EndoRN

I went into GI when I had small children. I needed to switch from afternoons to days. 6 years in I moved from a hospital to outpatient setting (no more weekends, holidays, evenings or taking call !!). I've now been in GI for 12 years & still love it! It's fun & the pay is good. :)

I'm not sure what IL law is re: LPN's giving conscious sedation. I know in our GI lab they do not. In regards to the first post, SGNA states if the nurse is doing the sedating (vs. a CRNA) then that should be their ONLY responsibility in the room, to sedate/monitor the pt. I have worked places where it's like you said, we are sedating AND teching. But it's pretty bad practice.

Our docs use the Miralax prep. You mix it w/32 oz gatorade and 32 oz H20. Speaking w/pts that have done different preps in the past (Fleets, Go-Lytely) they say this one is much more tolerable.

It does sound like a micro perforation to me. I mean, if she had absolutely NO pain prior. Was that abcess in her colon? It seems doubtful to me that she developed diverticulitis from the scope if she didn't have it prior. Unless they missed an inflamed tic along the way. It seems that a perf would have shown up on the CT scan, though. Interesting! Hope she's doing OK. You'll have to keep us posted on what you find out.

We use the Miralax prep and it is the same for bariatric pts as regular pts. Patients are instructed to drink the prep as directed. When it is coming out perfectly clear they can stop, tho. Basically at that point it's just the prep coming out the other end. So some pts can get away w/drinking less. :)

I don't know.....I've heard Fellows ask some strange questions re:coloscopies. I've also heard other nurses criticising them behind their backs and saying how they could do the scope in half the time, etc. I've also seen these fellows graduate, continue to practice and develop into awesome GI docs. I don't presume to think I know more than them simply b/c I've done (or assisted, I should say) in more procedures than them. They've also gone to med school and I haven't. This thing w/the NP's is new to me, though I've heard about it coming at SGNA conferences for many years. Guess it's finally happening and we need to change w/the times. If the hospitals are going to embrace it then we are going to need to be flexible, as always in nursing. I've seen nurses b*tch and dig their heels in over change. And, ultimately it never makes a difference. I suppose you can refuse to assist the NP, but it will probably just make you look petty and jealous. It would be nicer if you could share your knowledge. I'm sure he is nervous but willing to learn. Just my .02 :)

Keep your colon healthy with fiber supplementation and a high fiber diet (whole grains, high fiber cereal and some fruits/veggies such as raisins, strawberries, broccoli. Most are actually very low in fiber, tho). They used to advise against a high residue diet with "tics" (diverticuli) saying that peanuts, seeds, etc. get "trapped" and can cause diverticulitis. This has since been found to be a wives' tale. Tho you may still hear it from time to time from old school MD's and nurses. As for the "veins"....maybe hemorrhoids? Or AVM's (arteriovenous malformations) which are vessels close to the colon surface and prone to bleeding. Can't say for sure what he was talking about there. Interesting. Amy :)

I've read those before. They're funny!!

Call is rough when you have kids. That's why I have to work per dieum right now. I have 4 (kids). At the hospital where I work you get called in A LOT! Lots of times when we come in in the AM, the call nurse is up in ICU and has been there since wee hours.

So........did you get the job? How's it going??? Amy :)

I don't have any experience w/Interferon. But I did want to say I hope your husband is doing well !! Amy :)

No. If we are doing someone unsedated or using IVCS then we have them gargle w/4% lidocaine. Otherwise we don't use anything. We have anesthesia sedation and they are so deep there's never any gagging. They also can eat as soon as they wake up. Then leave. :) I'm actually starting a new job (in additon to my current job at the surgery center). I'll be back in a hospital doing GI. I'm curious what they'll be doing. I never saw that methemoglobanemia when I worked in a hospital before. I had actually never heard of it. The one MD who had it happen is our lab director. So when he freaked and told us to stop using it we didn't argue. We rarely used it anyway. Now if we have to numb them up, they gargle. Amy :)

Still debating rectal tubes? Sigh...guess I don't know the "theory" behind them. All I know is the patients seem to have an easier time getting rid of the residual air. Patients can relieve themselves of the air a lot quieter (our recov. area is jam packed and not the most private place in the bldg). "age of the endoscopist" doesn't really seem to be a deciding factor in the placement. About 1 inch of tube is lubricated and inserted. Instant air return. You'd have to go crazy w/the thing to cause damage. I guess I just don't know what else to say about rectal tubes. LOL. Other than I want one when I get scoped!! Amy :)

I'd just as soon avoid it as long as possible. Yes, we can get adverse effects from normal IVCS, but those agents can be reversed. There is no reversal agent for propofol other than "tincture of time". I am ACLS certified and have been in more codes than I cared to be in. But I still don't consider myself in the class of nurse anesthetists, especially when it comes to airway management. Amy :)

Jbahoffman, 2 of our MD's requested we stop using it. Evidently (I've not ever seen this happen) they had some cases of desaturation. I think it was called methiglobinemia (LOL. something like that...the O2 gets displaced from the cells.) Amy :)

Guess we'll never know....... ? Hope the kiddos are doing OK !! I'm w/you Ullee....no one on here is trying to be a doctor. Just offering the advice that was requested. Of course a mom would take her child to the doctor if needed. Amy ?

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 :)

LOL. I guess I never thought of those little rectal tubes as "extreme". With propofol they wake up pretty quickly so I guess I would say the tube's in about 10 min. Give or take. The recovery room nurse takes it out. Though they've been known to forget and it just falls out on the way to the bathroom. Amy :)

Yes, the doctor does take air out as he comes out. But it's not 100%. There is always some air still left that the pt. will need to expel. I'm an advocate of rectal tubes. It need only be inserted 1-2 inches. It also helps pts. get rid of the air more QUIETLY! Our pts. recover in a pretty crowded recovery area that includes eye and plastic pts. If there was difficulty getting into the terminal ileum, or a lot of time spent in the R. colon for any reason (polpectomy, whatever). There is usally trapped air that is harder to get rid of. And rectal tubes don't really help air up that high. Positon changes and walking as soon as possible are key. As for lying prone......that's a new one for me. Ours recover in a side-lying position, usually left. But when they are awake enough, we let them move around however they want. Amy :)

We only use anesthesia sedation at our surgery center. It's heavenly! I have seen ERCP's. I actually spent half a day watching them, to see if I wanted to work there. (this was back when I was in the hospital. They had an ERCP team. It was separate from the GI lab). Anyway, it was soooooo dark and looooong and boring. And the lead aprons.....I said "no thanks!". :) That other stuff (the manometry stuff) I've never even seen!! Someday..... Right now I'm pretty happy. My job is so easy. Anesthesia sedation. An RN to assist. An RN to circulate. Diagonostic colonoscopies and upper endoscopies. That's weird about the droperidol. That happened after I left. I've forgotten the rationale for why they stopped using it. Was it because of arrythmias or something like that? We've had to stop using the cetacaine spray, per request of a couple of our MD's. Are the incidences of desaturation really that common? Amy :)

Patsue, I think the pay is probably less than at the hospitals. The base rate is pretty comparable (at least around here) at 22.00$. But there is no shift differential or call pay. The hours are also very variable. I guess it usually works out to a 35 hr. wk. :) Amy :) Thank for checking in. !! Congrats on your GI cert. I just joined SGNA this year. I am very interested in becoming certified. But I would definitely have to be back in the hospital first. I've never done an ERCP in my life.....

Scopette, Yah, I do miss all that stuff. I just don't miss HOSPITALS !! I love it here at the surgery center. Maybe someday I'll go back to the hospital. Right now, No. I have such a busy life, 4 kids and I teach aerobics as a part time job. So taking call is really hard. I use to have to leave the beeper w/the desk staff at the club. They'd come wave at me if it went off. Sigh....end of class. Thankfully, it wasn't too frequently, though. I just joined SGNA and I always attend all the workshops (I have a Mich. license that requires CEU's to maintain.) So I keep as current as possible. I know, not as good as the real thing, though! So for now, lots of polpectomys and biopsies and that's about all. :) Amy :)

I've been lurking around this site for a couple years. This GI section is really sloooooow...... Where are you guys? Tell me about yourselves! Please! I'm so bored right now. Me, I've been doing GI about 4 yrs. now. Prior to that I was a med/surg nurse. I've also worked in a family practice office and as a home health nurse (briefly). I worked in the GI lab at a hospital for a year or so. Since then I've been working in an outpatient surgery center, which is heavenly! We only do upper/lower endoscopies. No bronchs/ERCP's or anything else. 99% of our procedures are diagnostic (vs. therapeutic) so I rarely see GI bleeds, food boluses, etc. anymore. Sometimes I actually miss that.....but....I DON'T miss taking call and working Saturdays! :chuckle Anybody else alive out there??? Amy :)

When I worked at the hospital, I took call about once a week and a weekend every other month or so. It wasn't too bad. Now I work at an outpatient surgery center and there is NO CALL !! Yippee. Amy :)

We don't do our own sedation where I work. Anesthesia does it. But when I worked at the hospital we were NOT allowed to push it. Only Demerol/Versed/Droperidol...........the usual stuff. :) I just atttended a workshop for IVCS. It was pretty interesting. They said Propofol can be given by any RN. So it must just be up to the hospital's policy where it can be pushed. Only in ICU...or whatever. Amy :)