SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 40 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission I N T H E AT R E - PO S I T I ON I NG AND MON I T OR I NG Prior to the patient arriving in theatre, there should be a briefing between all staff members so that everyone knows what procedure is planned, and what equipment is, or may be required (see above). Some things are the same for all procedures, however. I’ve never quite worked out why, but it seems quite difficult to explain the optimum position for ERCP to the patient. The best idea I have seen is to keep a laminated copy of the image below in the ERCP trolley and to show it to the patient so they can adopt the position themselves! In this position the duodenum falls forward to allow the ampulla to be seen at a distance from the end of the duodenoscope, and the left arm is kept out of the way of the chest and abdomen, so Xray images can be taken. The patient is likely to be in this position for 20-30 minutes so it’s worthwhile telling them to make adjustments until they are comfortable. In patients with Rheumatoid arthritis, there is a risk that the joints in the neck are fragile and particular care must be taken in this position. Manipulating the head must be avoided at all costs to prevent cervical dislocation and spinal damage. Prior to assuming this position, Lignocaine throat spray is administered to numb the throat. Blood pressure cuff, nasal oxygen, pulse oximetry and a mouth guard are standard in ALL procedures . ECG leads are desirable, particularly in elderly patients and those with pacemakers. Electric diathermy pads are stuck to the thigh/buttock/lower back whenever diathermy is necessary. These pads are the exit for an electric current that is passed down the diathermy 14