreia Trigo RN BSc MSc, I am a nurse consultant with over a decade of experience in anaesthesia, sedation and pain management.

This involves patient care, as well as lecturing at post grad level on these topics, presenting at conferences and co-developing a very successful sedation course at SedateUK. My passion for creating safer environments for patients and professionals led me to collaborate with Medtronic and share my knowledge and expertise with our professional community.

    

    

The content of this article is written by a blogger with whom Medtronic has a relationship. However, the contents represent the personal objective views, comments and techniques of the blogger and are not statements from Medtronic. To the extent this material might contain images of patients or any material where a copyright is held by a third party, all necessary written permissions from the patient or copyright holder, as applicable, with respect to use, distribution or copying of such images or copyrighted materials has been obtained by the blogger.