Reducing Soft Tissue Injury and Realizing Significant Cost Savings
Through Use of Innovative New Endoscopy Device
Jim Slattery RN, CGRN
Colonoscopy is a procedure performed in hospitals and freestanding
clinics to diagnose and evaluate the heath status of the bowel. The goal
of the procedure is to reach an anatomic landmark called the ileocecal
valve, thus allowing for complete evaluation and treatment of colonic
disease states and detection and removal of pre-cancerous polyps.
As part of the procedure, endoscopy personnel are required to press
firmly on the abdomen.
N-Doe Pillow™
is a unique new device
available exclusively through
N.M. Beale Company, Inc.
It allows for hands free
compression of the abdomen
during colonoscopy.
Abdominal pressure applied by the nurse or assistant provides countertraction to aid in the prevention and management of scope loop
formation. (Fig 1)
Without this assistance, reaching the
target can be exceptionally difficult to
achieve by the endoscopist.
Techniques for counter pressure have
been well described in the literature,
and include closed hand, open hand
and forearm methods. Each has its
advantages and disadvantages.
Fig. 1: Looping During Colonoscopy
In the closed hand method the fist is used at various points on the
abdomen. The ability to feel loop formation with the fingertips is lost and
the shoulder and neck muscles provide the force necessary. Extension of
the forearm places stress on the triceps and shoulder, while during the
open handed method, where the senses of touch are most acute, the
wrist is hyperextended.
The Problem
While one of the above methods, or a combination of them, may be
preferable to a particular individual, they all have one thing in common:
these repeated stresses on joints, muscles and ligaments result in fatigue
and micro-tears resulting in soft tissue injuries (STIs).
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Scope and Prevalence of the Problem
The Centers for Disease Control
and Prevention (CDC) has
estimated that there are 14.2
million colonoscopies performed
each year in hospitals in the
United States for colo-rectal
cancer screening and could
increase to 22.4 million annually.
Freestanding clinics do not
have the reporting obligations
that hospital based units do.
According to the World Health
Organization (WHO), another
136 million individuals are in need
of screening for colon cancer.
STIs are the most common work related injuries, accounting for millions
of dollars in lost time at work, pain and reduced quality of life. The
hospital industry is the third most expensive of 313 U.S. industries
resulting in 900 million dollars in cost of work-related injury and illness in
1993. [Waehrer]
Endoscopy personnel become afflicted with acute and chronic injuries to
the soft tissues of the hand, arm, shoulder and neck as a result of assisting
with colonoscopy. [Drysdale]
A number of studies examine the incidence, disabilities and quality of life
as a result of soft tissue injuries (STI).
The DASH Questionnaire is a scoring method that is widely utilized by
orthopedic surgeons to determine disability of the shoulder, arm and
hand. The questionnaire, once scored, helps determine the limitations
in activity and quality of life. The score range is 0-100. The general
population has a DASH score 8.8. The mean DASH score for the Canadian
endoscopy study group was 15.8. This finding was confirmed by Drysdale
in the US questionnaire.
The following facts have been established:
1) 36% of endoscopy nurses have or have had acute or chronic STI.
2) 5
9.9% see a doctor because of pain in the hands, wrists, shoulders
and neck.
3) U
p to 45% take over-the-counter non-steroidal medications to
treat said pain.
4) 3
2.7% of sick time used by the nurses in the study (n=147) was
because of STI/pain issues.
5) Mean hands-on pressure is delivered for 6.3 minutes per case.
While the above figures are alarming, the extent of STI on endoscopy
personnel is not fully known, as it is suspected to be under reported.
An endoscopy nurse or assistant may assist with up to 50 colonoscopies
per week — the equivalent of holding a push up position for 5 hours!
In addition to applying hand and/or forearm pressure, the nurse or
assistant is also required to aid the sedated patient to move into different
positions as an additional method for loop control, incurring back stress
in the process. Sedated patients may be moved 2-3 times per case and
moving a sedated patient during colonoscopy can injure back muscles.
Clearly, there is a huge need to address the problem. Ideally, the solution
would involve less hands-on time, and less repositioning.
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The Solution
A unique device called the N-Doe Pillow™ has been developed to meet
this challenge.
It was invented by a 30 year veteran of endoscopy nursing whose own
injuries were severe enough that he feared a career change may be
necessary. He searched for a tool that would aid him but found no device
to address these issues.
After experimenting for almost a year, he developed a soft but firm device
that uses a combination of the patient’s body weight and leveraging
to safely and effectively allow compression in the right areas without
requiring pressure form the nurse or assistant’s hands.
Using this innovative device, his DASH score improved by 50% in one
month.
The device was introduced to the public as the N-Doe Pillow.™
Fulcrum Points
How It Works
Palpation Arch
The N-Doe Pillow is designed to provide focal
pressure to the abdomen, rather than pressure
provided by the endoscopy assistant.
Contact Columns
After the patient is sedated and positioned,
the N-Doe Pillow is used to compress three
different zones, singularly or in combination, to
control loop by counter traction. The patient’s
own body weight helps to keep the device in
place.
By using the N-Doe Pillow as directed, the
nurse or assistant’s hands are free to be used
for palpation instead of pressure, and patient
position changes are rare.
2
3
1
The N-Doe Pillow is easy to use, affordable and
reusable.
Three pressure zones on the abdomen are compressed with N-DOE PILLOW™
singularly or in combination, to control loop by counter traction.
For a VIDEO demonstration of the N-DOE PILLOW™
visit www.nmbco.com/pillow.html
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