BY LYNN ELSLOO RN CGRN Chapter 23 Endoscopic Diagnostic Procedures and Tests.
CAPSULE ENDOSCOPY Kendall Yoshisato, RN, CGRN Northern CA SGNA September 22, 2012.
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Transcript of CAPSULE ENDOSCOPY Kendall Yoshisato, RN, CGRN Northern CA SGNA September 22, 2012.
CAPSULE ENDOSCOPY
Kendall Yoshisato, RN, CGRNNorthern CA SGNASeptember 22, 2012
OBJECTIVES
Understand the history of small bowel exploration
Review the indications for capsule studies
Discuss the nursing assessment/education for capsule endoscope
Describe the role of the nurse reviewer
Capsule Endoscopy
History of Small Bowel Imaging Radiology
Small Bowel Follow Thru Angiograms Tagged Red Blood Cell Studies
Capsule Endoscopy History of Small Bowel Exploration
Use of colonoscopes Sonde Enteroscopes Development of push enteroscopes Capsule Endoscopy (2001)
Given; Olympus; IntroMedics (Korea); OMOM (China)
Double Balloon/Single Balloon Enteroscopy (Japan 2001)
Capsule Endoscopy
Current Capsule use: Small Bowel
Obscure GI bleeding Small Bowel Disorders
Tumors NSAID ulcers Celiac/Sprue Crohn’s Colitis
Esophageal Varicies Barrett’s Esophagus
Capsule Endoscopy – Small Bowel
Process: Prepares
bowel using standard colon prep
Sensor Array applied
Ingest Capsule
Capsule Endoscopy – Small Bowel
Download images
Wait 6-8 hours
EGD Capsule Placement
Capsule Endoscopy - Esophagus
Patients typically fast for two hours prior to undergoing the PillCam ESO procedure. Upon arriving the physician’s office, patients follow the Simplified Ingestion Procedure (SIP). While standing, a patient will first drink 100 mL of water. They will then be asked to lie on their right side, swallow the PillCam ESO video capsule and take one sip of water every thirty second for seven minutes. After seven minutes, the nurse will instruct the patient to sit upright, drink another sip of water and wait for thirty seconds. The PillCam passes naturally with a bowel movement usually within twenty-four hours.
Nursing Assessment/Education
Procedure Preparations
Standard Colon Preparation
½ Colon Preparation
Clear Liquids
Nursing Assessment/Education
Patient is able to meet time parameters (8 hour study). Patient has a valid consent. Patient is responsible to return equipment. Patient is able to understand and perform colon preparation. Patient is able to tolerate clear liquid diet. Patient does not have any swallowing disorders. (Review radiological studies). Patient does not have or suspected to have a gastrointestinal obstruction. (Review
radiological studies). Patient does not have or suspected to have strictures. Patient does not have or suspected to have fistulas. Patient does not have or suspected to have a Zenker's or Meckel's Diverticulum. Patient does not have a cardiac pacemaker or implanted electromedical devices. Patient does not have a history of or suspect slow gut transit time. Patient does not have an MRI scheduled within 1 week of capsule ingestion. Patient is not pregnant. LMP for women of child bearing ages. Patient requires EGD for capsule placement. Type of work. Check for possible electromagnetic issues.
Agile Capsule
Nursing Assessment/Education
Once the capsule is ingested
1. Document the time the capsule was swallowed 2. You may start clear liquids 2 hours after swallowing the capsule. You may take your necessary medications at this time. **Nothing Red.3.You may have a light lunch (half sandwich/cup of soup, etc) 4 hours after swallowing the capsule.4. You should not be near any source of electromagnetic fields (MRI, Ham radio) or microwave oven. 5. NO strenuous physical activity, including bending over during the exam.6. You will need to check the blue light on the top of the data recorder every 15 minutes during the exam. The exam takes approximately 8 hours.7. DO NOT DISCONNECT the equipment during the exam.8. DO NOT enter federal or state buildings, airports, or banks with metal detectors while wearing the recorder. 9. Return to GI Clinic if you have nausea, vomiting or abdominal pain.
Streamlined Functionality – Function Bar
PillCam SB
Progress Indication available for full videos and only in A-mode
(not in M-mode nor for video segments)
Function bar
Streamlined Functionality – Tooltips
Place mouse cursor over any icon on the RAPID main
screen for Tooltip to display
Capsule Endoscopy
Capsule Endoscopy
Small Bowel Capsule Images:
Capsule Endoscopy
Esophageal Images:
FICE LITERATURE REVIEW
Computed Imaging Modification for Enhancement of Small-Bowel Surface Structures at Video Capsule Endoscopy
By emphasizing lesion hypervascularity and vascular morphology, FICE might aid in differentiation of neoplastic and non-neoplastic lesionsThis novel imaging technique has the potential to improve the diagnostic yield of video capsule endoscopy for obscure gastrointestinal bleeding
Endoscopy 2010;42(6):490-492.
Report Templates
Electronically Signed by:
Moti Frisch MD 01/06/2010
Referring physician’s reason for referral
Referring physician’s reason for referral
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Template
Localization
Progress Indicator
1 ON ON
2 ON OFF
3 OFF ON
4 OFF OFF
RAPID Real-Time v7.0
FEATURES
Key Feature Comment
Dedicated real-time only software
• No RAPID Reader
Lower pricing• Dell 2100 platform lowers costs while maintaining product quality
Functionality• Touch screen• Small size enables hand held use• Support for all PillCam video capsules
DELL 2100
Standard USB cable
DR 2
Capsule Endoscopy
Limitations: Diagnostic only Can’t control image view/direction Cannot inflate the bowel Limited field of view Still requires bowel prep Takes 6-8 hours May require EGD to pass capsule Capsule can be retained/cause bowel
obstruction
Smart Pill
Wireless Motility Capsule
Measures pH, pressure and temperature
Ingests the capsule after a meal.
Wears data receiver for up to 5 days
Excreted in stool after 24-48 hours
Smart Pill
Future of Capsule Endoscopy Colon Capsule Steering Drug Delivery Biopsy
Magnetically Guided Capsule Endoscopy
Swimming Capsules
Robotic Capsules
Drug Delivery Capsules