ENDOS

BANGALORE BAPTIST HOSPITAL Page: 1 of 34
DEPARTMENT OPERATING MANUAL Version No: 03

PM/DOM-03/SCOPY SCOPY DEPARTMENT Effective Date : 01/06/18
TABLE OF CONTENT
Sl. No. Topic Page No

1. Scope of the Department 2
2. SOP for outpatient examination 3
3. SOP for Care of the Endoscopy Patient 4
4. Other Services 5
5. SOP for sterilization 6
6. SOP for Patient Care Protocol 7
7. Staff Training And Patient Education Procedures 8
8. Giving Appointment for Scopy 9
9. Preparation of Scopy Room 10
10. Scopies 11
11. Bronchoscopy 14
12. Electoconvulsive therapy 16
13. Cytoscopy 17
14. Endoscopic Retrograde Cholangio Pancreatography (ERCP) 18
15. Assisting With Endoscopic Esophageal Dilatation 20
16. Cleaning, Disinfection of scopy 22
17. Aldrete Recovery Score 25
18. SOP for Reuse of catheterization hardware 26
19. SOP for scheduling appointments for endoscopy patients 28
20. List of associated records 30
Annexure List
Annexure No.1 Role of HOD, consultant, Nurse, Nursing Aide
Reviewed & issued by: Division Head Approved by: Director(CEO)

1 SCOPE OF THE DEPARTMENT

1.1 Purpose
1.1.1 To define guidelines for different procedures carried out in the endoscopy
department
1.1.2 To teach undergraduates and post graduates(DNB) endoscopic procedures under
the supervision of consultants
1.2 Scope of the department
All inpatients and Out patients of BBH
1.3 Responsibility
The Head of department of Surgery is directly responsible for ensuring
implementation of guidelines and instructions laid down.
1.4 Quality Objectives
1.4.1 The staff will commit to provide treatment with the set standards of
professionalism. This entails confidentiality and quality care for patients.
1.4.2 Treatment is provided in such a way as to ensure minimum scope for error,
ensuring good accuracy.
1.4.3 To treat patients with equality and respect. We shall endeavor to value the
patient’s time and minimize waiting time.
1.4.4 Case presentation, seminars, journal clubs etc. for undergraduate & post graduate
are conducted regularly.
Note*: For all the general nursing procedures refer OP - nursing department operating manual

2 SOP FOR OUTPATIENT EXAMINATION
2.1 Patients who come after the registration are called in according to their ‘queue’ number.
2.2 They are seen either by the consultants or by the junior medical staff depending upon
the type of registration made PC/By-choice/general.
2.3 Inter-departmental referrals, if seen by a junior doctor, are shown to a consultant.
2.4 A detailed history is elicited about their complaints, followed by a thorough physical
examination.
2.5 A diagnosis/provisional diagnosis is made and relevant investigations are asked for if/as
needed.
2.6 Patient is then prescribed medications and asked to come back for follow-up
accordingly.
2.7 Other outpatient facilities to help in diagnosis are imaging and endoscopy.
2.8 Out patients details are entered in the endoscopy register.
2.9 Outside referral patients are asked to open a new file and come for procedure.

3 SOP FOR CARE OF THE ENDOSCOPY PATIENT
3.1 Out Patient

3.1.1 A full and complete history will be taken followed by a thorough physical
examination. This will be recorded in detail in the O.P. chart.
3.1.2 Pertinent lab / imaging studies/endoscopy may be requested.
3.1.3 All data will be recorded / available in the O.P. chart.
3.1.4 A provisional / differential diagnosis should be entered.
3.1.5 Treatment is prescribed as per the provisional diagnosis.
3.1.6 Patient is asked to report back as and when the investigation reports are ready.
3.1.7 Medication / treatment plan may be changed as per the investigation reports.
3.1.8 Follow up will be done at intervals at the discretion of the treating doctor,
commensurate with the severity / type of patients illness.
3.1.9 Patient may be asked to stop/modify medication / treatment when the treating
doctor is satisfied that the symptoms / disease is cured / under control.
3.1.10 Preventive measures (medication, lifestyle modification, physical therapy) may be
advised as required.

4 OTHER SERVICES
4.1 Endoscopic Services
4.1.1 Elective Gastroscopy and colonoscopy procedures are done in the mornings on
Mondays, Wednesday s and Thursdays, Emergency scopies as required.
4.1.2 The patients for endoscopic services are given an appointment.

5 SOP FOR STERILIZATION

5.1 Sterilization of instruments is as follows:
5.1.1 All the scopes after use are thoroughly washed.
5.1.2 Then they are washed thoroughly in rapid multi enzyme cleaner.
5.1.3 These washed scopes are placed in glutaraldihyde for 20 minutes
5.1.4 Bactericidal Surface disinfectant is routinely used in between each procedure to
clean surfaces etc.

6 SOP FOR PATIENT CARE PROTOCOL

6.1 All patients are treated with respect by all the staff of surgery department.
6.2 All outpatients are informed of the waiting time, availability of the doctors, procedure
fees etc.
6.3 Patients should be suitably directed to various areas of the hospital by the staff as and
when necessary.
6.4 Staff should try to avoid conflict with the patients as far as possible. in an inevitable
circumstances help should be sought from doctors, guest relation officers or other
administrative staff at the earliest as per established protocol.
6.5 When a patient is adviced for admission or surgery the approximate costs are explained
by the doctor.
6.6 Availability of different types of wards and facilities are explained in brief.
6.7 Wherever possible, appointments are given to patients called for repeat procedures or
investigation and the appointment times are strictly adhered to.

7 STAFF TRAINING AND PATIENT EDUCATION PROCEDURES

7.1 STAFF TRAINING
7.1.1 At the time of joining all new staff undergo a department induction programme by
a senior staff.
7.1.2 New staffs are made to read department operating manual at the time of joining.
7.1.3 For professional development, all staffs are encouraged to attend academic
meetings, seminars and discussion in the hospital.
7.1.4 All the doctors are encouraged to attend CME’S and workshops.
7.1.5 All the staff including nursing staff undergo training if required by the appropriate
personnel whenever there is a new instrument, or a new procedure is started in the
out patient department.
7.2 PATIENT EDUCATION

7.2.1 All patients are educated about their condition diagnosis, treatment options,
medications give, risks and complications, preventive aspects and follow up
advice.
7.2.2 When specialist dietary advice is necessary patients aree referred to dietician.
7.2.3 For some specific conditions, information leaflets are developed by the
department of Surgery are given to the patients.
7.2.4 If interested the patients are informed of various websites for additional
information on their ailment.

8 GIVING APPOINTMENT FOR SCOPY
8.1 Appointments are given as per the following schedule

8.1.1 Monday, Wednesday and Thursday are the days for Gastroscopy, Colonoscopy,
Sigmoidoscopy and ERCP.
8.1.2 Tuesday, Friday and Saturday are the days for Bronchoscopy & cystoscopy /ECT.
8.2 Procedure charges and details of advance payment are explained to the patient
8.3 In case of emergency, appointments are given on any day with the permission of the
Doctors.
8.4 If the patients are RV +ve, HBsAg +ve or HCV + ve , the appointment is given on the
day, the Glutarax solution has to be changed ie on the 14 th day from the day the new
can of Glutarax is opened in case of emergency scopies patient is asked to pay for the
glutarax solution.
8.5 Informed consent should be taken by the doctor before starting the procedure.
8.6 Ask then not to register their chart, rather just handover the endoscopy requisition in
MRD and straight away come to the Scopy Room.(No 10) . Instruct the patient that on
the day of the appointment, the patient should come to the Scopy room (no.10) after
handing over the endoscopy requisition to the MRD. The patient should not register at the
counter.
8.7 All the preparatiosns are explained to the patient on the day of giving appointment.
Note: If Scan is asked for the same patient scan has to be done prior to endoscopy.

9 PREPARATION OF SCOPY ROOM

9.1 Do the dusting
9.2 Do bed making
9.3 Keep ready the washing area.
9.3.1 1 tub with soap water
9.3.2 1 tub with rapid multi enzyme cleaner
9.3.3 1 tub with gastro scopy solution
9.3.4 tub with colonoscopy solution
9.4 Channel washer, Brush, Scrub, and syringe
9.5 Fix the suction jar
9.6 Check and keep ready the oxygen flow meter.
9.7 Switch on the computers, printers and the processor.
9.8 Load papers in the printer
9.9 Fix the Scope
9.10 Keep 1 kidney tray with water to check the scope
9.11 1 kidney tray with mouth piece.
9.12 Enter the patient name and details in the computer.
Note: Make sure to check all the equipments are in good working condition

10 SCOPIES
10.1 GASTROSCOPY
10.1.1 Definition: Visualization of the upper gastrointestinal tract, from the oral
cavity to the duodenum.
10.1.2 Preparation: Patient is kept NPO from 12am midnight..
10.1.3 Procedure:
a Once patient's medical record is received, check for the consent form of the
patient. Payment to be made
b Ask the patient to lie down on the cot and explain the procedure to the patient.
c Give 15 ml of xylocaine viscous to the patient, ask him/her to keep it in the throat
for 3 to 5 min and then swallow it.
d Keep the mouth gag insert in the mouth.
e Ask the patient to breath through their nose while the procedure is going on.
f Ask him/her to swallow when asked to do so
g Explain the patient there may be fullness in stomach, as the doctor would inflate
some air and would suck out the air while removing the scope out.
h If any abnormalities are noted then biopsy is taken and sent for investigation.
i The nurse assisting the procedure is responsible for
i Receiving the specimen
ii Labelling at bed side
iii Entry in the lab register
iv Dispatch of specimen
v Acknowledgement by signature
j Patient is sent back home.

10.2 COLONOSCOPY
10.2.1 Definition: Visualization of the lower gastrointestinal tract from the anus to the
terminal illeum.
10.2.2 Preparation:
a To take only clear liquid diet for two days prior the day of procedure.
b To mix the laxative solution in 1 litre of limca/sprite or lime and drink it the
previous day by 4pm-6pm.
c Patient will have loose stool not to take any medication to stop loose stools but
drink lot of fluid to prevent dehydration.
d Come to hospital the next day i.e. the day of appointment.
10.2.3 Hospital preparation:
a To provide hospital cloth ( gown and draw sheet)
b Make the patient to lay down on the bed.
c Start on IV line (jelco /scalp vein)
d Put on the pulse oxymeter and oxygen.
e Provide privacy.
10.2.4 Medications needed:
a 2% lox gel
b Jelco No 20
c Syringe 5ml
10.2.5 Procedure:
a Explain the procedure to the patient.
b Position in left lateral with knee chest position.
c The colonoscopy is inserted through the anus and needed findings are noted
d If any abnormality is noted then biopsy is taken and sent for investigation.
e The nurse assisting the procedure is responsible for

f Advice the patient to come for review after 5 days
g Patient is sent back home.
10.3 SIGMOIDOSCOPY
10.3.1 Definition: Visualization from anus to the transverse colon.
10.3.2 Preparation: To take 2 nos Tab. Dulcolax, inform to take light dinner the
previous night and light breakfast the next day morning.
10.3.3 Hospital preparation:
a Provide hospital linen.
b Position patient on the bed
c Connect the pulse oxymeter
d Provide privacy
e Enema given prior to procedure.
2% lox gel
10.3.5 Procedure:
a Explain the procedure to the patient.
b Position in left lateral with knee chest position.
c The Sigmiodoscopyis inserted through the anus and needed findings are noted
d If any abnormality is noted then biopsy is taken and sent for investigation.
e The nurse assisting the procedure is responsible for
f Advice the patient to come for review after 5 days
g Patient is sent back home

11 BRONCHOSCOPY
11.1 Definition: Visualization of the respiratory tract.

11.2 Preparation: NPO from 12 mid night.
11.3 Hospital preparation :
11.3.1 To provide hospital cloth gown & pyjamma.
11.3.2 Make the patient lie down in supine position.
11.3.3 Put on the pulse oxymeter / oxyygen.
11.3.4 To start cannula (iv line)
11.3.5 Provide privacy.
11.3.6 Prior to procedure Inj. Atropine 0.6 mg & Inj. Phenergan 12.5mg should be
given.
a Half an hour before to the procedure. Nebulization should be given in
(Inj.Xylocaine 2% 3ml + NS 3 ml
a Inj. Xylocaine 2% - 1vial
b Inj. Midazolam - 1 vial
c Inj. Atropine - 1ampule
d Inj. Phenergan - 1 ampule
e Inj. Lox 2% gel -1
f Scalp vein No 21 - 1
g Gloves -2
h Nasal pronge -1
i Mucous extractor -1
11.3.8 Procedure:
a Patient is positioned in supine.
b Pass the scope through nose to trachea to trachea to visualize respiratory
organs.

c If any abnormality is noted then biopsy is taken and sent for investigation.
d The nurse assisting the procedure is responsible for
11.3.9 Post Procedure: Keep the patient in the recovery room and check for the aldrete
recovery score. When score is 9-10 patient can be discharged.
a Advice the patient to come for review after 5 days
b Patient is sent back home.

12 ELECTROCONVULSIVE THERAPY (ECT)

12.1 ECT (Electroconvulsive therapy): It is a treatment of several severe mental illnesses
which consists of passing an electrical current from an ECT machine under anaesthesia through
the brain to produce an epileptic fit.
12.2 Preparation:
12.2.1 Duly signed consent form for ECT to be done.
12.2.2 NPO from 12 midnight.
12.2.3 To empty bladder before the procedure.
12.3 Hospital Preparation:
12.3.1 To provide hospital cloth gown and pyjama.
12.3.2 Make the patient lie down in supine position.
12.3.3 Put on the pulse oximeter.
12.3.4 To start cannula (IV line).
12.4 Medications needed:
12.4.1 Inj. Diazepam / Lorazepam
12.5 Procedure:
12.5.1 Patient is made to lie in supine position.
12.5.2 Anaesthetic and relaxant agent are given by the anaesthetist along with oxygen for the
patient to sleep.
12.5.3 Bite guard is inserted and patient is ready for ECT treatment.
12.5.4 Suction machine is kept ready if there are excessive secretions.
12.5.5 Patient is shifted to the recovery room once the anaesthetist has given the clearance.
12.6 Post procedure:
12.6.1 Patient is made to lie in left lateral position.
12.6.2 Vitals, orientation and cognitive side effects are checked and reported to the psychiatrist
if any.
12.6.3 Patient can be shifted out once physical state is stable and they are ready to do so.

13 CYSTOSCOPY
13.1 Cystourethroscopy: Diagnostic and theaurpetic
13.1.1 In diagnostic scopy submeatal, urethra and bladder is visualised to see for abnormality
and to assess the bladder for any tumour, calculus and biopsy if necessary is taken.
13.1.2 In theaurpetic scopy DJS are removed.
13.2 Preparation:
13.2.1 Urine culture should be sterile or urine microscopy should have less than 5 pus cells per
high power field.
13.2.2 It is preferable to do serum creatinine level but not mandatory.
13.2.3 Hospital preparation
13.2.4 Provide hospital linen
13.2.5 Consent taken
13.2.6 To give Inj. Gentamicin 160mg I.V stat or Inj. Amikacin 500mg I.V stat(see that serum
creatinineis with in normal limits)
13.2.7 Provide privacy
13.2.8 Position:supine for flexible cystoscopy and lithotomy for rigid cystoscopy.
13.3 Procedure
13.3.1 The procedure is explained to the patient
13.3.2 Clean the area(external genitalia) with 5% betadine
13.3.3 2% xylocaine is inserted into the urethra
13.3.4 Cystoscopy is done findings noted.
13.3.5 Patient is sent home after the procedure and asked to review in the urology OPD
according to the need.

14 ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY (ERCP)

14.1 E.R.C.P: When contrast flows retograde in to the gallbladder stones appear as filling
defects and can be detected with a sensitivity of approximately 80%. ERCP is the gold
standard test for stones in the CBD with the sensitivity and specificity of approximately
95%.
14.2 Indications:
Obstructive jaundice due to:
14.2.1 CBD calculus
14.2.2 Periampullary carcinoma
14.2.3 Stricture CBD
14.2.4 Cholangitis
14.3 Preparation: NPO from 12pm midnight.
14.4 Hospital Preparation:
14.4.1 Provide hospital cloths (gown & pyjama).
14.4.2 To start an IV line (Jelco).
14.4.3 Mouth gag.
14.4.4 To put oxygen/ pulse oxymeter and connect cautry plate.
14.4.5 Position the patient in left lateral / prone position.
14.5 Medications needed:
14.5.1 Inj.Midazolam – 1 vial
14.5.2 Inj. Phenergan - 1 ampule
14.5.3 Inj. Fortwin - 1 ampule
14.5.4 Inj.Urografin - 1 ampule
14.5.5 Inj. Buscopan - 4 ampule
14.5.6 Disposable Syringe 20cc -2, 10cc-2, 5cc-1,2cc-4
14.5.7 Scalp vein No 21-1
14.6 Procedure:
14.6.1 Just as sonography is the gold standard for the diagnosis of cholelithiasis, ERCP
is the gold standard for the diagnosis of cholelithiasis.

14.6.2 The patient is placed in prone position on a fluroscopy table. While the
patient is under conscious sedation, a side viewing endoscope is passed in to the
second duodenum, and the major pailla is identified and selectively
cannulated Water soluble iodinated contrast material is injected in to the CBD
and pancreatic duct and radiographs are obtained.
14.6.3 Stones within the CBD appear as filling defects and be detected with a
sensitivity of approximately 95% .Care should be taken to avoid inadvertent
injection of air in to the biliary tract because resulting bubbles may mimic the
appearance of a gallstone.
14.6.4 The overall specificity of the ERCP for the detection of CBD stone.
14.7 Complications:
14.7.1 Infection
14.7.2 Biliary cirrhosis
14.8 Post procedure:
14.8.1 Keep the patient in the recovery room and check for the aldrete recovery score
14.8.2 When score is 9-10 patient can be discharged (Aldrete Recovery Score)

15 ASSISTING WITH ENDOSCOPIC ESOPHAGEAL DILATATION

15.1 Definition: It is a procedure in which a balloon or semi-flexible dilator is inserted as
a means for dilation of the esophagus.
15.2 Indications
15.2.1 Dilate esophagus in case of achalasia
15.2.2 Relieve surgically or chemically induced stricture if esophagus and pylorus.
15.3 Preparation
15.3.1 Articles
a Video gastroscope
b Light source
c Saline or water for irrigation
d Colored printer
e Suction and connecting tube
f Mouthpiece with strap
g Secondary suction
h Gloves, mask, and gown
i Rag pieces
j Topic anesthetic: xylocaine spray 10% or 2% lidocaine jelly
k Oxygen with mask or nasal cannula
l Pulse oximeter
m Cardiac monitor
n Savary dilators and giudewire 1.035mm
o Achalasia balloon dilators
p Fluroscopy unit
q Lead gown
r TLD badge
s Drinking water in a glass with straw
15.3.2 Nursing Action (in X-ray Dept.)
a Explain procedure to the patient

b Get consent form patient or relative

c Connect patient to cardiac monitor, observe and monitor vital signs during the
procedure.
d Remove dentures and contact lens if worn.
e Reassure the patient
f Spray back the throat with xylocaine 10% instructing patient to hold his breath.
g Position the patient on left side and suction mouth as needed to prevent aspiration.
h Administer Inj. Midazolam and Inj. Fortwin IV as per order if the patient is
uncooperative
i Wear radiologic protective devices
j Assst the physcican by giving the guidewire, which has to be introduced in the
biopsy channel of the gastroscope and through the stricture intil flexible tip is in
the stomach as verified in fluoroscopy. Assit the physicians as he slides the
dulator and introduce over the guidewire with good lubricant. This process is
repeated several times as he increases the size of the dilator.
k Document observation and other information pertinent procedure performed.
15.3.3 Post procedure care
a Instruct the patient to be on NPO status for 12hrs. Start fluid thereafter.
b Check vital signs Q 15H till it becomes stable.
c Observe for signs of complications like perforation and bleeding (pain, abdominal
distention, change in vital signs).

16 CLEANING, DISINFECTION OF SCOPY

16.1 Cleaning:
16.1.1 Immediately after use wipe the insertion tube with a detergent soaked cloth
16.1.2 Aspirate detergent then air through the suction channel
16.1.3 Install Airway channel cleaning adapter. Flush water then air through air/water
channels.
16.1.4 Flush detergent then air into elevator wire channel/ auxiliary water channel.
16.1.5 Disconnect all detachable parts and cleaning equipment.
16.1.6 Attach water resistant cap (video scopes only).
16.1.7 Attach leakage tester, turn on pump prior to immersion, and confirm bending
section has expanded.
16.1.8 Immerse entire endoscope in clean water, perform leakage test angulated tip
during test. Remove from water detach tester after tip has deflated.
16.1.9 Immerse in freshly prepared detergent solution clean all external surfaces. Brush
endoscope distal tip ( forceps elevator if applicable)
16.1.10 Brush the insertion tube portion of the suction channel. Repeat until all debris is
removed.
16.1.11 Brush the universal cord portion of the suction channel. Repeat until all debris is
removed.
16.1.12 Brush the suction cylinder and instrument channel port. Repeat until all debris is
removed.
16.1.13 Aspirate detergent solution into suction channel.
16.1.14 Attach injection tube and channel plug. Flush detergent solution into the air,
water channel flush forceps elevator if applicable.
16.1.15 Flush detergent solution into auxiliary water /elevator – wire channel soak in
detergent solution for the time recommended by the detergent manufacturer
16.1.16 Rinse the entire instrument in clean water
16.1.17 Flush clean water through all channels (including auxiliary water/elevator wire,
if applicable) flush air through all channels

16.1.18 Use a soft lint free cloth to remove excess moisture from endoscope and
cleaning accessories in preparation for disinfection.
16.2 Disinfection:
16.2.1 Fill basin with disinfectant attach channel plug and injection tube to previously
cleaned endoscope. Immerse completely in disinfection solution.
16.2.2 Use syringe to completely fill air water and suction channels with disinfectant
solution for 10 – 15 min.
16.2.3 Flush disinfectant solution into elevator wire channel auxiliary water channel.
16.2.4 While the endoscope is immersed disconnect cleaning accessories and use a
clean lint free cloth to wipe away any bubbles clinging to external surface.
16.2.5 Soak all equipment according to the disinfectant manufacturer's recommended
time and temperature. Use a timer to measure exact contact time.
16.2.6 Disconnect all channel irrigation and allow fiber instrument to remain in
disinfectant solution for 20- 30 min.
16.3 Rinsing
16.3.1 Connect channel plug and injection tube inject air to remove disinfectant from
air, water and suction channels remove endoscope from disinfectant.
16.3.2 Inject air into elevator wire channel auxiliary water channel to remove
disinfectant.
16.3.3 Disconnect channel plug and injection tube, immerse endoscope and detached
parts in water thoroughly rinse all external surface
16.3.4 Connect channel plug and injection tube to endoscope use a syringe to flush
water through air water and suction channels.
16.3.5 Flush water elevator wire channel auxiliary water channel.
16.4 Drying:
16.4.1 Remove endoscope and then rinse with water, use syringe to inject air through
air water and suction channels expelling the rinse water.
16.4.2 Inject air to flush water from elevator wire channel/ auxiliary water channel.

16.4.3 Use syringe to flush 70% alcohol through air water and suction channels inject
air to remove retained alcohol.
16.4.4 Flush 70% alcohol into elevator wire/ auxiliary water channel, inject air to
remove alcohol.
16.4.5 Disconnect all accessories with an alcohol moistened cloth. Make sure
equipment is completely dry prior to storage.

17 ALDRETE RECOVERY SCORE
Original Criteria Modified Criteria Point

Value
Color Oxygenation
Pink SpO2 >92% on room air 2
Pale or Dusky SpO2 >90% on oxygen. 1
Cyanotic SpO2 <90% on oxygen. 0
Respiration
Can breathe deeply and cough Breathes deeply and coughs freely 2
Shallow but adequate exchange Dyspneic, Shallow or limited breathing 1
Apnea or obstruction Apnea 0
Circulation
Blood pressure within 20% of normal Blood pressure +20mm Hg of normal 2
Blood pressure within 20-50% of normal Blood pressure +20-50mm Hg of normal 1
Blood pressure deviating > 50% of normal Blood pressure more than +50 mm Hg of normal 0
Consciousness
Awake, Alert and oriented Fully awake 2
Arousable but readily drifts back to sleep Arousable on calling 1
No response Not responsive 0
Activity
Moves all extremities Same 2
Moves two extremities Same 1
No Movement Same 0

18 SOP FOR REUSE OF ENDOSCOPY INSTRUMENTS

18.1 All endoscopic instruments which are reused are verified by the treating Doctor prior
to use to determine the fitness for use. In case endoscopic instruments are used beyond
the determined number of reuses, they need to be certified for fitness of use by the senior
consultant.
18.2 All used endoscopic instruments are washed with water, flushed with glutaraldehyde
and immersed in glutaraldehyde for 30 minutes.
18.3 After 30 minutes all endoscopic instruments are once again washed with running
water.
18.4 The labeling of instrument is marked on the catheter hub.
18.5 Documentation of reuse catheters done.
18.6 A register will be kept to note down the usage of instruments each time .The
instruments will be checked for the functioning by senior Endoscopist every 2 weeks and
will be documented in the same register
18.6.1 Gastroscopy
S.No Single use Medical device Re-used Maximum No of Reuse
a Gastroscopy Basket Web – 2*4 50 Times
b Oval Snare (Bard) – SD – 21OU 25 50 Times
c Oval Snare (New) 30 Times
d Snare (Hexagonal) 30 Times
e Mini Oval Snare 30 Times
f Sclerotheraphy Injection Needle 30 Times
18.6.2 Colonoscopy
a 50 times
Colonoscopy Biopsy Forceps
18.6.3 Bronchoscopy
a Bronchoscopy basket 30 Times
b TBNA needle 5 Times
c Bronchoscopy Biopsy Forceps 30 Times

18.6.4 ERCP
a Hydra Jag Wire 20 Times
b Ultratome XL 35 Times
c Microknife 50 Times
d CBD Extraction Baloon 20 Times
e 7 FR Pusher 20 Times
f 10 FR Pusher 50 Times

19 SOP FOR SCHEDULING APPOINTMENTS FOR ENDOSCOPY PATIENTS

19.1 Purpose: To provide proper guidelines about the scheduling of appointments and
preparation for endoscopy procedures
19.2 Scope: Out patients and In patients
19.3 Responsibility: Endoscopy nurse
19.4 List of procedures
19.4.1 Gastroscopy
19.4.2 Colonoscopy
19.4.3 Sigmoidoscopy
19.4.4 Bronchoscopy
19.4.5 Cystoscopy
19.4.6 ERCP
19.5 Procedure Day and Timings
19.5.1 Monday: Gastroscopy-8am to 1pm,Colonoscopy-1pm to 4pm
19.5.2 Tuesday: Bronchoscopy-8am to 4pm and emergency scopies as scheduled by
the consultant
19.5.3 Wednesday: Gastroscopy-8am to 1pm,Colonoscopy-1pm to 4pm
19.5.4 Thursday: Gastroscopy-8am to 1pm,Colonoscopy-1pm to 4pm
19.5.5 Friday:Cystoscopy-8am to 1 pm,Bronchoscopy-1pm to 4pm, emergency
scopies as scheduled by the consultant
19.5.6 Saturday: emergency scopies as scheduled by the consultant
19.5.7 ERCP: Any day according to the consultants schedule
19.5.8 On call endoscopy;any day –any time for emergency scopies as per consultants
advice.
19.6 Procedure
19.7 All endoscopy appointment forms to be filled by the respective doctors.
19.8 Endoscopy appointment forms should contain details about patient like
name,age.sex.hospital no, name of the procedure ,details of blood investigations .
19.9 Indications for scopy should be explained and written by the consulting doctor and the
doctors name to be written clearly

19.10 In case of In-patients: ward and bed number, name of the doctor, details of
investigation to be mentioned properly.
19.11 HIV,HBSAG,HCV status to be mentioned by the doctor for all patients.In case the
investigation is not done, requisition slip to be given to the patient one day prior to the
procedure or at the time of giving appointment.
19.12 If patient is getting discharged before undergoing the procedure,the assigned staff
should communicate with the endoscopy staff and send the patient relative with the
endoscopy request form to endoscopy department.
19.13 Endoscopy staff should explain about the procedure and provide the timings for scopy
and make a note of patient details in the appointment book and handover the
instruction form with date and time of procedure.
19.14 If patients are getting discharged in the evening, ward staff should communicate with
the endoscopy staff before 4:30 pm.
19.15 No appointments for endoscopy procedures can be given over the phone since
preparation differs for each procedure.
19.16 A copy of endoscopy preparation leaflet /instruction copy to be attached with the
endoscopy requisition form for all patients coming for scopy appointments.
19.17 For all patients undergoing ercp procedure an advance of Rs.20,000 to be collected
before the procedure.
19.18 On the appointment date patient’s need not do registration since the op-folders of all
patients are collected by the endoscopy staff prior to the day of procedure.
19.19 All patients are called for scopy according to the queue no displayed on the endoscopy
board, priority is given based on triage (diabetic, old age,op-poisoning, hemetemesis,
foreign body ingestion, giddiness, severe abdomen pain, difficulty in swallowing
liquids).
19.20 NOTE-Emergency scopies have to be discussed with the surgery consultants by the
doctor advising for scopy.
19.21 All the scopies for IP patients should be scheduled for the patient during their stay to
ease the patient’s experience with the endoscopy procedure.

20 LIST OF ASSOCIATED RECORDS
20.1 CSSD register R/NS/ENDO/10

20.2 Inventory & Condemned Register R/NS/ENDO/12
20.3 Lab Register R/NS/ENDO/14
20.4 Triage Register R/NS/ENDO/15
20.5 Scopy Register R/NS/ENDO/17
20.6 Emergency Trolley Register R/NS/ENDO/06
20.7 Stock Register R/NS/ENDO/26
20.8 Reuse Register R/NS/ENDO/57
20.9 Stent Register R/NS/ENDO/58
20.10 Glutarex Monitoring Register R/NS/ENDO/59
20.11 ECT Register R/ENDO/01
20.12 Cystoscopy Register R/ENDO/02
20.13 Non Stock Register R/ENDO/03
20.14 Forms
20.14.1 Endoscopy Requisition Slip F/ENDO/01
Signature: Signature:

Annexure I
A. Role of Consultant
1. To participate in all activities of the department – professional, administrative, social and
spiritual
2. To provide quality care to all patients
3. To take primary responsibility for the area of work allotted by the HOD
4. To attend emergency calls as required
5. To supervise / take part in teaching programs for medical / nursing / paramedical staff
and students.
6. To be present for the 8 am prayer and handing over session.
7. To help in the smooth functioning of the Department, help / be involved in the purchase
of equipments, sign concessional forms or perform any other duties as and when assigned
by the HOD or Administration.
B. Role of Registrar
spiritual
4. To supervise / take part in teaching programs for medical / nursing / paramedical staff
and students.
5. To be present for the 8 am prayer and handing over session.
6. To supervise Juniors (SHO, DNB students) where / when required
7. To take part in the scientific and teaching programs of the department / hospital
8. To attend department and medical staff meetings.
9. To perform any duties as and when assigned by the HOD / Administration.

C. Role of Junior Medical Officer / Senior House Officer

spiritual
4. To take part in teaching programs for medical / nursing / paramedical students.
5. To complete the morning rounds of ward patients and be present for the 8 am prayer and
handing over session.
6. To take part in the scientific and teaching sessions of the department / hospital
7. To attend department and medical staff meetings.
8. To work up patients allotted, follow them up and document their progress in the wards
daily and prepare discharge summaries.
9. To perform any duties as and when assigned by the HOD / Administration.
D. Role of Staff Nurse

1 To participate in all hospital activities including the administrative, social and spiritual
events and to extend support to the administration of the hospital.
2 To be responsible for providing a positive public image.
3 To coordinate nursing care of patients when scheduled for therapy or procedures.
4 To report relevant observations accurately and concisely.
5 To assist providers with special tests and procedures.
6 To assist team members in giving care to patients, or administer direct care when
professional skills and judgment are needed.
7 To establish and maintains communication and utilized teaching opportunities with
patients, family members and staff.
8 To assist with and institutes emergency measures for sudden adverse developments.
9 To enter and maintains patient data and other statistical in the outpatient register.

10 To review patient charts and records for the identification and the evaluation of clinical,
social and logistical problems, thus improving the thoroughness and quality if care
delivered.
11 To understand the purpose of visit and review charts for recent visits, chronic problems,
recent and outstanding laboratory studies, and other information that would facilitate
prompt and complete care.
12 To adhere to hospital policies and procedures.
13 To know the purpose, expected results, and the safety factors involved in the patient care.
14 To utilize the knowledge and skills in giving safe nursing care.
15 To be responsible for fulfilling the activities of the job.
16 Not to divulge confidential information concerning the patient’s or hospital affairs except
to authorized personnel.
17 To self-direct in learning and/or improving the abilities needed for the job.
18 To participate in studies related to nursing practice.
19 To participate in the in-service education programs of the institution.
20 To maintain a professional level of conduct.
21 To accept direction, supervision, and evaluation of performance.
22 To ensure economical use of time, effort and material.
23 To keep abreast of literature in nursing.
24 To perform any other duties assigned by the charge nurse, ACNO/CNO.
E. Role of Nursing aide

1 To participate in all hospital activities including the administrative, social and spiritual
events and to extend support to the administration of the hospital.
2 To give the quality of service, which meets the standards for practice of the hospital.
3 To adhere to hospital policies and procedures.
4 Not to divulge confidential information regarding patients and hospital affairs except to
authorized personnel

5 To conduct himself in a courteous, friendly manner and treat the patient as guest in the
hospital.
6 To assist the staff nurse in the care of patients as directed.
7 To report all observations concerning patients to a staff nurse.
8 To assist in admission procedure for patients admitted through the casualty and
outpatient department.
9 To assist patients in preparing for examination, dressings, suture removals plaster
applications and removals by the doctor.
10 To collect specimen as directed (urine, stool, sputum).
11 To transport patients to the various locations as needed.
12 To obtain, clean and return equipments and supplies handled in the ward.
13 To take responsibility for seeing that the working area kept clean and equipment is kept
in its place.
14 Runs errand to other departments; pharmacy, central supply, lab cashier, medical record,
other nursing units.
15 To be accountable for her/his assigned patients hospital linen.
16 To perform any other duties as directed by the charge nurse or unit supervisor.

ENDOS

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BANGALORE BAPTIST HOSPITAL Page: 1 of 34

DEPARTMENT OPERATING MANUAL Version No: 03

Sl. No. Topic Page No

Reviewed & issued by: Division Head Approved by: Director(CEO)

1 SCOPE OF THE DEPARTMENT

Reviewed & issued by: Division Head Approved by: Director(CEO)

2 SOP FOR OUTPATIENT EXAMINATION

Reviewed & issued by: Division Head Approved by: Director(CEO)

3 SOP FOR CARE OF THE ENDOSCOPY PATIENT

3.1 Out Patient

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

5 SOP FOR STERILIZATION

Reviewed & issued by: Division Head Approved by: Director(CEO)

6 SOP FOR PATIENT CARE PROTOCOL

Reviewed & issued by: Division Head Approved by: Director(CEO)

7 STAFF TRAINING AND PATIENT EDUCATION PROCEDURES

7.2 PATIENT EDUCATION

Reviewed & issued by: Division Head Approved by: Director(CEO)

8 GIVING APPOINTMENT FOR SCOPY

8.1 Appointments are given as per the following schedule

Reviewed & issued by: Division Head Approved by: Director(CEO)

9 PREPARATION OF SCOPY ROOM

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

11.1 Definition: Visualization of the respiratory tract.

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

12 ELECTROCONVULSIVE THERAPY (ECT)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

14 ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY (ERCP)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

15 ASSISTING WITH ENDOSCOPIC ESOPHAGEAL DILATATION

Reviewed & issued by: Division Head Approved by: Director(CEO)

b Get consent form patient or relative

Reviewed & issued by: Division Head Approved by: Director(CEO)

16 CLEANING, DISINFECTION OF SCOPY

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

17 ALDRETE RECOVERY SCORE

Original Criteria Modified Criteria Point

Reviewed & issued by: Division Head Approved by: Director(CEO)

18 SOP FOR REUSE OF ENDOSCOPY INSTRUMENTS

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

19 SOP FOR SCHEDULING APPOINTMENTS FOR ENDOSCOPY PATIENTS

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

20 LIST OF ASSOCIATED RECORDS

20.1 CSSD register R/NS/ENDO/10

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)

C. Role of Junior Medical Officer / Senior House Officer

D. Role of Staff Nurse

Reviewed & issued by: Division Head Approved by: Director(CEO)

E. Role of Nursing aide

Reviewed & issued by: Division Head Approved by: Director(CEO)

Reviewed & issued by: Division Head Approved by: Director(CEO)