Upper GI endoscopy preperation

Thursday, January 5, 2023 18:02

How do you prepare a patient for an UPIE ??

Preperation depends on
1. Patient factors
2. Condition that we are anticipating
3. Whether we are planning doing a procedure

In order to perform a safe endoscopy there are

Pre procedure
Intra procedure
Post procedure preperations

Componants of pre procedural preperation includes

1. Identification of patient , procedure type , indication
2. Informed consent
3. Hx taking and examination
4. Risk stratification and sedation planning
5. Need for antibiotic prophylaxis
6. Patient monitering devices
7. Preparing for emergency situations

Upon receiving the patient to ward

1. Check the correct patient
2. Consent
1. "voluntary agreement by a patient with sound decision
making capacity to undergo proposed endoscopic
procedure after adequately understanding the
purpose, nature, benefit, risks, complications, and
alternatives related to the procedur

3. Hx and Ex
1. Abnormalities of the major organ systems
2. Previous adverse experience with sedation/analgesia
as well as regional and general anesthesia
3. Drug allergies, current medications, and potential drug
interactions
4. Time and nature of last oral intake
5. History of tobacco, alcohol, or substance use or abuse
Patients medical Hx should be thouroughly assessed.
Cardiopulmonary co morbidities

Examination
1. Vitals , Airway
2. Auclutation of heart and lungs
3. Conciousness
4. Assesment of airway
i. Micro/retrognathia
ii. Limited neck movements
iii. Loose dentures
iv. Raniofacial abnormalities

If the patient is in anticoagulation

Warfarin , clopidogrel , aspirin

Decision is based on
1. Risk of bleeding during procedure
2. Risk of thrombotic/embolism if anticoagulation is withheld

Clopid action - thienopyridines

Bind to ADP receptors
Which prevent activation of GPIIb/IIIa complex , reducing
aggregation.

Aspirin - no need of witholding

Clopidogrel
Depends on indication
Baremetal stents - 1 months
Drug eluting stents - 12 months
Warfarin
Withoulding shiuld be done 5-7 days
Bridging should be considered

Fasting period
Minimally if there is no outflow obstruction
2 hrs for clear liquids
6 hours for solids

If a patient is in obstruction
GOO , Achalasia
Prolonged fasting 24 hrs for solids
NG tube aspiration ??

Type pf anaesthesia
Commonly used is
10% Xylocaine spray
Pumps 10mg per spray dose
Max dose is 20 sprays
Can use upto 10 sprays to anasthetize the throat

Or can be performed under sedation

Antibiotic prophylaxis when to consider ???

May be need in high risk patients

1. Cirrhosis patients with UGI bleeding
2. Drainage of a pancreatic collection
3. PEG
4. NOTES surgery
5. EUS Fnac of a lesion in GI tract

Upon receiving the [atient to theatre

1. Run a checklist to patient identification
2. Clinic notes
3. Make sure a cannula is placed
4. Make sure patient monitering system is working and ready
5. Make sure you are prepared for an emergency situation
1. Defibs , IC tubes , ambou
2. Emergency tray drugs