Definition
Endoscopic Retrograde Cholangiopancreatography (ERCP) refers to the endoscopic visualization of the common bile, pancreatic and hepatic ducts with a flexible fiberoptic endoscope inserted into esophagus passed through the stomach and duodenum and into common bile duct and pancreatic duct. Procedure is done in endoscopy department.
Purposes for ERCP
- To diagnose obstruction in cholangiopancreatic tree.
- To detect extrahepatic biliary obstruction.
- To diagnose pancreatic disease.
- To determine nature and level of pathology in biliary obstruction.
- To evaluate preoperative and postoperative conditions of obstructions.
Articles
- Side-viewing duodenoscope.
- Endoscopic retrograde cholangiopancreatography (ERCP) catheters.
- X-ray compatible table.
- Contrast medium.
Preparation of the Patient for ERCP
Preparing for Endoscopic Retrograde Cholangiopancreatography (ERCP) involves several important steps to ensure the procedure is safe and effective:
- Fasting:
- Avoid eating or drinking for at least 6-8 hours before the procedure to ensure the stomach is empty.
- Medication Adjustments:
- Inform your healthcare provider about any medications you are taking, especially blood thinners, as adjustments may be necessary.
- Disclose any allergies, particularly to contrast agents or sedatives.
- Medical History Review:
- Discuss your medical history, including any current or past health problems, allergies, or symptoms.
- Transportation:
- Arrange for someone to drive you home after the procedure, as sedation may impair your ability to drive.
- Clothing and Accessories:
- Wear loose, comfortable clothing and avoid wearing jewelry or metallic items.
- Consent and Communication:
- Discuss the procedure with your healthcare provider, ask any questions, and sign the consent form.
Specific Preparations
- Hydration: In some cases, hydration with intravenous fluids may be recommended before the procedure.
- Pre-Procedure Tests: Blood tests or imaging studies may be conducted to assess the condition of the bile and pancreatic ducts.
Procedure
| Nursing action | Rationale | |
| 1. | Explain the procedure to the patient and confirm that an informed consent has been taken from the patient. Also explain to him how he has to cooperate. | Allays anxiety and helps in obtaining cooperation of the patient. |
| 2. | Assess for any allergies to iodine and seafood. | Contrast medium usually contains iodine. |
| 3. | Explain to the patient that he will experience a flushing sensation during administration of contrast medium. | Prepares the patient for the procedure. |
| 4. | Instruct patient to be NPO at least 4-6 hours before the procedure. | Prevents aspiration during the procedure. |
| 5. | Ensure that artificial dentures are removed. | Prevents possibility of loose dentures obstructing airway. |
| 6. | Monitor vital signs and observe level of consciousness and tolerance to the procedure. | Obtains baseline data for comparison in future. |
| 7. | Administer antibiotics as ordered. | Acts as a prophylaxis against postprocedural infection. |
| 8. | Administer sedatives, glucagon or anticholinergics as ordered. | Glucagon stops duodenal peristalsis. Anticholinergics reduce secretions. Sedatives reduce anxiety and help in relaxation of the patient. |
| 9. | Spray throat with xylocaine or instruct patient to gargle and swallow topical anesthetic agent. | Decreases gag reflex. |
| 10. | Place the patient in left semi-propped position and inform that multiple position changes are required during the procedure. | Enables easy passage of the endoscope and enables effective radiographic visualization. |
| 11. | Observe patient for any adverse effects of medication administered, such as respiratory depression, central nervous system depression, hypotension, vomiting, etc. Monitor IV fluids administered during procedure and help in changing position as required. | Sedatives may induce side effects, such as respiratory depression, central nervous depression, hypotension, vomiting, etc. Position changes may be required for radiographic visualization. |
| 12. | Record events of emesis, respiratory distress, vasovagal reaction or diaphoresis. | |
| 13. | Document all drugs administrated, stents placed, and biopsies taken in nurse’s record. | Promotes communication among healthcare workers. |
| 14. | Record fluids administered, techniques used, and patient’s condition at the end of the procedure. | Helps to identify patient’s tolerance to the procedure. |
Postprocedural care
- Monitor vital signs and level of consciousness.
- Position patient to prevent aspiration and transport to recovery area.
- Observe and report abdominal distention and signs of perforation, gastrointestinal bleeding or signs of possible pancreatitis including chills, fever, pain, vomiting, tachycardia, and notify physician immediately.
- Maintain NPO status until gag reflex returns. Check for gag reflex by applying gentle pressure using a tongue depressor placed on the back of the tongue.
- Give verbal and written instructions to patient and relatives regarding diet, medications, activities and possible complications.
- Instruct the patient to drink ample amount of fluid after administration of the dye.
- Warn the patient that there may be some discomfort with urination while the dye is excreted.
Complications
- Pancreatitis.
- Pleural effusion.
- Gastrointestinal bleeding due to cervical perforation and esophageal perforation.
Special considerations
- Cervical perforation would be exhibited by neck or throat pain, feeling of pressure, dysphagia, or crepitus around the neck area.
- Epigastric or shoulder pain could be the result of esophageal perforation.
- Evaluate for cyanosis, dyspnea, and pleural effusion as a result of perforation affecting the respiratory system.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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