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Performance of Gastrointestinal Manometry Studies and Provocative Testing

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Disclaimer

The Society of Gastroenterology Nurses and Associates, Inc. (SGNA) assumes no responsibility for the practices or recommendations of any member or other practitioner, or for the policies and procedures of any practice setting. Nurses and associates function within the limitations of licensure, state nurse practice act, and/or institutional policy.

Definitions

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

Anorectal manometry refers to a catheter with sensors measuring pressures which include the anus and rectum and the area in between (SGNA, 2013a).

Esophageal manometry measures pressures throughout the regions of the esophagus, which include the upper esophageal sphincter (UES), esophageal body, and lower esophageal sphincter (LES) (SGNA, 2013a).

Antroduodenal manometry refers to the measuring of gastric and small intestinal contractions (SGNA 2013a).

Gastrointestinal manometry is a broad term for all diagnostic tests that measure changes in intraluminal pressure and the coordination of activity in the muscles of the gastrointestinal (GI) tract (SGNA, 2013a).

Gastroenterology Nurse refers to practitioners (Advanced Practice Registered Nurse, Registered Nurse, and Licensed Practical Nurse/Licensed Vocational Nurse) in gastroenterology, hepatology or endoscopy.

High resolution manometry (HRM) has the advantage of displaying the dynamics of the entire esophagus and sphincters as colors assigned to the pressures called a Clouse plot. High resolution manometry is evolving technology with new types of pressure measurements and classifications of manometry abnormalities (SGNA, 2013a).

Impedance manometry refers to the technology that combines impedance sensors with pressure sensors throughout the esophagus to measure bolus clearance (SGNA, 2013a).

Licensed Practical/Vocational nurse refers to Licensed Practical Nurse (LPN) and Licensed Vocational nurse (LVN) (SGNA, 2013b).

Nursing Assistive Personnel (NAP) refers to individuals who are trained to function in an assistive role in the gastroenterology setting. Nursing Assistive Personnel who have specialized training or education in a specific area (gastroenterology), may be further classified as Technicians, for example, GI assistants, GI technicians, GTS (GI Technical Specialist) or AGTS (Advanced GI Technical Specialist) who have direct patient care responsibility and are supervised by a GI Registered Nurse (RN) (ANA, 2007; SGNA, 2013b).

GI Registered Nurse refers to Advanced Practice Registered Nurse (APRN) and Registered Nurse (RN) (2013b).

Provocative testing refers to a technique designed to reproduce non cardiac chest pain that may be esophageal in origin (SGNA, 2013a).

Sphincter of Oddi manometry refers to a recording of pressures within the Sphincter of Oddi, usually obtained during endoscopic retrograde cholangiopancreatography (ERCP) (SGNA, 2013a).

Background

The gastroenterology nurse and associate continue to have a prominent role in the diagnosis of motility abnormalities including procedures of esophageal (standard or high resolution), sphincter of Oddi, impedance, antroduodenal and anorectal manometry. Nursing care of the patient undergoing these studies involves (SGNA, 2009; SGNA, 2013a):

Identification of indications and contraindications, 
Nursing assessment, 
Medication administration, if indicated, 
Probe insertion, 
Performance of the study, 
Patient Education, 
Recognition of potential complications, and 
Documentation. 

Pediatric patients undergoing manometric procedures also require a nurse or associate familiar with the special developmental and behavioral needs of this population (Di Lorenzo et al., 2002; Nurko, 2004).

Provocative testing may include pharmacological and non-pharmacological agents.

Position

The role of the gastroenterology nurse and associate includes reporting the manometric findings, maintaining the equipment and recognizing technical difficulties or mechanical malfunction (Conklin, Pimentel, & Soffer, 2009; Murray Clouse, & Conklin, 2003; Parkman & Orr, 2007).

The Society of Gastroenterology Nurses and Associates, Inc. recommends that the GI personnel responsible for manometry and provocative testing have the education, knowledge of medications, and technical skills for the test being performed and follow institutional guidelines. Personnel performing the study must have knowledge of anatomy and physiology and be prepared to identify untoward patient reactions.

The GI registered nurse experienced in gastroenterology nursing and manometry studies is responsible for assessing, educating, and preparing the patient, and performing the study. During the procedure the GI registered nurse documents events and pertinent information (e.g., patient position) on the tracing necessary for interpretation by the physician. The GI registered nurse must be prepared to intervene in the event of untoward reactions, including but not limited to epistaxis, vaso-vagal reactions, syncope, intravenous (IV) infiltration, and adverse reactions to medications used for provocation.

The Society of Gastroenterology Nurses and Associates, Inc. supports the position that the licensed practical/vocational nurse and the nursing assistive personnel, experienced in gastroenterology and/or manometry studies, may be given the responsibility of preparing the patient and performing the study under the direction of the GI registered nurse and/or physician. The LPN/LVN and NAP may document events during the procedure on the tracing that correspond to patient activity for interpretation by the physician.

The Society of Gastroenterology Nurses and Associates, Inc. recommends GI nurses and associates follow state, institutional and manufacturer guidelines for performance of these procedures. The Society of Gastroenterology Nurses and Associates, Inc. also recommends that the responsibility to perform pharmacological provocative testing be limited to qualified GI registered nurses.

References

American Nurses Association. (2007). Registered nurses utilization of nursing assistive personnel in all settings [Position statement]. Retrieved from  http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/ Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/Registered-Nurses-Utilization-of-Nursing-Assistive-Personnel-in-All-Settings.html

Conklin, J., Pimentel, M., & Soffer, E. (2009). Color atlas of high resolution manometry. New York, NY: Springer Publishing.

Di Lorenzo, C., Hillemeier, C., Hyman, P., Loening-Baucke, V., Nurko, S., Rosenberg, A., & Taminiau, J. (2002). Manometry studies in children: Minimum standards of procedures. Neurogastroenterology Motility, 14, 411-420. doi: 10.1046/j.1365-2982.2002.00347.x

Murray, J. A., Clouse, R. E., & Conklin, J. L. (2003). Components of the standard oesphageal manometry. Neurogastroenterology Motility, 15, 591-606. doi: 10.1046/j.1365-2982.2003.00446.x

Nurko, S. (2004). Gastrointestinal manometry: Methodology and indications. In

W. A. Walker, O. Goulet, R. E. Kleinman, P. M. Sherman, B. L. Schneider, & I. R. Sanderson (Eds.), Pediatric gastrointestinal disease: Pathophysiology, diagnosis, management (4th ed.) (pp. 1786-1801). St. Louis, MO: Mosby.

Parkman, H. P., & Orr, W. C. (2007). The gastrointestinal motility laboratory.
Gastroenterology Clinics of North America, 36, 515-529.

Society of Gastroenterology Nurses and Associates, Inc. (2013a). Gastroenterology nursing: A core curriculum (5th ed.). Chicago, IL: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2009). Manual of gastrointestinal procedures (6th ed.). Chicago, IL: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2013b). Standards of clinical nursing practice and role delineations. [Practice standard]. Chicago, IL: Author.

Recommended Reading

American Society for Gastrointestinal Endoscopy. (2005). Wireless esophageal pH monitoring system. Gastrointestinal Endoscopy, 62(4), 485-487.

American Society for Gastrointestinal Endoscopy. (2011). Sphincter of Oddi manometry.
Gastrointestinal Endoscopy, 74(6), 1175-1180.

American Society for Gastrointestinal Endoscopy. (2012). Esophageal function testing.

Gastrointestinal Endoscopy, 76(2), 231-243.

Bredenoord, A. J., Fox, M., Kahrilas, P. J., Pandolfino, J.E., Schwizer, W., Smout, A.J., & International High Resolution Manometry Working Group. (2012). Chicago classification criteria of esophageal motility disorders defined in high resolution esophageal pressure topography (EPT). Neurogastroenterology Motility, 24, 57-65.

Gyawali, C. P., Bredenoord, A. J., Conklin, J. L., Fox, M., Pandolfino, J. E., Peters, J. H., Roman, S., Staiano, A., & Vaezi, M. F. (2013). Evaluation of esophageal motor function in clinical practice. Neurogastroenterology & Motility, 25, 99-133.

Park, M. (2010). Recent concept in interpreting high-resolution manometry. Journal of Neurogastroenterology Motility, 16, 90-93.

Parkman, H. P. (2006). Training in gastrointestinal motility. Digestive Disease, 24, 221-227.

Society of Gastroenterology Nurses and Associates, Inc. (2012). Minimum registered nurse staffing for patient care in the gastrointestinal endoscopy unit [Position statement]. Chicago, IL: Author.

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 the registered nurse in a staff position in gastroenterology [Position statement]. Chicago, IL: Author.

Society of Gastroenterology Nurses and Associates, Inc. (2013). Role delineation of nursing assistive personnel in gastroenterology [Position statement]. Chicago, IL: Author

Contributors

SGNA Practice Committee 2013-14 ‚Äč
Michelle R. Juan, MSN, RN, CGRN — Chair
Ann Herrin, BSN, RN, CGRN — Co-chair
Judy Lindsay, MA, BSN, RN, CGRN
Midolie Loyola, MSN, RN, CGRN
Beja Mlinarich, BSN, RN, CAPA
Marilee Schmelzer, PhD, RN
Sharon Yorde, BSN, RN, CGRN
Kristine Barman, BSN, RN, CGRN
Cynthia M. Friis, MEd, BSN, RN-BC

 
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