Anorectal manometry

Author:寧波邁達醫療儀器有限公司 Click: Time:2019-05-27 17:02:27

Preparation before operation

(1) Patient preparation

1 Ask the medical history including symptoms (constipation, incontinence, abdominal pain, perineal pain) history of allergies, history of anorectal surgery, taking laxatives, history of pelvic trauma. Gastrointestinal drugs and sedatives were banned for 3 days before the test, and no fasting or bowel preparation was needed on the day of examination.

2 register the patient's basic information and sign the consent form for the patient;

3 Before the operation, the patient evacuates urine and feces

4 Explain the inspection process to the patient, obtain cooperation, and reduce discomfort;

(2) Instrument preparation

1 Open the computer and anorectal pressure measurement software, and prepare the tape;

2 Check that the water level of the water tank of the instrument should be no less than 1\4 position, otherwise please add distilled water in the water tank to be no more than 3\4 position;

3 The treatment bed is provided with white pad, gauze and toilet paper;

4 With good gloves, check whether the anorectal pressure measuring tube and catheter balloon are intact, check the air bag for air leakage, connect the pressure measuring tube to the pressure sensor on the instrument without leaking gas, and then the catheter number and the pressure sensor on the electronic amplifier. Numbered 1-1, 2, 2, 3, ..., 8-8, one-to-one correspondence;

5 Click the “Open Water Valve” and “One Button Flush Capsule” buttons on the main interface. At this time, drain the gas in the tube and place the pressure measuring tube horizontally until the water in the 8 channels is even. Click “Restore normal pressure”.

(3) Operation process

1 Add a patient to the computer, register the patient's basic information, and save it;

2 Let the patient lie in bed, position the body, and bend the knee on the left side;

3 In the main operation interface, select the patient information to be checked, and select the correct procedure in the operation navigation (anorectal manometry), select the appropriate pressure measuring catheter, and then click to enter the “Start Pressure Measurement” button;

4 anorectal digital examination, instructing patients to do simulated defecation and anal movements, the purpose of this operation: 1) to discriminate the patient's anal fistula; 2) to feel the anal sphincter muscle strength and direction through defecation and anal movement; 3) to examine the patient's rectum Whether there is any feces inside;

5 pressure calibration: According to the prompt on the computer to do the pressure calibration of 0 to 50cm high and low, if and only after the pressure calibration is successful, the formal inspection procedure can be carried out;

Adjust the baseline pressure: Place the catheter horizontally at the height of the patient's anus. Click the “Adjust Baseline” button for about 5 seconds. The system can adjust the 8-lead pressure curve to around 0mmHg. If the deviation is large, please adjust it again.

6 The pressure measuring catheter is lubricated and inserted from the anus. The insertion length is 8th in the anal canal. The catheter can be 8.5cm in the anus. The 30 seconds rectal resting pressure is recorded, the catheter is fixed, and the blanket is covered and protected. Patient privacy.

(Recommendation: You can slowly pull the catheter while observing the curve on the computer. When the 8th guide leaves the anal canal, stop pulling and return 0.5cm;)

7 patients relax for 2-5 minutes to allow the patient to adapt to the pressure catheter;

8 Enter the catheter distance and save the recorded data;

9 Record rectal and anal sphincter resting pressure: The patient recorded at rest for about 30 seconds, and the average value was calculated for the rectal and anal sphincter resting pressure.

(2) Instruct the patient to do the action and ask the patient's feelings:

1 Let the patient do a "cough" movement, check the systolic pressure of the anal sphincter when the cough is increased by abdominal force.

2RAIR rectal anal inhibition reflex: inject air into the balloon, the gas injection volume is increased from 10ml to 50ml, each insufflation should be completed within 1-2 seconds, rapid insufflation and rapid withdrawal, 30 seconds interval. Every time you ask the patient, do you feel it? If you feel it, click “RAIR”; if you don’t feel it, click “RAIR”.

3 contraction anal movement:  patients forcefully contract the anus, and try to extend the time until it can not be uncomfortable or more than 15 seconds, then click “relax” to let the patient relax, wait until the baseline returns to the level before the examination, do 3 times in a row, every time twice Leave at least 1 minute apart (if you have a fecal incontinence, do it 5 times in a row).

4 Defecation action: patients do simulated bowel movements, then click “relax” to let the patient relax, wait until the baseline returns to the level before the test, and do 5 times in a row, at least 1 minute every two times; (normal people simulate bowel movements, Increased rectal pressure and reduced anal canal pressure)

5 Ask the patient's feelings: First explain to the patient the four sensations that will result from injecting gas into the rectum: 1. initial sensation, 2, intention, 3, urgency, 4, maximum tolerance, definition of these four sensations;

? initial feeling: for the first time, there is gas injection in the rectum;

? Conscientiousness: the feeling of having to defecate;

? Distress: The patient has a sense of urgency, although it is urgent, it is still within the scope of tolerance;

? Maximum tolerance: the patient is almost unbearable.

A 60 ml syringe was used to inject slowly into the balloon. For each additional 10 ml, the patient was asked about the sensory condition. Each time a feeling was generated, the volume of gas in the balloon was simultaneously marked on the computer until the patient could not tolerate it. When the patient is intolerable, the gas is immediately withdrawn and the amount of withdrawal should be equal to the amount of gas injected.

Post-operational treatment: exit the pressure measurement software, 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.

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