Gastroenterological Endoscopy. Группа авторов
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Название: Gastroenterological Endoscopy

Автор: Группа авторов

Издательство: Ingram

Жанр: Медицина

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isbn: 9783131470133

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СКАЧАТЬ endoscopic processor should be considered in order to avoid CO2 supply via gas cylinders. Placement of oxygen and suction outlets has to be well considered as the lines to the patient or the endoscope should not cross the working area or the floor. Thus, suction should be close to the endoscopic processor and oxygen close to the patient’s head.

      Sufficient power outlets are necessary in the procedure room to ensure flexible working conditions and so that auxiliary equipment can be used safely. The electric sockets can be either wall-mounted or attached to the ceiling supply units. The electric sockets should be connected to various circuits. Some power outlets should also be connected to the hospital’s emergency energy supply. Sockets used for endoscopic light sources and the video processor as well as the surveillance monitors should have an uninterrupted emergency power supply. The compressed air supply, intravenous fluids hooks, suction lines, and connections for closed circuit television should preferably be fixed to the ceiling, to prevent cables crossing the floor.

      Within the endoscopy room, air conditioning and temperature control must be optimal. If there are outside windows, then blinds or blackout facilities are needed. Ceiling lighting should be bright, but easily dimmed. There is a new trend to use colored lights such as blue or green light for procedure rooms, as blue light increases the contrast and facilitates viewing of the monitor image while still having enough surrounding light for handling and controlling the patient. Various functions of the endoscopic procedure room (room light, video recording, picture documentation, video switching and video streaming, video sources for the monitor, communication) can be handled with touch screen–based devices. There are several commercial systems which offer such functionality as complete room service package (e.g., Endo-Alpha by Olympus, OR1 by Storz). Other optional features such as writing surfaces and dictation facilities depend on the report generation management (see documentation).

      Cubicles, or at least curtained-off partitions and washing facilities, should be available for patients who have undergone sigmoidoscopy or colonoscopy.

      5.8.3 Monitor Systems and Anesthesia

      Surveillance monitors are mandatory in each procedure room for optimal patient safety during the procedure, as well as during the recovery period. The monitor display should be positioned in such way that it can be easily viewed and controlled. The monitor system should consist of a noninvasive blood pressure measurement, a pulse oximeter, and an ECG. There is some debate as to whether CO2 monitoring should be performed during endoscopic procedures.17 Due to the high rates of artifacts of current systems, no specific recommendations for the use of CO2 monitoring can be given. The positioning of the monitor should also consider that cables and lines connect to the patients, and these should not cross the working areas of the endoscopist. A positioning of the monitor system opposite to the endoscopist near the video monitor is a possible solution, which avoids these problems (

Fig. 5.4). The suction equipment may be either free-standing or placed on a trolley or incorporated in a ceiling supply unit (
Fig. 5.4). As in most operating rooms, documentation of the vital parameters (respiratory rate, heart rate, blood pressure, medication administration) is increasingly carried out via digital online recording of the respective parameters. The implementation of an IT-based documentation of monitoring data has to be taken into account and a separate computer workplace in the procedure room close to the patient has to be planned for the anesthetist or personnel performing sedation and monitoring.

      In addition, there should be a resuscitation equipment within the unit. A resuscitation trolley should be in the endoscopy room or easily available. In some units, it has been found convenient to place markers on the floor so that mobile equipment is placed correctly.

      As general anesthesia has changed mostly to intravenous agents, the installation requirements for general anesthesia have decreased. However, the needs of the anesthesiologist should be considered during the primary planning. There should be anesthesiology trolleys or equipment and infrastructure (pressure air and oxygen sockets, IT connections) to accommodate the needs of the anesthetist. Preferentially, the X-ray room should be equipped with such facilities.

      Fig. 5.4 Example of an endoscopic room for upper GI endoscopy with optimized positioning of video monitors and surveillance monitors.

      5.8.4 Video Integration and PC-Based Documentation

      Modern GI endoscopy uses digital video endoscopy almost exclusively. While the analogue video signal (SVHS, RGB) is still available, most newly designed units use the digital high-definition video technique. Whether videos are stored centrally or in the local endoscopic documentation system depends on the video concept of the unit or the hospital. Increasingly, the Digital Imaging and Communications in Medicine (DICOM) standard is used to store endoscopic pictures in the PACS. This offers the advantage that all images are stored with the respective patient case in a central system which is generally accessible. A corresponding video standard is yet to be developed.

      As IT-based documentation of endoscopic procedures is standard, a specialized area for documentation within the procedure room has to be planned. This area should be located outside either the sterile or contaminated procedure area but should be close enough to access written or PC-documented information (Clinical Information System [KIS] or PACS information). In the radiographic procedure room, this documentation area must be located outside the radiation area.

      Various commercial endoscopic documentation systems with integrated report generation are available. As endoscopic terminology has been widely standardized, reports can be generated with these systems. Integrated systems also allow video streaming and video switching. For the integration of additional equipment, additional video inputs and video lines have to be planned and installed. It is advisable to have a separate video planning concept for a new unit. In most larger units, it is advisable to centralize video information to a central video switchboard which allows central video streaming or storage. Most integrated systems (EndoAlpha, OR-1) are based on such a concept.

      As already mentioned, IT documentation is also standard for sedation as well as for documentation of procedure parameters (endoscope and equipment and material used). Thus, in addition to the IT working place for the endoscopists, additional areas have to be planned for anesthetists and nursing staff. Recently, there have been attempts to switch the documentation process to handheld devices, which will then decrease space requirements. However, this emphasizes the need for high-speed WLAN connectivity in the endoscopic suite.

      5.8.5 Endoscopes and Endoscopic Equipment

      Sufficient endoscopes must be available within a endoscopic unit to allow a smooth sequence of the endoscopic procedures and to allow for optimal work efficiency of the endoscopists and endoscopic staff.

      The number of endoscopes needed is dependent on the reprocessing cycles, the number of procedures and rooms active in parallel, and the amount of specialized procedures that require specialized endoscopes and equipment (e.g., therapeutic endoscopes, large working channel, pediatric scopes).

      In addition to the equipment within the procedure room, a mobile endoscopy trolley carrying all essential instruments and endoscopic processors should always be on standby, as occasionally СКАЧАТЬ