Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates
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An abdominal radiograph is considered the "gold standard" for determining the position of flexible small-bore nasogastric/orogastric tubes. However, placement must be checked frequently while a tube is in place, and the summative radiation risk of multiple radiographs, as well as their expense, make the development of adequate bedside placement-locating methods imperative. Several methods of detecting tube placement have been investigated in adults, including: aspirating gastric contents and measuring the pH, bilirubin, pepsin, and trypsin levels; examining the visual characteristics of aspirate; placing the proximal end of the tube under water and observing for bubbles in synchrony with expirations; measuring the carbon dioxide level at the proximal end of the nasogastric/orogastric tube; auscultation for a gurgling sound over the epigastrium or left upper quadrant of the abdomen; and measuring the length from the nose/mouth to the proximal end of the tube. ⋯ Research on gastric tube placement in children is relatively new because children are challenging to study in that they are considered a vulnerable population. This review of the literature includes results of both adult and pediatric studies. Tube placement error rates varied from 1.9% to 89.5% in adults and between 20.9% and 43.5% in children.
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Intravenous sedation is routinely administered for endoscopic examinations to help alleviate patient anxiety and discomfort. The goal of moderate sedation is to provide patient comfort to facilitate the completion of the procedure. ⋯ Propofol is a rapid acting sedative-hypnotic that produces the desired level of consciousness without the residual sedative effect that often persists with the use of benzodiazepines and analgesics. This article reviews current literature regarding the use of propofol for sedation of patients in the endoscopy setting, and highlights the trends in research that may impact future nursing practice.
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Practice Guideline Guideline
SGNA position statement. Statement on the use of sedation and analgesia in the gastrointestinal endoscopy setting.
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Anesthesiologists have recognized the increased risk inherent in obstructive sleep apnea patients, yet studies on sleep apnea and endoscope procedures are limited. As more procedures are being done in clinics, ambulatory care centers, and procedures labs, nurses are now performing moderate sedation on this high risk patient population with little information to guide them. ⋯ A resource list of agencies, internet sites, and references are included. This review of obstructive sleep apnea can assist gastroenterology nurses administering sedation to better recognize and monitor this high risk group.