ABSTRACT
The argon plasma coagulator is a device used for noncontact thermal coagulation of tissue. The device was first used in open and laparoscopic surgical procedures and in 1991 was adapted for use in endoscopy. Since then, argon plasma coagulation has expanded its clinical applications in the treatment of various gastrointestinal conditions. The endoscopy nurse plays an important role in the care of patients before, during, and after argon plasma coagulation treatment. This article reviews the principles and components of the argon plasma coagulator, and provides a summary of the various clinical applications, patient safety practices, and potential complications of argon plasma coagulation therapy.
Subject(s)
Endoscopy, Gastrointestinal/methods , Endoscopy, Gastrointestinal/nursing , Laser Coagulation/methods , Laser Coagulation/nursing , Perioperative Care , Angiodysplasia/surgery , Argon , Barrett Esophagus/surgery , Endoscopy, Gastrointestinal/adverse effects , Esophageal and Gastric Varices/surgery , Gastric Antral Vascular Ectasia/surgery , Hemostasis, Endoscopic/methods , Hemostasis, Endoscopic/nursing , Humans , Laser Coagulation/adverse effects , Laser Coagulation/instrumentation , Nurse's Role , Nursing Assessment , Patient Selection , Peptic Ulcer Hemorrhage/surgery , Perioperative Care/methods , Perioperative Care/nursing , Proctitis/etiology , Proctitis/surgery , Radiation Injuries/surgery , Stomach Neoplasms/surgeryABSTRACT
BACKGROUND AND STUDY AIMS: Recent studies have documented the safety of propofol sedation for endoscopic procedures, but many endoscopists are reluctant to use propofol for high-risk patients because of adverse effects. The aim of this study was to demonstrate the safety and efficacy of nurse-administered propofol sedation during emergency upper endoscopy for patients with gastrointestinal bleeding. PATIENTS AND METHODS: Over a period of 18 months, 120 patients suffering from acute upper gastrointestinal bleeding received propofol sedation administered by a registered nurse. Among these, 15 patients were classified into American Society of Anesthesiologists (ASA) class IV, 84 were ASA class III, and 21 were ASA class II. Patients without gastrointestinal bleeding, who also received propofol during the same period and were matched for age, gender, and ASA class, served as controls. RESULTS: Endoscopic hemostasis was achieved in 98.3 % of patients, and 97.5 % were satisfied with the procedure. In patients with gastrointestinal bleeding, the rates of hypotension (systolic blood pressure < 90 mmHg) and hypoxemia (peripheral oxygen saturation < 90 %) were 8.3 % and 6.7 % respectively, values higher than those in the control group. However, neither mask ventilation nor endotracheal intubation was necessary. Although two patients with gastrointestinal bleeding developed pneumonia, most likely due to aspiration during the procedure, they recovered within 5 days of treatment. There were no sedation-associated severe complications or mortalities. CONCLUSION: Using a strict protocol designed to protect the patient's airway and cardiovascular function, nurse-administered propofol sedation during emergency upper gastrointestinal endoscopy is safe and appropriate in cases of acute gastrointestinal bleeding.