Clinical application of enhanced recovery after surgery in the treatment of choledocholithiasis by ERCP.

ABSTRACT: This study aims to investigate the effect of applying enhanced recovery after surgery methods (ERAS) in perioperative nursing of choledocholithiasis following endoscopic retrograde cholangiopancreatography (ERCP) for treatment of biliary calculus.Clinical data from 161 patients who underwent ERCP surgery in Wuhan Union Hospital from January 2017 to December 2019 were retrospectively analyzed. A total of 78 patients received perioperative nursing using the ERAS concept (experimental group) and 83 patients received conventional perioperative nursing (control group). Group differences were compared for the time to first postoperative ambulation, exhausting time, time to first defecation and eating, intraoperative blood loss, postoperative complication incidence (pancreatitis, cholangitis, hemorrhage), white blood cell (WBC), and serum amylase (AMS) values at 24 hours, duration of nasobiliary duct indwelling, length of hospital stay, and hospitalization expenses.No significant between-group differences were noted for demographic characteristics (age, sex, BMI, ASA score, and comorbidity) (P > .05). Time to first ambulation, exhausting time, time to defecation and eating, and nasobiliary drainage time were shorter in the experimental group than the control group, and the differences were statistically significant (P < .05). There was no significant between-group difference in postoperative WBC values at 24 hours (P > .05), but the experimental group's AMS values at 24 hours postoperation were significantly lower than those of the controls (154.93 ±â€Š190.01 vs 241.97 ±â€Š482.64, P = .031). Postoperative complications incidence was 9.1% in the experimental group, which was significantly lower than the 20.4% in the control group, and this difference was statistically significant (P = .039). Compared with the control group, nasobiliary drainage time (26.53 ±â€Š7.43 hours vs 37.56 ±â€Š9.91 hours, P < .001), hospital stay (8.32 ±â€Š1.55 days vs 4.56 ±â€Š1.38 days, P < .001), and hospitalization expenses (36800 ±â€Š11900 Yuan vs 28900 ±â€Š6500 Yuan, P = .016) were significantly lower in the experimental group.ERAS is a safe and effective perioperative nursing application in ERCP for treating choledocholithiasis. It can effectively accelerate patients' recovery and reduce the incidence of complications; therefore, it is worthy of being applied and promoted in clinical nursing.

Nurse-administered propofol sedation for endoscopy: a risk analysis during an implementation phase.

BACKGROUND AND STUDY AIMS: The aim of the present study was to perform a risk analysis during the implementation phase of nurse-administered propofol sedation (NAPS) and to validate our structured training program. PATIENTS AND METHODS: A structured training program was developed both for endoscopists and for endoscopy nurses who were administering propofol sedation. The nurses' program comprised a 6-week course including theoretical and practical training in airway management, and the endoscopists' program consisted of 2.5 h of theory and a short course in practical airway management. In the implementation phase, data from 1822 endoscopic procedures in 1764 patients were prospectively collected. All adverse events related to sedation were recorded (defined as oxygen saturation < 92%, airway handling, assisted ventilation, need for intubation, change in blood pressure > 20 mmHg). RESULTS: 78 cases of hypoxemia were documented in 1764 patients (4.4%), in 56/983 upper endoscopies (5.7%) and 22/754 lower endoscopies (2.9%) (P = 0.007). Assisted ventilation was necessary in 19 cases (1.1%) and anesthesiologic assistance was requested 10 times. Two patients required endotracheal intubation. A change in blood pressure was recorded in 451 patients (26%). Independent risk factors were type of intervention and level of experience of the staff performing the sedation. CONCLUSION: These results were obtained after development of a structured training program both for endoscopists and nurses using propofol for sedation, and can be used as basis for further comparison. NAPS for endoscopic procedures is safe when performed by personnel properly trained in airway handling and sedation with propofol, and has considerable advantages compared with conventional sedation for endoscopy.

The use of endoscopic retrograde cholangio pancreatography.

Endoscopic retrograde cholangio pancreatography (ERCP) combines endoscopic and radiographic techniques and is carried out to allow detailed examination of the bile ducts, pancreatic duct and gallbladder. It can serve as a diagnostic or therapeutic tool. This article provides an update on the procedure as well as indications and contraindications. The nurse's role in caring for patients undergoing ERCP--which includes preparing them for the procedure, observing them post-ERCP and providing health education for discharge and beyond--is also covered.

Preoperative education improves quality of patient care for endoscopic retrograde cholangiopancreatography.

The goal of this study was to evaluate the effect of preoperative education on patient satisfaction and cooperation during an endoscopic retrograde cholangiopancreatography (ERCP) procedure. Risk reduction was also studied in terms of decreased meperidine administration. Subjects were preoperatively educated by the endoscopy nurse regarding the ERCP procedure and how to communicate with the nurse during the procedure. Forty-five patients with a mean age of 58 years participated in the study. Effective patient cooperation was achieved. All subjects were satisfied with the educational process and the ERCP team. These findings suggest preoperative education is a cost-effective intervention in enhance patient cooperation and patient satisfaction for patients undergoing ERCP.

ALARA study of teaching effectiveness on reducing radiation exposure.

The purpose of this study was to measure the effectiveness of radiation safety instruction and the impact on radiation film badge levels. A convenience sample of 144 endoscopy nurses and technicians was pretested for radiation safety knowledge, given a course in radiation safety, and then posttested immediately after the course and then 6 months later. Radiation badges were analyzed for radiation exposure at preinstruction, 1 month postinstruction, and 6 months postinstruction. Results showed that the instruction was effective. There was only a slight decrease in radiation badge readings; the decrease, however, was not statistically significant.

Electrocautery and patients with implanted cardiac devices.

Implanted cardiac devices, pacemakers, and automatic cardioverter/defibrillators are becoming more common in the general population. There are more than one-half million persons with pacemakers living in North America, and approximately 20,000 patients have received automatic implantable cardioverter/defibrillators. As pacemaker and defibrillator patients experience common gastrointestinal afflictions, it is likely that more will require endoscopic procedures. Appropriate precautions must be undertaken during electrosurgical procedures in order to avoid damage and interruption of pacemaker/defibrillator devices. Through careful assessment, intervention, and discharge planning, the GI nurse and associate can reduce electrosurgical risks to the gastrointestinal patient with an implanted cardiac device. Specific recommendations for preprocedure patient assessment and intraprocedure interventions are discussed, and an actual case is presented to illustrate a successful plan of care.

Helpful hints for endoscopic biliary stenting.

At Duke University Medical Center approximately 1,000 endoscopic retrograde cholangiopancreatography procedures are completed per year. Hints for biliary stenting have been developed. This article is meant to provide the GI nurse/associate with a quick reference when assisting with stent placement.

Interventional ERCP: techniques and nursing care.

As a diagnostic and interventional procedure endoscopic retrograde choledochopancreatography (ERCP) is growing in popularity. Interventional endoscopists can diagnose and treat problems of the hepatobiliary system and technology is expanding the scope of the technique. Increasingly nursing staff on surgical wards are required to provide care for patients undergoing ERCP. A sound understanding of the procedure and potential complications allows accurate nursing assessment and individualised planning to ensure the highest standard of care.

Risks of endoscopic retrograde cholangiopancreatography and therapeutic applications.

Endoscopic retrograde cholangiopancreatography and its therapeutic applications are the most invasive and risky procedures performed regularly by endoscopists. Potential complications include those of the endoscopy (sedation reactions, infection transmission, perforation, etc.), those specific to instrumentation of the bile duct and pancreas (sepsis, pancreatitis) and those caused by therapeutic intervention, especially sphincterotomy (perforation and bleeding). These complex procedures require two fully trained GI nurse assistants. One is responsible for the safety of the patient (who is often elderly and frail) before, during and after the procedure. The other is responsible for ensuring that all necessary equipment is available and correctly disinfected and assists the endoscopist during the examination.