Rachelle Firman

Mrs. Heasley
Endoscopy
09/31/19
EGD and Colonoscopy

A 45 year old man received an EGD (Esophagogastroduodenoscopy) and a colorectal

cancer screening. The patient had been experiencing abdominal distension and a feeling of

fullness for several days. The patient is considered high risk because his father developed colon

cancer at age 73. In the outpatient preoperative phase the surgeon went through the procedure

with the patient, his aunt, and his uncle. The patient was given MiraLax and Dulcolax for colon

cleansing. The patient was informed of what medications to stop taking prior to the procedure.

The patient arrived at the hospital 2 hours prior to the procedures. The preop nurses

reviewed his charts to ensure the history was done and the informed consent was signed. They

then went through the preop checklist with the patient. The IV team came and started an IV in

the patients arm. Afterwards we explained postop teaching and answered the patient’s and

families questions. Then the anesthesiologist came in and spoke to the client to confirm

medications, allergies, and the possibility of an adverse reaction to sedation. Once the patient

was ready the circulating nurse and I took him back to the ENDO room.

In the operative phase we began by placing the patient on his left side in the Sims

position. We ensured he was warm, as it is cold in the procedure rooms. We then placed a chuck

pad under his buttocks. The doctor came in and spoke to the patient; he reassured him everything

would be fine and that the procedure wouldn’t take long. He asked him about his family in preop

and if it was okay that he speaks to them postop. The circulating nurse called a time-out to

confirm the patient and procedure and everybody agreed. The anesthesiologist hooked the patient

up to the vital machine and then pushed propanol. The doctor placed a spacer in the patient’s

mouth to hold it open.

Rachelle Firman
Mrs. Heasley
Endoscopy
09/31/19
The doctor began with the EGD. The scopes have cameras that relay a live feed of the

internal view of the patient’s bodies. The doctor was very careful as he descended through the

pharynx to the esophagus and into the stomach. In the stomach the scrub nurse inserted the

forceps through the scope and the doctor took a few enteric biopsies. The scrub nurse removed

the forceps and placed the specimens in a cup for the circulating nurse to label and deliver to the

label for testing. In the stomach the doctor noted slight gastritis. The doctor then continued to the

duodenum and took a few more samples, which the nurses placed in a separate specimen cup and

labeled random duodenal X3. The doctor then removed the scope and prepared for the

colonoscopy. Throughout the procedure, the circulating nurse was charting the doctor’s progress

and his findings into the patient’s chart.

The doctor ensured the patient was positioned correctly; he then placed the sheath on the

scope and lubricated both the scope and the anus. The doctor slowly inserted the colonoscope

into the rectum. Throughout the colon he took random biopsies, but did not see anything of

significance. When he reached the cecum, the circulating nurse documented the time, to ensure

that he took enough time for a thorough investigation of the entire colon. From the time you

reach the cecum to the time you exit the rectum you have to at least exceed six minutes, however

he exceeded 12 minutes. When in the cecum you can actually see the red light from the

colonoscope through the patient’s stomach.

Once the doctor was finished, he went to update the family on his findings and completed

his charting. The nurses cleaned the scopes and sanitized the room for the next patient. The

patient began to come out of sedation before we even left the room. We took him back to his

room for postop. The postop nurse came in to receive the handoff report. We took his vitals to
Rachelle Firman
Mrs. Heasley
Endoscopy
09/31/19
ensure he was handling the anesthesia properly. We then explained to the patient and his family

once again that as soon as the patient began passing flatus he could leave. It usually takes about

30-60 minutes postop, but they were gone in about 45 minutes.

During the procedure everyone knew their responsibilities, yet they also helped each

other out. The circulating nurse called timeout, monitored everything including the environment

and the staff, obtained specimens and pictures for labelling, and charted throughout the

procedure. The scrub nurse assisted doctor with the scope, moved patient and applied pressure to

abdomen when necessary, inserted forceps, and printed pictures. The anesthesiologist pushed

propanol as needed and monitored vitals for reaction. Throughout the procedures the whole team

was very friendly, you could tell that they all knew each other well and worked together often.

The nurses knew what the doctor needed before he even asked for it. They conversed throughout

the procedure, but never lost focus of their duties. Although watching colonoscopies all day is

probably not the most exciting career, the staff definitely makes it seem like it is. I don’t want to

do surgery, although it was interesting to see, I prefer more patient interacting and hands on care.

However, I do hope that my career is even half as fun as they made endoscopy seem.