Do U Apply Abdominal Pressure During Colonoscopy?

  1. Are you also asked to apply pressure on the left lower iliac region during colonoscopy, esp after reaching the sigmoid?

    We're usually asked to do it in order to straighten the splenic and hepatic flexure and facilitate easier insertion and to quickly reach the caecum.

    It's just too tiring esp with patients having big bellies.
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  2. 14 Comments

  3. by   LibraSun
    It can be exhausting with people with difficult turns or Drs with less skill, FOR SURE! My boss and I even thought up a compression device, but it seems someone else patented our idea in 1997, but didn't do anything with it!! dang! I wonder if anyone has any helpful hints as to making it easy and comfortable for the nurse and the patient.......
  4. by   EndoRN
    We use pressure quite often.
    I usually have a hand resting on the belly. I take note of wherever the looping seems to be taking place. After the doctor reduces the loop, I put pressure on where it was.
    Pressure can be key in some cases. Others....it seems nothing helps.

    Amy
  5. by   paula77720
    lucky for me, my doctor is a good driver and i only do it when it is really difficult for him to get through. Normally, sigmoid support is always needed or transverse. He said i have a golden hand ... i always press the right area and the scope goes through. Thats nice to know
  6. by   altomga
    we do scopes on the floor quite often....I don't work in the GI lab....but I haven't seen it done, but they may do it down the the lab.
  7. by   twhatley
    We do have to give abd pressure sometimes, depending on the difficulty of the case. A step stool in every room is a must! The height gives you a much better position. Good luck!
  8. by   Kyli
    We often give abdo pressure too. Not always though. Usually just when there is looping etc and also depends on the Dr and each individual patient.
    The more experienced you are at endo nursing, the easier it gets to determine where to push!! The sigmoid area is most common (because it's the most twisty bit of the colon!!).
    Sometimes people have terribly tortuous bowels and is does get quite tiring!!
    I have to say, I'd rather do some pushing than rolling the patient - as some Drs ask us to do!!
  9. by   ibnrn
    We do apply (L) abd pressure...mostly for the docs who are less skilled at 'scoping. When the GI doc does his scopes...no problemma! But the surgeons...now they are a different story. :chuckle
  10. by   Lys
    I'm a little confused with this question...I recently had my first sigmoidoscopy done about a month ago, but I was kneeling but bent over onto my stomach on a bed (unsure of position name). In this position, it would likely be pretty difficult for the dr or nurse to have applied pressure to my abdomen...and I would have likely kicked them in pain if they had *lol*

    Is this technique used predominantly when clients are anesthetised for the procedure or is a different position used?

    Thx
  11. by   ibnrn
    Quote from Lys
    I'm a little confused with this question...I recently had my first sigmoidoscopy done about a month ago, but I was kneeling but bent over onto my stomach on a bed (unsure of position name). In this position, it would likely be pretty difficult for the dr or nurse to have applied pressure to my abdomen...and I would have likely kicked them in pain if they had *lol*

    Is this technique used predominantly when clients are anesthetised for the procedure or is a different position used?

    Thx
    A sigmoidoscopy is visualization of the sigmoid colon only; in other words, the flexible tube is inserted up to the splenic flexure, or first major turn, in the bowel. At our institution, no sedation is used for this procedure. If you had a full colonoscopy, you would have (should have) been given sedation, to include drugs like Demerol, or Fentanyl, and Versed, for example, and you would have been lying on your left side with your knees drawn up, sort of fetal position, if you will. The assistant sometimes has to put pressure upward on the left side of your abdomen to prevent a loop from forming with the scope.
  12. by   Lys
    Ibnrn,

    Thanks for the clarification!
  13. by   mshultz
    I assume that the GI doctors are better at doing colonoscopies than surgeons because they have had more experience. http://www.gastro-pro.org emphasizes the importance of experience in minimizing patient discomfort. They also consider abdominal pressure a necessary technique. In addition, the studies on colonoscopy tolerance seem to only use GI doctors with extensive experience (An Australian study only used doctors who had done >2000 colonoscopies).

    My colonoscopy experience is described in the Recent Colonscopy Experience thread. No abdominal pressure was used; however, I was told to turn from my left side to a supine position as the transverse colon was reached. I am fairly sure now that the pain I experienced was from excessive looping, and that I will be able to watch the entire procedure next time with the use of abdominal pressure, doing this myself if necessary. This will be an interesting experiment.

    My doctor is listed as a surgeon, not a GI doctor. I had sent him a letter only a few days before the colonoscopy stating that I wished to watch the procedure, so there was no real opportunity to discuss the matter. He did not try to talk me out of it, or refuse to follow my wishes, which I appreciate.
  14. by   janjoy52
    I've been doing flexible sigmoidoscopies for 17+ years and I apply the same pricipals of scope advancement as the doctors use with the colonoscopes. The difference is I have the patients, who are not sedated, turn to their backs and press on their lower left bellies themselves. I achieve two benefits: I can better straighten the scope in the bowel and the patients become part of the team in getting the best possible exam they can. Currently we are using the 75cm Olympus scopes in our flexible sigmoidoscopies and with these methods I have been able to advance the scope many times into the cecum. Its good we have a camera to document the appendiceal orifice and terminal ileum because there are a lot of skeptics in family practice but our GI docs are used to us doing this and its fun to hear them say when questioned, "Yeah they (RN endoscopists) do that a lot!"

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