A Planning Playbook for Opening a New Orthopedic ASC
The ASC market continues its rapid growth. In 2023, roughly 116 new ASCs opened in the U.S., many of which were orthopedic-specific in nature....
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By: Robin Egbert
Published: 10/10/2007
RMV->) Your biggest patients might also be your biggest colonoscopy challenges. We once had to tie two stretchers together to scope a 500-plus-pound patient. Even then, all that weight pressing on his abdomen and his short neck made for a tense time. We had the Ambu bag ready, just in case.
Whether it's the obese patient with a compromised airway; the frail, elderly patient at risk for bleeding and perforations; or the patient whose NPO status changes depending on who's doing the asking, colonoscopy can go from routine to red alert in an instant. And this is to say nothing of anesthesia complications or malfunctioning equipment.
Looking back over my decade of experience in the endo suite, here are some suggestions and tips every nurse should be aware of. As you'll see, prevention is the key to an uneventful colonoscopy. There's plenty we can do to minimize problems.
1 Start with a good physical assessment.
There's much you can detect by physically assessing the patient and reviewing his history and physical, including his weight, allergies, current medications, medical history and surgical history. Some examples:
2 Assess every patient for NPO status.
Patients NPO for less than six hours are at higher risk for aspiration. You can never ask a patient too many times about his NPO status - double- and triple-check and you'll see that the glass of water turns into two and that nothing to eat turns into a hot dog consumed one hour ago. Keep in mind that patients may not be totally truthful with the nurse, but may feel the need to confess as soon as the anesthesia provider walks behind the curtain.
3 Keep your pulse oximeter on.
Propofol depresses the central nervous system and may decrease patients' respiratory and cough centers. Maintain good ventilation and keep your pulse oximeter on. It will alert you when something is wrong and allows for early intervention if the patient's oxygen saturation begins to fall below acceptable levels (see "If You're Thinking of Buying ' A Pulse Oximeter" on page 84). It's always a good idea to pre-oxygenate patients before the procedure via nasal cannula, especially smokers and patients with compromised respiratory status. Getting the oxygen level up before you sedate really makes a significant difference. Be careful not to over oxygenate COPD patients.
4 When the procedure's done.
The case is over. All went well. The patient is emerging from sedation. Where's your focus? Likely on the screens and scopes, when it should still be on the patient as he emerges. Make sure the patient is breathing normally. As you know, patients can experience hypoventilation due to medications or laryngospasm at any time.
5 Check your equipment.
Before the patient enters the room, all equipment should be set up, turned on and checked - from top to bottom. It's a long list, but you're going to significantly reduce problems in the long run.
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6 When things go wrong.
So far, we've talked about preventing problems before they occur. Now we're going to touch on what to do when things go wrong, as they inevitably will.
Not long ago, we couldn't connect the water bottle to the scope. The problem? One of the scope's fittings that plugged into the light source was off maybe an eighth of an inch, enough that we couldn't get the water bottle connected. I wouldn't want my equipment rep to hear this, but we needed to fix it then and there, so I pulled out a pair of pliers and tweaked (ever so gingerly) the fitting just a hair. And it fit. Most equipment problems, however, will require you to send the scope out for repair.
In the case of suspected microperforation, typically the patient may run a fever after an uneventful colonoscopy 24 to 48 hours post-procedure. You may discover this on your follow-up call. The physician may choose to treat the patient with oral antibiotics prophylactically and send him for an X-ray.
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