Biopsy Forceps. Who handles it? PLEASE HELP

  1. Nurses who work in an endoscopy clinic can you guys help me answer a question.

    Who is the one who handles the biopsy forceps and "opens/closes" it?

    At the place I just recently got hired at, they used medical assistants for that. Is that legal?

    This is my first time working in an endoscopy clinic. I have been an MA for a family practice for 2 years. The doctor said that I can be trained to handle the forceps and from the looks of it, it isn't that hard to master, but I am just worried about the legal issues. I don't want to be sued or have a chance of being sued.
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  2. 13 Comments

  3. by   sirI
    We want to welcome you to allnurses.com

    Members who might have information regarding their practice settings will come along and assist you.

    Hope you enjoy the site.
  4. by   ThePrestige
    Yes its perfectly legal, most places use MAs/GI Techs to assist the physician during the procedure which can include opening and closing the biopsy forceps/snare/etc. The physician always directs the forceps in and out and tells the tech when to open and close, very safe when properly trained.
  5. by   brownbook
    It is CLEAR AS MUD, yes I am shouting.

    I posted a similar question almost 5 years ago (I can't believe it was that long....time flies). Anyway one very legitimate sounding answer was you are ''practicing medicine'' if you "sever or penetrate the tissues of human beings....in the treatment of disease....unless they have a license to perform the functions within the scope of their license."

    I have worked GI over 15 years....(actually floated in and out, it was never my primary position). Techs, MAs, CNAs, have always assisted the gastroentrerolgist in opening and closing forceps and other even more technical procedures used in GI.

    One day I floated to GI and the tech said...."Oh by the way tech's can't obtain biopsies...you have to do it!" YIKES I had never done it...the gastroenterologists was NOT very happy (however that is his baseline).

    Well.....that lasted one day....I never heard any official reason, policy, things went back to the old regular ways...techs, CNAs, MAs, continue to obtain biopsies.

    To be factual at my current position OR techs assist the gasteroenterologists. I don't know if they would use or train an MA or CNA, however at my old job a CNA was trained to do the job.

    So as I said....CLEAR AS MUD.
  6. by   hayest
    Quote from brownbook
    It is CLEAR AS MUD, yes I am shouting.

    I posted a similar question almost 5 years ago (I can't believe it was that long....time flies). Anyway one very legitimate sounding answer was you are ''practicing medicine'' if you "sever or penetrate the tissues of human beings....in the treatment of disease....unless they have a license to perform the functions within the scope of their license."

    I have worked GI over 15 years....(actually floated in and out, it was never my primary position). Techs, MAs, CNAs, have always assisted the gastroentrerolgist in opening and closing forceps and other even more technical procedures used in GI.

    One day I floated to GI and the tech said...."Oh by the way tech's can't obtain biopsies...you have to do it!" YIKES I had never done it...the gastroenterologists was NOT very happy (however that is his baseline).

    Well.....that lasted one day....I never heard any official reason, policy, things went back to the old regular ways...techs, CNAs, MAs, continue to obtain biopsies.

    To be factual at my current position OR techs assist the gasteroenterologists. I don't know if they would use or train an MA or CNA, however at my old job a CNA was trained to do the job.

    So as I said....CLEAR AS MUD.
    That is scary. I would not want someone who did not have an MD behind their name to take the biopsy. In fact, I'm a few years behind in having my colonoscopy done. I am not refusing it, I just want it done my way. No sedative, no assistants in the room, just the doctor who is performing the colonoscopy and my doctor who will be in the room talking me through it. Three hospitals in my area all said this can be done. Just waiting for my doctor to do his part and make contact with a few GI doctors who will perform it. My guess, I will still be waiting several more years.
  7. by   brownbook
    Dear Hayest......I would hate to think of you dying of colon cancer because of my comment. I am not sure what you are scared of?

    Millions and millions of colonoscopies are done every year, millions and millions of biopsies are taken. I do not know of any gastroenterologists who uses a MD to obtain the biopsies.

    Because the GI MD is inserting the end of the scope with one hand, and using the other hand to manipulate and all the dials, knobs, various other accessories at the head of the scope there is no way (unless he has four hands) he can also open and close biopsy forceps!

    The tech "obtaining" the biopsy does no more than depress a spring to open the biopsy forecps and release the spring which causes the biopsy forceps to close.
    All under the direction of the GI MD who is seeing everything the forceps are doing and telling the tech...."open...close."

    I can't imagine why it would take a MD to depress a spring "open" and release the spring "close." Can you?
  8. by   bramsey934
    I certainly would want more staff in the room other than the gastroenterologist and a Doctor (who has never teched or performed a colonoscopy) in the room.

    More power to you if you choose no sedation, but often people change their minds halfway through and we (the procedure RNs) will give a little versed to take the edge off.

    We often remove polyps with "hot snares" which is more than just "opening" and "closing". It isn't something I would want a first time random MD trying on me. Not to mention if something starts to bleed and the gastroenterologist wants to use clips to stop the bleeding. Your other MD is going to be getting those and trying to learn to use that. All the while who is paying attention to you? One set of eyes are on this bleed planning on how to stop it and one trying to figure out how the clip works!

    Our techs and procedure RNs are a vital part of the team, not just the MDs!!
  9. by   MissChrissy
    Quote from hayest
    That is scary. I would not want someone who did not have an MD behind their name to take the biopsy. In fact, I'm a few years behind in having my colonoscopy done. I am not refusing it, I just want it done my way. No sedative, no assistants in the room, just the doctor who is performing the colonoscopy and my doctor who will be in the room talking me through it. Three hospitals in my area all said this can be done. Just waiting for my doctor to do his part and make contact with a few GI doctors who will perform it. My guess, I will still be waiting several more years.
    Lol. That is very ill advised. I assure you that performing a Colonoscopy is NOT a one-person operation. The only reasonable way a doctor can get away with not having any one else in the room is if you have a pristine non-tortorous colon with no polyps, inflammation, bleeding, etc. Besides the general fact that a lot of MDs havent familiarized themselves with where all the equipment is in the procedure room....would you like them to constantly stop the procedure, take off their gloves, fumble through the cart to find what they need, try to maneveur the scope with one hand and push in and manipulation a hot snare or forcep or a hemo clip, or an injector, with the other? Take the risk of losing sight of the polyp because the doctor is jarring the scope around so much trying to do a job that requires two people? You do realize that if you have a tortorous colon, you need someone to provide abdominal pressure to help guide the scope along the colon, how will a doctor do this? How about priming for injections? Or setting up the machine and pads during a polpypectomy that requires a hot snare? Documenting all the times, location and number of biopies and methods of removal in real-time? All nurses, techs, MAs are trained and under the direct supervision of the MD, so I honestly don't see what your adversion is to it.
  10. by   hayestm
    Quote from MissChrissy
    Lol. That is very ill advised. I assure you that performing a Colonoscopy is NOT a one-person operation. The only reasonable way a doctor can get away with not having any one else in the room is if you have a pristine non-tortorous colon with no polyps, inflammation, bleeding, etc. Besides the general fact that a lot of MDs havent familiarized themselves with where all the equipment is in the procedure room....would you like them to constantly stop the procedure, take off their gloves, fumble through the cart to find what they need, try to maneveur the scope with one hand and push in and manipulation a hot snare or forcep or a hemo clip, or an injector, with the other? Take the risk of losing sight of the polyp because the doctor is jarring the scope around so much trying to do a job that requires two people? You do realize that if you have a tortorous colon, you need someone to provide abdominal pressure to help guide the scope along the colon, how will a doctor do this? How about priming for injections? Or setting up the machine and pads during a polpypectomy that requires a hot snare? Documenting all the times, location and number of biopies and methods of removal in real-time? All nurses, techs, MAs are trained and under the direct supervision of the MD, so I honestly don't see what your adversion is to it.
    Hi Miss Chrissy! Thank you for your info. I do understand, but I've had numerous mistakes that have taken place with "assistants" and I am having a hard time trusting them again. I deeply appreciate your expertise in what can happen, etc., but I've talked with numerous doctors throughout the country regarding having the colonoscopy my way and have been given the "green light". None of them indicated it wasn't doable. They all have given me additional advice regarding a colonoscopy; i.e., pediatric scope instead of adult; water instead of air, etc. My personal MD would be there to watch and assist and he has done hundreds of colonoscopies in the past, so he is not new to them. He would also be able to provide abdominal pressure if needed. I have always said that an "assistant" (preferably an actual nurse and not a tech) can be outside the door if something would need to be done, but only then is when she could enter, help with the immediate situation and then leave again. I just do not want anyone else in the room than the two MD's. Thank you again for your expert advice. I really appreciate it and will make note of it.
  11. by   BSN16
    Quote from hayestm
    Hi Miss Chrissy! Thank you for your info. I do understand, but I've had numerous mistakes that have taken place with "assistants" and I am having a hard time trusting them again. I deeply appreciate your expertise in what can happen, etc., but I've talked with numerous doctors throughout the country regarding having the colonoscopy my way and have been given the "green light". None of them indicated it wasn't doable. They all have given me additional advice regarding a colonoscopy; i.e., pediatric scope instead of adult; water instead of air, etc. My personal MD would be there to watch and assist and he has done hundreds of colonoscopies in the past, so he is not new to them. He would also be able to provide abdominal pressure if needed. I have always said that an "assistant" (preferably an actual nurse and not a tech) can be outside the door if something would need to be done, but only then is when she could enter, help with the immediate situation and then leave again. I just do not want anyone else in the room than the two MD's. Thank you again for your expert advice. I really appreciate it and will make note of it.

    Can be outside the door??? What world are you living in lol? 90% of MD's don't even know how to run the equipment themselves much less do the entire procedure entirely by themselves.
  12. by   BuckyBadgerRN
    Hayest has very concrete ideas as to how her healthcare needs are met. She is adamant about certain personnel not being allowed anywhere near her and has gone so far as to make demands of her providers that her instructions are to be carried out to the letter. (She claims her physician is in total agreement with her). Hayest is not a nurse, ma, CNA, student or any other member of the healthcare team, yet posts here often about our profession.


    Quote from brownbook
    Dear Hayest......I would hate to think of you dying of colon cancer because of my comment. I am not sure what you are scared of?

    Millions and millions of colonoscopies are done every year, millions and millions of biopsies are taken. I do not know of any gastroenterologists who uses a MD to obtain the biopsies.

    Because the GI MD is inserting the end of the scope with one hand, and using the other hand to manipulate and all the dials, knobs, various other accessories at the head of the scope there is no way (unless he has four hands) he can also open and close biopsy forceps!

    The tech "obtaining" the biopsy does no more than depress a spring to open the biopsy forecps and release the spring which causes the biopsy forceps to close.
    All under the direction of the GI MD who is seeing everything the forceps are doing and telling the tech...."open...close."

    I can't imagine why it would take a MD to depress a spring "open" and release the spring "close." Can you?
  13. by   FreckledCoffeeRN
    I work in a hospital, so we do inpatient and outpatient procedures. The certified surgical tech does the opening and closing of the biopsy forceps and also the snare forceps (cold and hot). In the procedure room we have MD, RN, and CST. I've never felt this was a problem because in all seriousness the tech deals more with instrumentation than I do. Never had a problem.
  14. by   BklynHeightsRN
    yes, it is absolutely legal as long as they are trained. And most places do this as it is less costly to have an RN in the room at all times.

    RNs are the only ones who may inject the site (Epi, NS, whatever) or tattoo as far as I'm aware.

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