Colonoscopy Procedure

Posted By Lhynnelli, RN On September 4, 2010 @ 5:26 am In Medical Laboratory & Diagnostic
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 [1]Colonoscopy uses a flexible fiber-optic video

endoscope to permit visual examination of the lining of the large intestine. It’s indicated for
patients with history of constipation or diarrhea, persistent rectal bleeding, and lower abdominal pain
when the results of proctosigmoidoscopy and a barium enema test are negative or inconclusive.
Purpose

 To detect or evaluate inflammatory and ulcerative bowel disease.

 To locate the origin of lower gastro intestinal bleeding.
 To aid in the diagnosis of colonic strictures and benign or malignant
 lesions.
 To evaluate the colon postoperatively for recurrence of polyps and
 malignant lesions.

Patient Procedure

1. Check the patient’s medical history for allergies, medications, and information pertinent to the
current complaint.
2. Tell the patient to maintain a clear liquid diet for 24 to 48 hours before the test and to take
nothing by mouth after midnight the night before.
3. Instruct the patient regarding the appropriate bowel preparation.
4. Inform the patient that he’ll receive an I.V. line and I.V. sedation before the procedure.
5. Tell the patient that the colonoscope is well lubricated to ease insertion and initially feels cool.
6. Explain that he may feel an urge to defecate when it’s inserted and advanced.
7. Inform him that air may be introduced through the colonoscope to distend the intestinal wall
and to facilitate viewing the lining and advancing the instrument.
  [2]Colonoscopy Procedure

1. The patient is assisted onto his left side with knees flexed.
2. Cover the patient with drape.
3. Baseline vital signs are obtained.
4. Vital signs and electrocardiogram are monitored during the procedure.
5. Continuous or periodic pulse oximetry is advisable.
6. The physician palpates the mucosa of the anus and rectum and inserts the lubricated
colonoscope through the patient’s anus into the sigmoid colon under direct vision.
7. A small amount of air is insufflated to locate the bowel lumen and then advance the scope
through the rectum.
8. Abdominal palpation or fluoroscopy may be used to help guide the colonoscope through the
large intestine.
9. Suction may be used to remove blood and secretions that obscure vision.
10. Biopsy forceps or a cytology brush may be passes through the colonoscope to obtain
specimens for histologic or cytologic examination; an electro-cautery snare may be used to
remove polyps.
11. Tissue specimens are immediately placed in a specimen bottle containing 10% formalin and
cytology smears in a Coplin jar containing 95% ethyl alcohol.
12. Specimens are sent to the laboratory immediately.

Nursing Interventions for Colonoscopy

1. The patient is observed closely for signs of bowel perforation.

2. Check the patient’s vital signs and document them accordingly.
3. Watch the patient closely for adverse effects of the sedative.
4. After recovery from the sedation, he may resume his usual diet unless the physician orders
otherwise.
5. The patient may pass large amounts of flatus after insufflation.
6. After polyp removal, the stool may contain some blood. Report excessive bleeding
immediately.
7. If a polyp is removed, but not retrieved, give enema and strain the stools to retrieve it.

Precautions

1. Although it’s usually a safe procedure, beware that colonoscopy can cause perforation of the
large intestine, excessive bleeding, and retroperitoneal emphysema.
2. This procedure is contraindicated in pregnant woman near term, the patient who has had a
recent acute myocardial infarction or abdominal surgery, and one with ischemic bowel disease,
acute diverticulitis, peritonitis, fulminant granulomatous colitis, perforated viscus, or
fulminant ulcerative colitis. For these cases of for screening purposes, a virtual colonoscopy
may be an option to help visualize polyps early before they become concerns.
Interpretations
Normal Results

 Normally, the mucosa of the large intestine beyond the sigmoid colon appears light pink-
orange and is marked by semilunar folds and deep tubular pits.
 Blood vessels are visible beneath the intestinal mucosa, which glistens from mucus secretions.

Abnormal Results

 Visual examination of the large intestine, coupled with histologic and cytologic test results,
may indicate procrititis, granulomatous or ulcerative colitis, Crohn’s disease, and malignant or
benign lesions. Diverticular disease or the site of lower gastrointestinal bleeding can be
detected through colonoscopy alone.

Interfering Factors

 Fixation of the sigmoid colon due to inflammatory bowel disease, surgery, or radiation therapy
that may hinder passage of the colonoscope. Blood from acute colonic hemorrhage that
hinders visualization. Insufficient bowel preparation or barium retained in the intestine
from previous diagnostic studies which makes accurate visual examination impossible.

Complications

 Perforation of the large intestine, excessive bleeding and retroperitoneal emphysema.