First, patient preparation
1. Detailed medical history, including symptoms (dysphagia, heartburn, acid reflux, hernia, chest pain, etc.), history of allergies, presence of heart disease, asthma, history of surgery, history of gastrointestinal motility medication, etc. Gastrointestinal drugs and sedatives were banned for 3 days before the test, and the day was fasted.
2. Sign the consent form.
3. Explain the whole process of the examination to the patient, and obtain cooperation to reduce discomfort.
4. Fill the sink with water, connect the conduit, and calibrate the instrument.
5, catheter: 24 guide pressure measuring catheter, catheter spacing 1- 2- 2- 2 -2 -2 -2- 2 -2- 2 -2 -2 -2- 2- 2 -2 -2 -2 -1 - 1 -1 -1 -1 -5.
6, pressure calibration: take 0-50cm two planes for pressure calibration.
Before the new conduit is used; after the pump is replaced with water; change the tank pressure
Second, the steps
1. 1 hour before intubation, soak the solid catheter into warm water, and try not to float out of the liquid surface, so that the catheter is soft, and the patient will feel more comfortable when intubating.
2. The patient is sitting in a straight position.
3, let the patient inhale from different nostrils to determine which nostril is more smooth, the intubation should be carried out through the nostrils on the smooth side.
4, stimulate the uvula or oropharynx, detect vomiting reflex, the patient with poor reflex is more likely to have lung inhalation.
5. Nasal local anesthesia (such as lidocaine spray or gel). Patients should be consulted in advance, and those who do not want users or allergic drugs should not use local anesthesia.
6. Wait a few minutes for the anesthetic to take effect.
7. Apply a lubricant (such as paraffin oil) to the top of the catheter.
8. Gently insert the catheter into the nasal cavity.
9. When the catheter is in the nasopharynx, the patient's head is tilted forward until the lower jaw hits the chest. The head tilts forward to close the trachea, facilitating the catheter to enter the esophagus.
10. When the catheter enters the nasopharynx, the sputum patient normally breathes and swallows. In order to make the patient swallow the catheter more easily, the patient can absorb a few mouths through the straw while maintaining a straight posture, and let the lower jaw lean against the chest. .
11. It should be noted that the catheter should easily enter the esophagus without causing coughing. A cough may indicate a dislocation of the catheter (if it may enter the throat). If the LES is high in tension and cannot be slack when swallowed, there is a certain difficulty in the catheter entering the stomach, and the catheter may be discounted at the distal esophagus. In this case, the catheter can be pulled out of the part and slowly sent to the stomach cavity. If there is still difficulty, the metal guide wire can be inserted into the water-filled catheter, and the catheter can be sent to the stomach under fluoroscopy. Cavity.
12. Insert the catheter to the required depth so that all pressure measuring channels enter the gastric cavity (evaluation criteria, sputum deep inhalation, when all pressure channel pressure rises), set the gastric cavity pressure to baseline pressure.
13. Monitor the patient's vital signs. Because nasal insertion of the stomach tube and tension may trigger vasovagal reactions or syncope.
14. After the intubation is successful, the patient is supine and rested for 2 minutes to allow the patient to fully adapt to the catheter.
Third, esophageal pressure measurement
1, LES pressure length measurement:
(1) LES pressure is measured by fixed point or sectional pull method (SPT), each time the external pressure measurement is 0.5 cm, so that each channel passes through the LES, and at least 10 respiratory fluctuations are detected at each point.
(2) LES length measurement: When the pressure measuring catheter of a certain channel enters the LES, the base of the pressure wave is raised, and the pressure rising point is the distal end of the LES (lower end), and the scale on the recording catheter is recorded; in Acm. Continue to pull the catheter, when the channel catheter leaves the LES into the esophagus, the pressure wave immediately drops to the esophageal pressure (the esophageal pressure is below the baseline of the intragastric pressure), which is the proximal end of the LES (upper end), recording catheter Upper scale; in Bcm, the length of the LES is the difference between the AB values.
(3) LES swallowing function measurement: When channel 3 is in the LES pressure zone, the catheter is repeatedly pulled so that the 3 channels are at the highest peak of the LES pressure, marked "LES", and the LES pressure wave curve is recorded for about 20 seconds. Three times of 5 ml of water were swallowed, each time 30 seconds apart, and the "wet pharyngeal" mark was accurately placed at the beginning of swallowing. When the channels 4-7 entered the LES, the appeal operation was repeated.
2, esophageal body movement measurement: continue to pull the catheter, when the channel 8 is 2cm above the LES, fixed pressure measuring catheter, 10 times 5ml water swallowing, each interval 30 seconds, observe the esophageal body movement changes.
3. UES pressure measurement: Pull the catheter. When channel 1 is in the UES part, click the “UES” mark to record the UES pressure wave curve for at least 10 seconds. Perform a dry swallow and accurately place the “dry throat” mark at the beginning of swallowing. When the channels 2, 3 enter the UES, respectively, the above operation is repeated.
Fourth, data analysis
Five, catheter cleaning and disinfection
For hospitals that are not sterilized with the endoscope room, we use this method of disinfection:
1. First clean the catheter that the patient has used in clean water, and clean each tube with a syringe to clean the water;
2. Place the catheter into the 2000mg/L effective chlorine (Jianzhisu) disinfectant and soak for 30 minutes. In each tube, use a syringe to inject the disinfectant solution;
3. Rinse the tube again with clean water. Each tube should be rinsed with water using a syringe.
4. Use a syringe to dry the water in the catheter, place it in a cabinet with air circulation, or place the colonoscope and gastroscope in the endoscope room.
For hospitals that are sterilized with the endoscope room, we use the standard of the endoscope room.
1. Cleaning and disinfection procedure: preliminary cleaning at the bedside → cleaning in the water tank → leak detection → enzyme washing → water cleaning → 2% alkaline glutaraldehyde soaking (soaking time according to the specification) → sterile water washing → suction mirror Sterile fluid can be used for the next inspector.
2. Endoscopic disinfection is soaked with 2% alkaline glutaraldehyde.
Soaking time: 1 gastroscope, colonoscopy, duodenoscopy soak for not less than 10 minutes;
2 bronchoscope soak for not less than 20 minutes;
3 Patients with special infections such as Mycobacterium tuberculosis and other mycobacteria should be immersed in the endoscope for not less than 45 minutes.
3, 2% alkaline glutaraldehyde solution is changed once a week, monitored and recorded daily with test paper, if the concentration is not up to standard, replace it at any time. Biological monitoring is performed once a month.
4. The endoscope after disinfection is biologically monitored once a quarter. The sterilized accessories are biologically monitored once a month.