SAGES Magazine

THE SOUTH AFRICAN GASTROENTEROLOGY REVIEW 2022 | VOLUME 20 | ISSUE 3 | 41 ERCP | A GUIDE FOR NURSES AND ASSISTANTS | Re-printed with permission wire (sphincterotome or needle knife) which then dissipates through the patient and out of the large pad on the skin. Electrical current will tend to flow towards this pad so it is advised to keep it at a distance away from any implanted metal objects in the body (eg prosthetic hips, spinal implants etc). The majority of modern pacemakers are safe to use in this scenario as the current passes away from the upper chest where the pacemaker is situated. Oxygen is given throughout the procedure as sedated patients will often breathe more slowly when asleep. It is given at 2-4L/min via nasal specs. It is worth noting that some patients cannot breathe through their noses well, and in these cases the extra nasal oxygen is ineffective. Specialised mouthguards are available, but in practice the nasal prongs are re- situated to allow oxygen flow into the mouth. If you notice the oxygen saturations falling however, the endoscopist must be informed straight away. Some patients are worried that they won’t be able to breathe in the position they need to be, but actually our lungs fill more easily when lying forwards and many patients with breathing difficulties due to COPD actually improve their oxygen saturations in this position - this is a hangover from the days when we humans walked about on all fours 3 or 4 million years ago! Many patients are elderly, have been NBM for 12 or more hours or have been vomiting, may have fragile renal function, or be on diuretics. Some may have had their IV’s discontinued in transit from the ward to theatre. Dehydration is associated with an increased risk of pancreatitis and a fall in blood pressure during ERCP. Diclofenac is rarely associated with kidney dysfunction, but particularly so in dehydrated patients. The use of IV fluids during ERCP should always be borne in mind (particularly if you notice the blood pressure falling during the procedure) and mentioned to the endoscopist if there are any concerns. 15