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Manipulation of Endoscopes During Endoscopic Procedures

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Disclaimer

The Society of Gastroenterology Nurses and Associates, Inc. present this guideline for use in developing institutional policies, procedures, and/or protocols. Information contained in this guideline is based on current published data and current practice at the time of publication. The Society of Gastroenterology Nurses and Associates, Inc. assume no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and practices of any practice setting. Nurses and associates function within the limits of state licensure, state nurse practice act, and/or institutional policy. The Society of Gastroenterology Nurses and Associates does not endorse or recommend any commercial products, processes, or services. A commercial product, process, or service is recognized as being consumed by or used on patients.

Definitions

For the purpose of this document, SGNA has adopted the following definitions:

Manipulation refers only to the act of advancing, maintaining position or withdrawing the endoscope under the direct supervision of the endoscopist. 


Gastroenterology Nurse
refers to practitioners (APRN, RN, LPN/LVN) in gastroenterology, hepatology, or endoscopy.

Nursing Assistive Personnel (NAP) refers to individuals who are trained to function in an assistive role in the gastroenterology setting who have direct care responsibility and are supervised by a Gastroenterology Nurse.


Background

The gastroenterology nurse or Nursing Assistive Personnel (NAP) may be called upon to provide assistance to the endoscopist by manipulating the endoscope, thereby enhancing the diagnostic or therapeutic abilities of the endoscopist.

Position

The Society of Gastroenterology Nurses and Associates, Inc. supports the position that the gastroenterology nurse or NAP is educated, experienced and has documented competency in gastrointestinal endoscopy may manipulate the endoscope under the direct supervision of the endoscopist when required to facilitate an endoscopic procedure. The endoscopist is responsible for providing detailed instructions to the gastroenterology nurse or NAP when manipulating the endoscope to promote patient safety. There should be clear communication between the endoscopy team members. A safety plan should be in place to address unexpected events. 

 

 SGNA also asserts the following: 

1. The gastroenterology nurse or NAP who assumes this role must have documented competency in: 

a. Techniques/skills of endoscope manipulation
b. Knowledge of complications associated with gastrointestinal endoscopy and their signs or symptoms,
c. Appropriate interventions under the direction of the endoscopist. 

2. It is essential that throughout the gastrointestinal endoscopy, the gastroenterology nurse or NAP manipulating the endoscope has a clear view of the entire lumen at all times and never uses force to advance the endoscope. 

3. The gastroenterology nurse or NAP manipulating the endoscope does not replace the endoscopist or assume responsibility of the endoscopic procedure. 

In addition to the gastroenterology nurse or NAP manipulating the endoscope a second registered nurse must be present to monitor and manage the care of the sedated patient (SGNA, 2016). 

Gastroenterology staff must review institutional policies and State Board of Nursing Position statements to provide safe patient care. 

References

Society of Gastroenterology Nurses and Associates, Inc. (2016). Minimum Registered nurse staffing for patient care in the gastrointestinal endoscopy unit [Position statement]. Chicago, IL: Author.

Recommended Reading

American Society for Gastrointestinal Endoscopists Standards of Practice Committee, (2011)

Complications of colonoscopy [Guideline].  Gastrointestinal Endoscopy, 74(4), 745-752.

Sagawa, T., Kakizaki, S., Iizuka, H., Onozato, Y., Sohara, N., Okamura, S., & Mori, M.  (2012).
Analysis of colonoscopic perforations at a local clinic and a tertiary hospital. World  Journal
 of Gastroenterology,
18(35), 4898-4904.

Shi, X., Shan, Y., Yu, E. et al. (2014) Lower rate of colonoscopic perforation: 110,785 patients of
colonoscopy performed by colorectal surgeons in a large teaching hospital in China. Surgical
Endoscopy,
28(8), 2309 – 2316

Singla, K.,  Mahajan,  G., Agarwal, S. & Sharma, S. (2012).  Role of histopathological examination
in nontraumatic perforation of colon. Tropical Gastroenterology, 33(4), 265-269.

Society of Gastroenterology Nurses and Associates, Inc. (2012).  Role delineation of the licensed
practical/vocational nurse in gastroenterology [Position statement]. Chicago, IL: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2012). Role Delineation of Nursing
Assistive Personnel in Gastroenterology [Position statement]. Chicago, IL: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2012). Role delineation of the registered
nurse in a staff position in gastroenterology  [Position statement]. Chicago, IL: Author.

Contributors

Adopted by SGNA Board of Directors, January 1991.

Revised February 1998, February 2004, September 2006, May 2009, March 2012 and October 2016.

SGNA Practice Committee 2016 – 17

Midolie Loyola MSN RN CGRN, Chair
Susan Bocian MSN BSN RN Co-Chair
Barbara K. Burkle, MSN ARNP FNP-BC
Angela Diskey, RN, MSN CGRN
Cynthia M. Friis, MEd BSN, RN-BC
Debbie Luteran, BSN RN CGRN
Lea Anne Myers, MSN RN CGRN
Candice M. Quillin, BSN RN CGRN
Susan Selking, BSN RN CGRN

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