Explaining scope procedures

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Our notes on how to counsel patients here!

Bronchoscopy

Explain what the procedure is
Explain the reason for the procedure
Before
  • Oral intake
    • 6 hours before – clear fluids (sips) only
    • 2 hours before – NBM
  • Also
    • Coagulation test
    • Stop antiplatelets 1 week before (unless high risk, e.g. drug-eluting stent)
    • Stop warfarin 5 days before (± give LMWH)
    • Stop direct oral anticoagulants 48 hours before
During
  • Midazolam sedative (→amnesia)
  • Lidocaine spray/gel to the nose, throat and windpipe
After
  • No eating/drinking 2 hours after as throat still numb
  • No driving, alcohol, operating machinery, or signing legal documents for 24 hours
  • Keep someone with you for 24 hours
  • Arrange follow-up
Risks
  • Lung damage/collapse
  • Infection
  • Bleeding (haemoptysis)
  • Sore nose/throat
  • Sedation side effects
  • Pneumothorax

Gastroscopy

Explain what the procedure is
Explain the reason for the procedure
Before
  • Oral intake
    • 6 hours before – sips of water only (sips)
    • 2 hours before – NBM
  • Also
    • Stop acid suppressive medications 2 weeks before
During
  • Lidocaine throat spray or midazolam sedative (→amnesia)
  • Continuous suction
  • Air passed through scope (→fullness, belching)
After
  • Arrange follow-up
  • If had throat spray
    • No eating/drinking 2 hours after as throat still numb
  • If had sedation
    • No driving, alcohol, operating machinery or signing legal documents for 24 hours
    • Keep someone with you for 24 hours
Risks
  • Perforation (<0.1%)
  • Bleeding
  • Infection (aspiration pneumonia)
  • Sore throat
  • Dental damage
  • Sedation side effects

Colonoscopy

Explain what the procedure is
Explain the reason for the procedure
Before
  • Oral intake
    • 2 days before – low fibre diet (no bran/roughage)
    • 1 day before – clear fluids only after light breakfast
    • 2 hours before – NBM
  • Also
    • Sodium picosulfate sachet afternoon before and morning of the procedure
    • Stop iron tablets 1 week before, and constipating agents 4 days before (e.g. codeine)
During
  • Midazolam sedative (→amnesia)
  • Digital rectal examination prior to scope insertion
  • Air passed through scope (→bloating, you may feel like you need to go to the toilet)
After
  • No driving, alcohol, operating machinery, or signing legal documents for 24 hours
  • Keep someone with you for 24 hours
  • Arrange follow-up
Risks
  • Perforation (0.1%)
  • Bleeding
  • Infection
  • Abdominal discomfort
  • Sedation side effects

Flexible sigmoidoscopy

Explain what the procedure is
Explain the reason for the procedure
Before
  • Oral intake
    • 2 hours before – NBM
  • Also
    • Phosphate enema 2 hours before (can be self-administered at home)
During
  • Digital rectal examination prior to scope insertion
  • No sedation required
After
  • Arrange follow-up
Risks
  • Perforation
  • Bleeding
  • Infection
  • Abdominal discomfort

Flexible cystoscopy

Explain what the procedure is
Explain the reason for the procedure
Before
  • None
During
  • Anaesthetic jelly
  • Water passed through scope
After
  • Home after passed urine
  • Arrange follow-up
Risks
  • Bladder damage (hole)
  • Bleeding (haematuria – normal for a few days)
  • Infection (UTI)
  • Dysuria
  • Urethral stricture
  • Retention
  • May need temporary catheter afterwards

Rigid cystoscopy

Explain what the procedure is
Explain the reason for the procedure
Before
  • Oral intake
    • 6 hours before – clear fluids only
    • 2 hours before – NBM
  • Also
During
  • Usually have anaesthetic
  • Water passed through scope
After
  • Home after recovered from anaesthetic and passed urine
  • No driving, alcohol, operating machinery, or signing legal documents for 24 hours
  • Keep someone with you for 24 hours
  • Arrange follow-up
Risks
  • Bladder damage (hole)
  • Bleeding (haematuria – normal for a few days)
  • Infection (UTI)
  • Dysuria
  • Urethral stricture
  • Retention
  • May need temporary catheter afterwards
  • Anaesthetic side effects

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  1. Explaining colonoscopy
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