Nurses advancing endoscopes - page 3

I am interested to find how how many places advance the endoscopes for the Dr.'s, both EGD and Colon. I work with surgeons and GI doc. We have 1 surgeon that can not manipulate the scope and... Read More

  1. by   JVN
    Quote from GInurse4U
    Perforations?
    What are the current standards--Which states allow nurses to advance scopes
  2. by   sadiej
    Quote from lmbv55
    I am interested to find how how many places advance the endoscopes for the Dr.'s, both EGD and Colon.

    I work with surgeons and GI doc. We have 1 surgeon that can not
    manipulate the scope and advance the scope at the same time.
    This Dr. has recently returned to work after an absence and since we have not had to advance scope since he has been gone we are reluctant to do so now.

    As one of our GI doc's said "who ever is driving the scope is doing the exam" and we are not sure we want to be "drivingtthe scope.

    So ,is it common practice for nurses to drive the scope for docs?

    Thanks,
    LMBV
    In our hospital, we have a gastroenterologist who comes once a week from out of town who pushes his own scope. The rest of the time, we have a mixture of internists, surgeons, and family practice docs who do procedures. We push the scopes for 99% of them ,which is covered under our scope of practice in this state, while they "drive" (and a few of them can't even do that very well). If you think we're given free rein, you're wrong. The doctor can (and most do) direct us to go forward or come back. We can halt at our own discretion and tell the doc, " it's a little difficult to push there -- would you like to try" or "I feel uneasy about going farther". No doc has ever demanded that I con't under those circumstances and if he did I'd refuse. A good endo nurse experienced in advancing the scope is safer than a doctor who may only do a colonoscopy 2 or 3 times a week. We also push the gastroscope but only after the doc has introduced it. In the end (no pun intended), we work under the full direction and supervision of the doc. The only perf I've been party to is a patient who was being scoped by a gastroenterologist (and he [U]was advancing). Also, at a recent GI seminar I heard that in the near future nurses may be allowed to do flex sig's totally on their own -- anyone else heard anything?
  3. by   QueenPenguin
    Our RN's and tech's are trained to advance the scope and SGNA does support this practice with training and while the open lumen is visible on the screen. It should not be done with a fiberoptic scope and should not be done if there is any question about the patients airway. The RN should be monitoring that specifically.
    Perforation is a risk but much less if scope advancement is done while watching on the video monitor.
    Our GI physicians don't ask us to advance the scope but a couple of the surgeons do.
  4. by   PDC
    I have some opinions about this, but if no one is viewing this anymore I would feel like I was talking to myself and I'm trying to cut down on that.
  5. by   mshultz
    Quote from PDC
    I have some opinions about this, but if no one is viewing this anymore I would feel like I was talking to myself and I'm trying to cut down on that.
    I am viewing this, and am interested in your opinions. Anyway, there is nothing wrong with talking to yourself, as long as you are not having an argument with yourself

    Michael

    "Outside of a dog, a book is man's best friend. Inside of a dog, it's too dark to read."
    Groucho Marx
  6. by   PDC
    I am currently a tech in a hospital GI Lab. Where I work techs and nurses advance colonoscopes for roughly half of the GI docs and all of the surgeons. We also advance upper scopes for a couple of the surgeons and flex sig scopes for family practice docs. Granted this is the only place I have worked in GI, but I don't see a problem with it. We are in constant communication with the doctor and they are always aware of what we are doing. We advance guidewires, inject contrast, etc. during ERCP as well. It is commonplace in the OR for nurses and techs to act as "a second set of hands" for the physician, I don't see why endoscopy shoud be different.
  7. by   CrohnieToo
    I'll keep it going w/a related question. Several of you have mentioned not advancing the scope unless you can see the lumen or words to that effect.

    ...enough scopes to know you don't push if you can't see a lumen...
    ...if I feel resistance or can't see the lumen, I don't force the scope...
    ...while the open lumen is visible on the screen...

    My understanding of the lumen is that it is the inside (in this case) of the colon. I've watched my colonoscopies both during the scope and on video. Things are a blur as the scope is advancing. When the scope stops or slows down considerably sometimes we can see the "ribs" of the "slinky" (colon) I don't know what else to call them. Other times the wall of the colon is smooth. I assume when I can see the ribs, the scope is pretty much 'resting' and not really advancing and when the wall of the colon is smooth it is pretty well stretched out.

    Are what I am calling the "ribs" what you are referring to as the lumen? Can someone clarify this for me?

    As far as the discussion regarding nurses advancing the scope. I can see where the nurses (most) would be the most empathetic/sympathetic with the patient and less in a hurry with more concern for the patient than most or at least a lot of doctors.

    On the other hand, seems to me if nurses are gonna have that kind of responsibility and liability they darn well oughtta get a much better "cut" of the colonscopy fee!!!! And I suppose that means that administration will insist on more training and schooling.
    Last edit by CrohnieToo on Apr 5, '06
  8. by   EndoGirlJulie
    We only have one GI doc we advance the scope for and his cases are always smooth and easy for both patient and staff.
  9. by   dorimar
    I cannot stress enough the importance of checking the nurse practice act for your state, and your faciltiy policy. Many nurses don't understand the concept of breeching scope of practice. What is a common complication that may be acceptable if you are OPERATING WITHIN YOUR SCOPE, may totally make you liable if you are not. For example, if in your state practice act, it is acceptable for nursing to advance the scope (as well as in your hospital policy, and the colon is perfed, you are much more protected. IF you advanced a scope and perfed a colon when the State says you should never have been advancing it in the first place... well your ----ed. We are experiencing this right now with flushing ventriculostomies in our neuro ICU. The current neurosurgical group has made it common practice to have nursing flush toward the brain if needed. In the past we were covered by policy. Now it is POINT BLANK in writing AGAINST POLICY. there are still nurses who say, "I would never telll you to do it, but I have always done it and feel comfortable with it and I will still do it" It is not about knowing how to do it, or feeling comfortable with it. Any complication screws you if you are not supposed to be doing it in the first place. Know your state practice act adn know your hopsital policy.

    Doris
  10. by   PDC
    First to answer your question Crohnietoo. You're right the lumen really is just the inside of the tube. When people are saying they would not advance the scope without being able to see lumen they are just saying they would not advance if the view was blocked, either because the tip is too close to the wall or the lens is covered with "debris". The "ribs" are rings are created by rings of muscle around the colon, they serve to segment the stool and move it through. They're called haustra. They all but disapear when the colon is pumped full of air by the scope.

    Also, I have a question for dorimar. I checked the nurse practice act in my state, there is really no mention of specific skills. I know each state will be different but where else could I look? I definitely see your point regarding liability and scope of practice. I was trained to do lots of stuff as a medic in the army that I wouldn't even think about doing that at work.

    Pat
    Last edit by PDC on Apr 7, '06
  11. by   CrohnieToo
    Thank you very much for the explanation, PDC. I really appreciate it. I find it fascinating to watch my scopes on the monitor and am terribly disappointed that all of a sudden our hospital has adopted a policy of no more video taping birthings or the monitor during a colonoscopy. Now my gastro has decided no more scopes w/o sedation and I'm terribly disappointed by this.

    I knew the purpose of the haustra but didn't know their correct name. I didn't realize that the air could or would "hide" the haukstra. I figured when they disappeared it was due to the colon stretching out lengthwise due to the scope advancing. Again, thank you for sharing.
  12. by   JEEMA
    We used to advance scopes in one of our doc during colonoscopy. He will tell us when to push, and whe also anticipate when, if the lumen is visible. He said it's the trend and wanted to start it in our department. Thankfully, no perforation had happened till i left the department.
  13. by   at2726
    At our facility our nurses do not advance the scope. Occasionally our GI technicians will advance or hold the scope during colonscopies.

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