Endoscopy Unit
Llandough Hospital
Student Placement
Pack
Welcome to Endoscopy, UHL
Unit Philosophy
We the members of the Endoscopy Team will care for the patients
peri-operatively and as advocates for the patients rights. We will at
all times provide a holistic, individualistic approach to care and
endeavour to update ourselves with current standards and practice in
order to give outstanding care.
Student Name........................................................................
Mentor.................................................................
We hope this pack is a useful resource to enhance your learning experience here
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Hello and welcome
The Endoscopy unit at Llandough Hospital is one of the busiest and most specialised
Endoscopy units in Wales. We are a day case unit carrying out over 6,000 procedures a
year. We currently have four dedicated Endoscopy procedure rooms and also work in
other departments such as operating theatres and ITU to provide specialist and
emergency treatment. Currently, we carry out diagnostic and therapeutic
Colonoscopies, Flexible Sigmoidoscopies, Gastroscopies and Bronchoscopies.
The role of the Endoscopy Nurse is varied. We work in the endoscopy theatres assisting
the Endoscopists with procedures, care for patients pre, peri and post operatively,
manage airways, recover and discharge patients and pre-assess in and out patients both
face-to-face and on the telephone.
The key for nurses working in this busy environment is to understand that our activity
is 'process led' but 'patient focused'. The Endoscopy Unit is a place where you can learn
and practice essential nursing care as well as observe specialised practice. You are not
expected to know everything, few of us do!! But if in doubt, ask and most of all enjoy.
Sister Jan Kirk and the team.
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The Team
Nursing Staff
Our nursing team comprises of twenty Endoscopy Nurses and four Theatre Assistants.
We are managed by Sister Jan Kirk and co-coordinated by experienced Senior
Endoscopy Nurses Rachael, Beth and Sam who offer clinical and managerial support for
the unit each day.
Medical Staff
Endoscopies are carried out by Gastroenterology Consultants and Specialist Registrars,
Surgical Consultants and Specialist Registrars, Consultant Chest Physicians and Nurse
Endoscopists.
Consultant Gastroenterologists:
Dr Jill Swift
Dr John Green
Dr Sunil Dolwani
Dr Jeff Turner
Dr Clare Tibbatts
Dr Barney Hawthorne
Consultant Surgeons:
Mr Mike Davies
Mr Simon Phillips
Mr Chris Morris
Mr Jared Torkington
Lt Col Leigh Davies
Mr James Horwood
Consultant Chest Physicians:
Dr Diane Parry
Dr Helen Davies
Dr Ramsay Sabit
Nurse Endoscopists:
Sister Kay Charles
Sister Jane Turner
Sister Helen Ludlow
Administration Team
Our receptionist and co-coordinators are a wealth of knowledge and will always point
you in the right direction and are always happy to help.
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Link Nurses
BLS – Sam/Bethan
Bowel Screening – Sallyann
COSHH – Sallyann/Yvonne
Decontamination - Rachael
Diabetes – Beccy
Diathermy – David/Helen
Fire – Carole
Infection control - Yvonne
Manual handling – Sallyann
Oxygen Cylinders – Mike
Pharmacy – Natalie/CJ
Working Hours
You will work four days a week Monday - Friday. Hours are 08.00 - 18.00 three days a
week and 08.00 - 17.30 one day a week. Your off-duty can be negotiated with your
mentor or the nurse in charge on the first day of your placement. You do not have to
work with your mentor all of the time but they will act as your first point of contact and
complete your paperwork at the end of your placement.
Breaks: Discretionary morning coffee break: 10 minutes (if unit activity allows),
Lunch: 30 minutes. Both to be taken at a time to fit into unit activity.
Sickness
If you are ill or unable to attend placement for any other reason please telephone the
Endoscopy Unit and ask to speak to your mentor or the nurse in charge. Please also
inform us if you will be late for any reason. If you do not arrive when we are expecting
you, we will worry!
Uniform
Please wear your usual student nurse uniform. If you are required to wear theatre
scrubs at any time these will be provided when necessary.
Telephone/Communication System
Endoscopy Procedure Rooms: (02920) 715965
Endoscopy Reception: (02920) 715970
Endoscopy Office: (02920) 715979
Endoscopy Recovery: (02920) 715969/7
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Emergency/Arrest Call: 2222. Inform operator of location and give description of
incident. I.e.: cardiac arrest, Endoscopy Unit.
Fire: 3333
Security: 25303
Switchboard: 100
To Bleep: Dial 81. Enter the bleep number. When prompted enter your extension
number followed by #. You should hear a message to inform you your paging request
has been accepted followed by a bleep.
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The Role of the Student Nurse
During your placement in Endoscopy the staff will lend you as much support as possible
to achieve your objectives and make it an enjoyable and constructive placement.
In return we ask students to:
 Conduct themselves in a professional manner at all times
 Be punctual and ensure appearance is appropriate (i.e. Adhere to uniform policy)
 Inform mentor/nurse in charge if you have any problems at all, at the earliest
opportunity.
 DO NOT use mobile phones in the patient area. The use of mobile phones is
permitted only in the staff room on designated breaks.
STUDENT NURSES MUST NOT:
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Administer I.V. drugs
Perform airway management
Perform venous cannulation or venepuncture on a patient
Provide discharge information for a patient without direct
supervision
Biopsy or assist in any therapeutic endoscopic interventions
Use the blood glucose monitor
However under direct supervision from a trained nurse you may:
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Admit patients and prepare them for procedures
Administer non I.V. drugs
Assist in the monitoring of patients during procedures (including vital
signs, pain and sedation scores)
Assist in the running of theatre lists (including setting up and taking down
endoscopes)
Remove venous cannulas
Assist in the recovery of sedated and non-sedated patients
Complete discharge paperwork
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Safety Issues
"It is the duty of every employee while at work to take reasonable care for health and
safety of himself and other persons who may be affected by his act or omission at work"
(Health and Safety at Work Act, 1974)
Control of Substances Hazardous to Health (1988)
Whilst in the Endoscopy Unit you may be exposed to bodily fluids and
chemicals/substances that are hazardous to health. The COSHH act was introduced to
ensure safety in the working environment by controlling and minimising the exposure
of personnel to substances hazardous to health. COSHH regulations apply to any
substances including solids, liquids, gases and vapours that can be inhaled, ingested,
injected or otherwise absorbed.
Staff must always work safely, use personal protective equipment (P.P.E.) where
indicated, read labels and use appropriate substances in the correct setting. All staff
have a legal responsibility to comply with any control measures taken. If you notice
defective or missing P.P.E. please inform a trained member of staff immediately as
professional nurses are accountable for the safety of the environment for the protection
of patients, visitors and staff. In the event of a chemical spillage please notify staff
immediately. If needed there is a spill kit located on the wall outside of the
decontamination room opposite the endoscopy procedure rooms.
Infection Control
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Please adhere to uniform policy at all times and ensure you are 'naked from the
elbow'
Wear gloves at all times when performing any task involving bodily fluids.
Gloves should be changed in between patients and procedures and hands must
be washed between glove changes.
Hand washing facilities are available throughout the unit. Pay particular
attention to hand washing technique. Alcohol gel is also available.
Sharps will be disposed of in the approved manner by the person taking
responsibility for them. Care must be taken to dispose of the sharp item into the
correct coloured bin. If unsure please check the trust sharps disposal policy
All breaches of infection control procedures must be reported so that necessary
action can be taken to minimise/prevent risk to patients, staff and visitors.
Any 'high risk' or 'biohazard' specimen or vacutainer should be labeled
accordingly.
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Security
Security is everybody's responsibility. Therefore all unknown staff, patients and
visitors entering the unit may be asked to verify their identity. Please wear your
student nurse I.D. at all times. Any suspicious persons must be reported to Security and
the nurse in charge.
Learning Opportunities
You will be assigned a mentor to help and guide you. They are your first point of
contact for any learning needs, concerns or problems that may arise. You may not be
working with them every day but you will be allocated to work with a qualified nurse
each day and we are all here to help. Please speak out if you are unable to meet your
learning objectives as it can be very busy and we do want you to get the most out of
your time with us. The list below comprises some of the learning opportunities available
in the endoscopy unit. This list is not exhaustive and if you identify a specific learning
opportunity elsewhere please ask and we will do our best to accommodate you. It may
be possible to shadow one of our Specialist Nurses, please ask your mentor if you would
like to arrange this. In addition to the everyday learning you will encounter whilst
working on the unit, we have a collection of books and journal articles available to
supplement your learning.
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Digestive/Respiratory Anatomy
Admissions
Consenting process
Interpersonal/communication skills
Advocacy
Monitoring of awake and sedated patients
Pain assessments
Recovery of sedated patients
Discharges and discharge information giving
Pharmacology
Operating theatre cases
Upper G.I. emergencies
Management of endoscopy lists
Multi-disciplinary team working
Pre-assessment process
Specialist nurse/consultant out-patient clinics
Decontamination
Please document the learning objectives you would
like to focus on while you are here………………………………
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Label the G.I. tract below...
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Label the respiratory tract/lungs below...
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Listed below are some of the procedure, interventions, conditions and diseases you
may encounter whilst working in the Endoscopy Unit. It may help your learning to
look up them up before you start your placement, however plenty of information is
available on the unit from staff, the intranet and literature resources.
An Endoscopy is a procedure where the inside of your body is examined internally
using an endoscope. In Llandough all procedures carried out in the Endoscopy Unit
look at the G.I. tract and the lungs. An endoscopy is usually carried out while a person is
awake. Before the procedure a sedative and pain killer may be give to help the patient
relax and tolerate the procedure better.
An Endoscope is a slender, tubular camera used to examine inside the body. The size of
the endoscope varies depending on the part of the body being examined. Within each
scope is a light source to enables the endoscopist to have a clear view of an organ and to
check whether or not disease or inflammation is present. All endoscopes have a suction
facility and scopes used on the G.I. tract also have an additional channel in which air and
water can be pumped down the scope into the body.
Procedures
Oesophageal-gastro-duodenoscopy (O.G.D./Gastroscopy): examination of the upper
gastro-intestinal tract looking at the mucosa of the oesophagus, stomach and
duodenum. In order for the test to be done safely all patients must be Nil By Mouth
before the procedure. 6 hours for food and 2 hours for clear fluids to minimise the risk
of aspiration. Patients are given the choice of either local anesthetic spray applied to
the back of the throat or intravenous sedation. Patients having sedation must have a
responsible adult to take them home and stay with them for the next 24 hours
(including overnight). Patients having sedation require close observation. The nurses
will monitor level of consciousness, respiratory function and vital signs during the
procedure and in the recovery room. Oxygen is always given when sedation is used.
Reasons for O.G.D.
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Anaemia
Weight loss
Reflux
Pain
Dyspepsia (indigestion)
Malaena (black stools)
Vomiting
Haematemesis (vomiting blood)
Odynophagia (painful swallowing)
Dysphagia (difficulty swallowing)
Surveillance of Varices, Barrett's Oesophagus, Peptic Ulcers
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Varices banding
Acute upper GI bleed
Dilatation of benign stricture
Insertion of oesophageal stent
PEG (Percutaneous Endoscopic Gastrostomy) insertion
Colonoscopy: examination of the whole of the colon. During colonoscopy the internal
lumen of the large bowel is visualised from the rectum to the caecum (and sometimes
into the terminal (end of) ileum. Often, but not always performed under sedation. Prior
to colonoscopy patients must stop all iron supplements for one week, eat only a low
residue diet for 48 hours prior to the procedure and take bowel preparation the day
before to empty the bowel and ensure the mucosal wall can be visualised.
Reasons for Colonoscopy
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Malaena
Diarrhoea
Change in bowel habit
Central or right sided abdominal pain
Anaemia
Weight loss
Polypectomy
Check site of previous polypectomy
Dilatation of benign stricture
Insertion of colonic stent
Surveillance of inflammatory bowel disease, certain genetic conditions,
Bowel Cancer Screening program
Flexible Sigmoidoscopy: examination of the lower (left side) of the colon from the
rectum to the splenic flecture. Patients do not usually require sedation for this
procedure as it is generally much quicker than a colonoscopy. To clear the lower part of
the bowel the patient will either be asked to take bowel preparation or administer a
phosphate enema. Depending on the medical condition of the patient, ability to tolerate
bowel preparation, mobility and indication for the test the doctor will decide on the
bowel preparation most suitable to the patient. A phosphate enema is usually selfadministered by the patient at home 1 - 2 hours before the procedure. If required a
nurses can assist with this before the procedure.
Reasons for Flexible Sigmoidoscopy
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Rectal bleeding (fresh, bright red blood)
Diarrhoea
Left sided abdominal pain
Change in bowel habit
Check site of previous polypectomy
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Haemorrhoid banding
Dilatation of benign stricture
Insertion of colonic stent
Post surgical procedure follow-up (eg. Pouchoscopy, following TEMS procedure)
Bronchoscopy: examination of the upper and lower airways including the larynx,
trachea, bronchi and bronchioles. An extremely fine endoscope is passed via the nostril
or mouth down the trachea and into the bronchial tree. Patients must be NBM before
the procedure, 6 hours for food and 2 hours for clear fluids. Patients are given local
anesthetic spray to the back of the throat and anesthetic jelly is applied up the nose.
Sometimes local anesthetic is injected straight into the trachea through the neck. The
vast majority of patients will also be given sedation. Patients must remain NBM for at
least an hour after the procedure to allow the local anesthetic to wear off.
Reasons for Bronchoscopy
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Abnormal x-ray or other imaging test
Suspected interstitial lung disease (inflammation and then damage to deep lung
tissues.)
Haemoptysis (coughing up blood)
Possible foreign body in the airway
Persistent cough
Diagnose infection of lungs/bronchi that cannot be diagnosed in any other way
Inhaled toxic gas/chemical
Endo-bronchial Ultrasound (E.B.U.S): Examination of airways and fine needle
aspiration of tissue or fluid samples from the lungs and surrounding lymph nodes to
diagnose and stage cancers, identify infection or inflammatory diseases of the lungs.
Endoscopic procedures can be diagnostic or therapeutic. A diagnostic procedure is
one that is used to have a look into persons' organs and diagnose disease/problems. A
biopsy is the sampling of a small piece of tissue that is sent to the histology laboratory
for testing that is used to aid a definite diagnosis. Biopsying is classed as a diagnostic
procedure. Therapeutic endoscopy is the term used for medical treatment that is
carried out via the endoscope. Often saving the patient from invasive surgery such as
full or partial colectomies (removal of the colon).
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Conditions/diseases seen in G.I. Endoscopy
For each of the below find out what it is, who is affected, signs/symptoms, treatments and
complications:
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Achalasia....................................................................................................................................................
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Barrett's Oesophagus............................................................................................................................
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Cancers........................................................................................................................................................
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Coeliac Disease........................................................................................................................................
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Constipation..............................................................................................................................................
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Hiatus Hernia...........................................................................................................................................
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Diverticula Disease................................................................................................................................
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Dyspepsia...................................................................................................................................................
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Gastric Ulcer.............................................................................................................................................
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Gastro-Oesophageal Reflux Disease (G.O.R.D.)..........................................................................
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Haemorrhoids..........................................................................................................................................
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Helicobacter Pylori infection.............................................................................................................
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Inflammatory Bowel Disease (I.B.D.).............................................................................................
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Irritable Bowel Syndrome (I.B.S.)....................................................................................................
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Polyps..........................................................................................................................................................
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Varices.........................................................................................................................................................
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Therapeutic Endoscopic Interventions
For each of the procedures/treatments listed below, explain what they are and what they
are how they are done:
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Endoscopic Mucosal Resection (E.M.R.)......................................................................................
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Polypectomy............................................................................................................................................
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Stricture Dilatation...............................................................................................................................
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Stent Insertion.........................................................................................................................................
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Haemorrhoid Banding.........................................................................................................................
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Varices Banding......................................................................................................................................
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Argon Plasma Coagulation (A.P.C.)................................................................................................
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Insertion of Naso-Jejunal tube (N.J.).............................................................................................
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Percutaneous Endoscopic Gastrostomy (P.E.G.) Insertion..................................................
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Drugs commonly used in Endoscopy/Gastroenterology
For each of the drugs below find out what they are used for, doses, side-effects and contraindications/cautions:
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Midazolam.................................................................................................................................................
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Fentanyl......................................................................................................................................................
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Hyoscine Butlybromide.......................................................................................................................
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Flumazenil.................................................................................................................................................
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Naloxone.....................................................................................................................................................
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Xylocaine....................................................................................................................................................
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Lignocaine 2%.........................................................................................................................................
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Pethidine....................................................................................................................................................
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Adrenaline 1:10,000..............................................................................................................................
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Instillagel....................................................................................................................................................
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Klean-Prep................................................................................................................................................
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Moviprep....................................................................................................................................................
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Senna and Citramag..............................................................................................................................
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Phosphate Enema...................................................................................................................................
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Salbutamol................................................................................................................................................
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Proton Pump Inhibitor (P.P.I.)..........................................................................................................
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Prokinetic...................................................................................................................................................
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Corticosteroids........................................................................................................................................
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Aminosalicylates.....................................................................................................................................
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For each of the fluids/solutions below find out how and why they are used in Endoscopy:
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Gelofusin.....................................................................................................................................................
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Indigo Carmine........................................................................................................................................
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Black India Ink (Tattoo)......................................................................................................................
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Simeticone.................................................................................................................................................
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Acetic Acid 3%.........................................................................................................................................
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Notes
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