Procedural explanations

Question 1

How should you explain a procedure?

Answer 1

Explain what it is
Explain the reason it is needed
Explain the procedure preparation
Explain what happens during the procedure
Explain what happens after the procedure
Explain the risks and benefits
Safety net the patient

Question 2

Explain bronchoscopy (+/- biopsy)

Answer 2

Before:

• -> 4 hours before - Clear fluids only
• -> 2 hours before- NBM
• -> Clotting test
• -> Stop aspirin/warfarin 1 week before procedure

During:

• -> Midazolam sedatime (–> Amnesia)
• -> Lignocaine gel for airways

After:

• -> No eating/drinking 2 hours after as throat is still numb
• -> No driving, alcohol, operating machinery
• -> Keep someone with you for 24 hours
• -> Arrange follow up

Risks & benefits:

• -> Sore nose/throat
• -> infection
• -> Haemoptysis next day (if biosied)
• -> Lung damage/collapse

Question 3

Explain gastroscopy

Answer 3

Before

• -> 8 hours before: clear fluids only
• -> 4 hours before - NBM
• -> stop antacids 2 weeks before procedure

During:

• -> Midazolam sedative (–> amnesia)
• -> Lidocaine spray
• -> Continuous suction
• -> Air passed through scope (–> fullness, belching)

After:

• -> No driving, alcohol, operative machinery
• -> Keep someone with you for 24 hours
• -> Arrange follow up

Risk & Benefits:

• -> Perforation (<0.1%)
• -> Bleeding
• -> Infection
• -> Cardio-respiratory arrest in elderly («0.1%)
• -> Infection (chest/pneumonia)
• -> Transient sore throat

Question 4

Explain a colonoscopy

Answer 4

Before:

• -> 3days before- no brain/roughage
• -> 1 day before - clear fluids only
• -> 3 hours before - NBM
• -> Sodium picosulfate sachet for morning and afternoon of the day before

During:

• -> PR first
• -> Midazolam sedative (-Amnesia)
• -< Air passed trough scope (–> bloating, sensation that you need to go to the toilet)

After:

• -> No driving, alcohol, operating machinery
• -> Keep someone with you for 24 hours
• -> Arrange follow up

Risks & Benefits:

• -> Perforation (0.1%)
• -> Bleeding due to structural damage
• -> infection
• -> Haemorrhage after biospy
• -> Abdominal discomfort
• -> Incomplete exam

Question 5

Explain a flexible sigmoidoscopy

Answer 5

Before:

• -> 2 hours before - clear fluids only
• -> 2 phosphate enemas 2 hours before (self-administered at home)

During:

• -> PR first
• -> No sedation required

Risk & benefits

• -> Perforation (0.1%)
• -> Bleeding due to structural damage
• -> infection
• -> Haemorrhage after biospy
• -> Abdominal discomfort
• -> Incomplete exam

Question 6

Explain a cystoscopy (rigid or flexible)

Answer 6

Before:

• -> 8 hours before: clear fluids only
• -> 2 hours before: NBM
• -> Normal pre-op assessment

During:

• -> May have sedative or anaesthesia
• -> Anaesthetic jelly
• -> water passed through

After:

• -> No driving, alcohol, operative machinery
• -> Keep someone with you for 24 hours

Risks & benefits:

• -> Bleeding due to structural damage
• -> Infection
• -> Mild burning on urinating for up to 24 hours
• -> Haematuria after biopsy