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Guidelines, Statements & Standards

Facts at your fingertips: Review important practice guidelines and the roles and responsibilities nurses play in specific procedures.

Endoscopy Procedures on Adults Staffing for Therapeutic Endoscopy Procedures

Position

The Canadian Society of Gastroenterology Nurses and Associates support the position that staffing patterns must reflect the responsibilities in the expanded role of the registered nurse in the performance of therapeutic Endoscopy procedures.

The registered nurse in this expanded role must also have skills in delegation and knowledge in the patient monitoring requirements.

The expanded role of the nurse is only to be carried out under the direct supervision of the attending physician. Responsibilities while assisting the physician with the equipment and performing specific actions will be in accordance with the provincial licensing body and the employer.  Each nurse is accountable for the responsibilities they accept.

During therapeutic Endoscopy procedures as identified by the Society a minimum of two nurses is recommended to be in attendance. One nurse would be an educated registered nurse experienced in gastroenterology and Endoscopy nursing and a second registered nurse to monitor the patient pre procedure, during the procedure, and post-procedure.

Definition

Therapeutic endoscopy procedures include but are not limited to: Emergency Endoscopy for control of bleeding (esophageal variceal banding, fundal variceal gluing, variceal sclerotherapy, esophageal gastric tamponade, heater probe/bicap/argon plasma coagulation, endolooping, endoclipping), Pneumatic Dilatation,  ERCP (diagnostic and therapeutic), Stent placement (esophageal and enteral), Laser therapy, Photodynamic therapy, Endoscopic Mucosal resection, PEG/PEJ insertion, Colonic decompression and Bronchoscopy.

Background

Gastroenterology nursing has witnessed significant evolutionary changes in the past 15 - 20 years. Factors such as an aging population, advanced technology and the specialization of gastroenterology medicine have all had an impact on nursing practice.  In the specialty of Gastroenterology, the factors that have influenced staffing include the performance of more complex diagnostic and therapeutic procedures, the changes in the physician practice (where one physician often performs the procedure with a nurse assisting, rather than another physician), and the resultant impact on the expanded role of the nurse.

The primary role of the registered nurse during endoscopy procedures is the maintenance of patient safety through continuous assessment of the patient’s condition and intervention as necessary.  Therapeutic endoscopy procedures involve advanced knowledge and technical skill in order to safely perform/assist with procedures to achieve desired patient outcomes.

Most patients undergoing therapeutic Endoscopy procedures will require “Conscious Sedation” (see position statement related to conscious sedation).

Accurate documentation is required that reflects that the standards of care have been met.    

Disclaimer

Canadian Society of Gastroenterology Nurses and Associates does not assume any responsibility for the practices or recommendations of any member or other practitioner or for policies and practices of any endoscopy unit.

Bibliography

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Bodinsky, Gretchen 1954. Developing a Staffing Model, Gastroenterology Nursing, 17(2), 71-75.
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Kidwell, J. 1991. Nursing Care of the Patient Receiving Conscious sedation During Endoscopic Procedures. Society of Gastroenterology Nurses and Associates. August , 23-32.
Kidwell,J. 1992. Nursing Management in an Endoscopy Setting. Gastroenterology Nursing. August 23-32
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Lalor, E. and Thompson, ABR 1996. Comparison of the utilization of Endoscopy Units in Selected Teaching Hospitals across Canada. Canadian Journal of Gastroenterology, 10 (56), October, 381-384.
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SGNA 2001 Role Delineation of the registered Nurse in a Staff Position in Gastroenterology/or Endoscopy