Gastroenterological Endoscopy. Группа авторов
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Название: Gastroenterological Endoscopy
Автор: Группа авторов
Издательство: Ingram
Жанр: Медицина
isbn: 9783131470133
isbn:
5.9 Endoscopic Ultrasound and Laser Treatment Room, Radiography Room
Large endoscopy units, from the so-called 4 + 2 room model and upward, should have a room dedicated to EUS, laser, or photodynamic therapy. Since such procedures tend to be time consuming, they should be scheduled and planned carefully so as to not interfere with general routine endoscopic activities. Radiographic facilities should be available when required during ERCP, dilation procedures, insertion of stents, etc. Such facilities avoid the inconvenience and waste of time involved in transporting patients and fragile equipment to and from the radiology department. An alternative for smaller endoscopy units is to modify one of the rooms in the radiography department to accommodate endoscopy.
The choice of radiography system should consider the special needs of the endoscopist. In most modern units, a C-arm system with flexible X-ray planes is used. Digital X-ray with a pulse radiographic beam is preferable due to high image quality and low radiation exposure. A solid phase X-ray detector is a new X-ray standard which offers less respiration and movement artifacts, which is helpful especially for ERCP and percutaneous interventions (
The radiographic procedure room is often used with additional imaging modalities such as endosonography and cholangiography. Therefore, the display capacity of this room must be versatile and flexible (see later). A “2 and 2” or “3 and 2” monitor system is recommended with flexible inputs to the various monitors, for example, by the use of a special switching device. The radiography monitor and the videoendoscopic monitor should be mounted together and positioned in such a way that the endoscopist and assistant personnel have a direct, unobstructed view. Preferentially, the main monitor system is composed of a radiographic and one endoscopic monitor, whereas the third monitor should be used for reference (X-ray) or additional imaging modalities (EUS, cholangiography, mother–baby endoscopy) (
Fig. 5.5 Modern multifunctional intervention room with X-ray and operative hygiene standard. Technical installations (e.g. for X-ray Siemens artis Zee with solid state detector) are in a separate room to gain space for anesthesiology and additional equipment. Modern video switching (Olympus Exera III with switching tool) allows versatile combination of video sources and distribution on the various procedure monitors. Ceiling supplies (Trumpf Medical) allow optimal hygiene standard and flexibility.
The radiographic room should have enough space for the X-ray protection and shielding system and should be especially equipped for procedures performed under general anesthesia.
5.10 Preparation and Recovery Room
Preparation and recovery rooms should be located close to the endoscopy unit. In general, three beds per endoscopy room are required.7,10 Seven square meters per bed is standard. The use of sedatives such as midazolam and/or propofol during upper or lower tract endoscopy requires recovery facilities (with nursing supervision), since it may be as long as an hour before these patients are able to leave the endoscopy unit. Oxygen and suction devices are essential in addition to pulse oximeters, electrocardiography monitoring, and resuscitation equipment.
5.11 Cleaning and Disinfection Area
Disinfection is a central problem in the endoscopic unit. Thus, the concepts for cleaning and reprocessing the endoscopes is of utmost importance and should be handled with local disinfection experts. Processing of the endoscopes can be done in a centralized area for the entire hospital, but requires elaborate logistics for transport to and from the unit. More commonly, a disinfection and reprocessing area is located within the endoscopic unit. When planning a new unit, there are two different concepts for the cleaning area. In one concept, the cleaning area is accessible directly from the procedure room. This is only practical in smaller units with few procedure rooms. In larger units with more than three procedure rooms, the cleaning area is best located centrally. For optimal hygiene, a one-way system for endoscope transport and processing has to be established. The cleaning and reprocessing area has to be divided into separate unclean and clean areas. These two areas should be completely separated by a separating wall and best by double side or load through washing and reprocessing machines, which act as separator for the two rooms.17,18 This completely avoids mixing of used and unused endoscopes and eliminates possible endoscope contamination. Cleaning of endoscopes should be carried out by fully-automated washing and disinfection machines by skilled personal. The unclean areas should contain stainless-steel work surfaces, with a double sink and an ultrasonic bath for initial cleaning. There should be 1.5 m on either side of the sink to position endoscopes. There should be enough room for brushing, ultrasonic cleaner, tightness control, and a compressed-air system for mechanical cleaning. After cleaning and disinfection of the endoscopes, they should be stored either hanging in a closed storage cabinet or in specially designed venting cabinets. There are various venting cabinets that are commercially available.
The entire cleaning process should be controlled by RFID chip or bar code–mediated control of the endoscopes, processing machines, and the venting cabinet. This allows generation of an endoscope “history” where all relevant data from the endoscope are collected in a central data file. These data include time and use of the endoscopes in the individual patients, time and responsible person who cleaned and processed the endoscope, processing protocol, time and success of the disinfection process, and time during transfer of the endoscope to the venting cabinet. With this log file, continuous monitoring of the endoscope use as well as cleaning and processing can be established. These data can be used to define interval for service and evaluation of endoscopes, hygiene controls, and mandatory service procedures.
The capacity of the disinfection equipment and washing machines needed for a given unit depends on the number of examinations, the time planned per examination, and the time needed to clean, disinfect, and dry (cleaning cycle) the endoscope. As vapors from disinfectants need to be removed from the room, a powerful ventilation system has to be in place for the cleaning and processing area to exclude the possibility of inhalation of toxic or allergenic vapors. There should be separate containers for waste, dirty linen, etc. There should be at least one dirty sink.
5.12 Staffing
Assistance for GI endoscopy is a task for fully-trained professional nurses and technicians.12,13,19 The nursing staff carries a major responsibility for patient safety. In some countries, nursing staff can be trained and specialized for administration of sedation and monitoring of the patient during the endoscopic procedure (NAPS nurses).2 In other countries, for example, France, the sedation and administration of sedatives are required to be performed by anesthetists.20
Per European guidelines, there must be one properly trained nurse assistant in each procedure room, and two for any complex endoscopies СКАЧАТЬ