According to iDataResearch, approximately 51 million patients in the U.S. underwent GI endoscopies in 2017, of which 19 million were colonoscopies. That’s a whole lotta patients, and the following 5 tips can lead to a better patient experience in your ambulatory surgery center for every one of those patients.
Prep Solutions - Prep solutions are either nasty to drink (mag citrate), expensive (SuPrep) or both. Give your patients some options to take and tips for minimizing the negative impact. For example, mag citrate, if allowed to really chill over a glass of ice and then barreled down in one gulp like a shot followed by a drink of Gatorade or black coffee to get rid of the yucky after-taste isn’t half bad (I’ve done it). There are similar strategies for the other prep solutions.
PreOp Hydration - Prep solutions can be VERY dehydrating. Add to that a bit of hot weather, an elderly patient, and the patient who takes diuretics, and you’ve created the perfect storm for massive dehydration. What to do? Get rid of NPO after midnight! Encourage patients to actively drink water and electrolyte drinks like Gatorade up until 2 hours before their procedure. This has numerous advantages: happier patients, easier iv starts, a lower incidence of hypotension, and even lower incidences of afib caused by hypovolemia and electrolyte abnormalities.
Local for IV Starts – A small skin wheal of 1 or 2% lidocaine with a TB syringe prior to sticking a patient with an iv makes a world of difference. For those of you who say “but it’s 2 sticks vs just 1”, the patient doesn’t feel the second stick. If I had a nickel for every patient who commented on the painless iv start vs prior experiences I would be rich….
CO2 - Use CO2 instead of air for colonoscopies. For centers that still use air, you are putting your patients through a lot of unnecessary discomfort. CO2 is absorbed 250 times more rapidly than air and is then excreted by the lungs. This means that the colonic distention required for colonoscopy goes away 250 times faster if CO2 is used. Less cramping and less pain leads to happier patients and faster discharges, more than making up for the small additional cost of buying CO2 tanks.
Propofol – If you are still using nurse-administered conscious sedation, you have never experienced how great propofol can be for endoscopy. No versed. No fentanyl. Just straight propofol administered by a qualified anesthesia provider. Average doses (in my experience) are 300-400mg for a 20 minute colonoscopy, and 200-300mg for a 10 minute upper endoscopy. Patients are wide awake in 5 to 10 minutes without nausea and vomiting. 60-100mg of lidocaine in the iv right before the propofol minimizes the sting of propofol. So does using larger veins (antecubital) vs hand veins.
I hope you find these tips helpful, and good luck trying some or all of them!! Send me your feedback and please feel free to share your own tips and tricks for making endo better!
(Dr. Punzak is an anesthesiologist who has spent most Tuesdays and Fridays over the last 5 years in the endoscopy suite of Tobey Hospital in Wareham, MA)