Nurses advancing endoscopes

JanetO · Dec 12, 2003

I've worked in an OR where we do scopes for over 20 years and the staff there has always passed the scopes for most of the doctors. I can't say we ever had a perforation when the nurse was passing the scope--just the doc. Our doctors are very careful and we know not to push if there is pressure. These are general surgeons. The GI doctors do pass their own scopes and they seem to have the most perforations--but not that often..thank GOD!

CCU NRS · Dec 12, 2003

Originally posted by formernurse
There is absolutely no way I would have a nurse advancing a scope in my colon. I've had several severe bouts with Crohn's Disease, which has resulted in the buildup of scar tissue in many places. Even my gastroenterologist has difficulty at times when she meets resistance from adhesons. As a nurse, I certainly would not want the responsibility of advancing a scope.

Sorry you would/will never know who does the drving, unless the doctor wants to tell you. you are sedated during the procedure I HOPE!

dragonfly954 · Dec 12, 2003

I had a scary thought.........just imagine having to sit in front of a nursing board and explain to them why your pt had a perf from a scope you were advancing........."well we do this all the time and nothing like this has ever happened before.....":eek:

miz annie · Jan 1, 2004

I have been a gastroenterology nurse for 15 years. Both nurses and techs advance scopes for the physicians in my department. There are only 2 physicians who advance their own scopes. In 15 years, I have only seen 3 perforations of the colon and all three were done by the physicians who advance their own scopes. The physicians who have nurses or techs advance their scopes use less air, and the case is generally much smoother and faster. (average exam is 15 minutes). Those who push their own scope have an average time of 30 minutes and the patient is usually very uncomfortable. If I were having a procedure (which I have), I would very much want someone assisting the physician to push the scope.

T.Hart · Jan 5, 2004

Our unit has a mix of physician preference re: advancing endoscopes. Preference seems to be driven by physician training. The SGNA has a position statement endorsing manipulation of endoscopes by nurses.

http://www.sgna.org/resources/statement1.cfm

Kyli · Feb 29, 2004

I think it is the old school Drs that expect nurses to advance the scope for them - from the days when the scopes were non-video. I did it a few years ago for 2 particular Drs, but I had a few yrs experience up my sleeve.

Now days, I would not do it, and should not be expected to. I'm not willing to be responsible for a perf - because you could almost guarantee the Doc would blame the nurse!

guntbr1 · May 28, 2004

yes where I work we always pass the scope for certain doctors.

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

SuperSGirl · Oct 7, 2004

according to sgna, it is okay to advance/withdraw the scope for the physician if he is there supervising. if your hospital policy and state nurse practice act do not state otherwise, you are okay. i have the definitions below.

i also highly recommend you join the professional organization of your practice. these guidelines coincide with jcaho guidelines.

for those who would "refuse" because they didn't feel right about it, you need to educate yourself and strive to acquire such skills so you can be a complete member of the team. nobody wants to work with somebody who can only pull part of the load. if you can not or refuse to grow in your scope of practice, you should consider another area of speciality. education, whether it be self education or professional, and skill acquiring/obtaining keep us excited and versatile.

sgna, principle #1

definitions

manipulation refers only to the act of advancing or withdrawing the endoscope under the direct supervision of the endoscopist.

nurse refers to registered nurse, licensed practical nurse, or licensed vocational nurse.

associate refers to assistive personnel such as technicians, technologists, and assistants.

suzanne62 · Dec 2, 2004

We used to advance scopes alll the time for our docs as like some one said the procedure does go quicker and most nurses have seen enough scopes to know you don't push if you can't see a lumen.

BUT after attending study days were they clearly stated the endoscopist is the person who advances the scope we stopped. We are not endoscopists

endodave · Dec 31, 2004

In our hospital endo unit we have LPNs and RNs both that advance the scopes for all of the Docs. Make for a much quicker and smoother procedure I think.

chords1 · Feb 13, 2005

[

QUOTE=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

Here is my 2 cents,

I have worked in Endo for 8 yrs and I work with 5 different Gastroenterologists on a regular basis. They all advance the scope by themselves as ANY Gastroenterologist should. General Surgeons that perform endoscopy should do so only with proper training and should be able to advance the scope without help. If they are unable to perform a colonoscopy without someone else advancing the scope for them they should not be performing the procedure. Thats why there is the specialty of Gastroenterology. If you are having a endoscopic procedure performed on you I would highly suggest the you have only a Gastroenterologist perform it and NOT a General Surgeon. Having a second person advancing the scope is an outdated practice utilized when scopes where fiberoptic. They have been video for over 12 years now! Advancing the scope increases the RN's liability, and last time I checked I didn't get the $500 reimbursment for performing the procedure that the MD gets. (The average hourly rate for an RN is $25) After 8 years I could perform the colonoscopy without someone advancing the scope for me, but until the MD wants to split the procedure reimbursement its not going to happen.

jacrn2 · Mar 29, 2005

O.K. I've got another two cents to throw in with chords1. I agree in many ways with those who think it's outdated. I also agree that the pay should be increased for this type of practice. However, this is the way that I learned. I pushed the scope for a general surgeon 1st for about a year. Now, I've been pushing the scope for a colorectal surgeon for almost 5 years. It just depends on where and how they were trained. I can't find anything that says I shouldn't be doing it from the BNE. Everything is so vague. I couldn't find it on AORN either. I saw here SGNA says it's O.K. under the supervision of the surgeon...and that as nurses we should be ready,willing and able to advance in our practice as much as we can...but when it comes to the liability, are we going to take the blame for something that they should have been doing all along? I have mixed feelings on this to be perfectly honest. Mainly because I know that I can tell when I shouldn't push...if I feel resistance or can't see the lumen, I don't force the scope. But I also don't know how things would come out if we were to have a problem (God forbid) that went to court. I can't say that I would be covered. I can't find any information that says one way or the other. It's very confusing. All the liability...crap. (Pun intended!!) :rotfl: