Definition
Endoscopic sclerotherapy is a minimally invasive procedure used to treat bleeding esophageal or gastric varices, which are dilated veins often caused by portal hypertension in liver disease. It involves injecting a sclerosing agent directly into or around the varices via an endoscope to induce thrombosis and fibrosis, ultimately obliterating the vessel.
Purposes
- To treat patient with acutely bleeding varices.
- To treat patient who had bleeding from varices in the past and continues to have varices.
- To treat patient with portal hypertension.
- To treat patients with hemorrhoids.
Contraindications
- Haemoglobin less than 8 g%.
- Uncooperative patient with severe coagulopathy.
- Acute myocardial infarction with arrhythmias.
- Encephalopathy.
- Acute respiratory distress.
- Shock.
Articles
- Gastroscope with large biopsy channel.
- Sclerosing agent – ethanolamine oleate, alcohol, sodium tetradecyl sulfate, methylene blue.
- Injector/needle.
- Emergency resuscitation equipment and drugs.
Preparation
Preparing for an endoscopic sclerotherapy procedure involves several key steps to ensure safety and effectiveness:
- Fasting:
- Avoid eating or drinking for at least 6 hours before the procedure to ensure the stomach is empty.
- Medical History Review:
- Inform your healthcare provider about any medications you are taking, especially blood thinners, as these may need to be adjusted.
- Disclose any medical conditions, such as liver disease or bleeding disorders.
- Pre-Procedure Tests:
- Blood tests may be conducted to check for clotting ability and overall health.
- Imaging tests like ultrasound or CT scans may be performed to assess the condition of the esophageal varices.
- Medication Adjustments:
- Follow your doctor’s instructions regarding medications, including stopping certain drugs temporarily.
- 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.
Procedure
| Nursing action | Rationale | |
| 1. | Identify the method of endoscopy to be performed (involving upper gastrointestinal tract or lower intestinal tract). | |
| 2. | Explain the procedure to the patient and obtain informed consent. Provide instruction to the patient about preprocedural care depending on method of performing endoscopy. | Helps in obtaining cooperation of patient. |
| 3. | Identify any contraindication to the procedure and review physician’s order for preprocedural medication. | |
| 4. | Instruct patient: To remain nil per orally (NPO) on the night before the procedure if sclerotherapy is done on upper gastrointestinal tract. | Prevents risk of aspiration. |
| 5. | Ensure that bowel preparation is done in case of patients posted for sclerotherapy for hemorrhoids in the lower gastrointestinal tract. | Ensures good visualization of varices. |
| 6. | Place the patient in left lateral position/Sim’s position as per requirement. | Position helps in insertion of endoscope. |
| 7. | Place mouth guard if method involves upper gastrointestinal tract. | |
| 8. | Assist doctor to pass endoscope into the gastrointestinal tract to look for evidence of pathology. | Ensures that patient does not bite on the scope. |
| 9. | Assist in introducing needle and injecting sclerosing agent. | |
| 10. | Ensure patient’s comfort and monitor for complication before shifting to daycare unit. | Identifies complication that may occur during the early stage following procedure. |
| 11. | Record the procedure and care given in the nurses’ record. | Documentation helps in continuity of care. |
| 12. | Transfer the patient to daycare unit when stable. |
Postprocedural care
- Patient should be closely monitored in daycare area for at least 2 hours, till vital signs are stable.
- Watch for signs and symptoms of bleeding.
- Allow fluid after 1-2 hours.
- Provide quiet environment and keep patient comfortable.
- Watch for complications, such as chest pain, dysphagia, fever, bleeding, stricture esophagus, and perforation.
- Record about starvation, time of sending patient to endoscopy room and time of receiving in recovery area.
Special Consideration
- Confirm the patient has followed pre-procedure instructions, such as fasting and medication adjustments.
- Address any anxiety by explaining the procedure and its purpose clearly.
- Observe the patient for signs of discomfort or complications, such as bleeding or allergic reactions to the sclerosing agent.
- Ensure the patient’s airway remains unobstructed if sedation is used.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure the endoscope and sclerosing agent are properly prepared and functioning.
- Monitor the patient for delayed complications, such as bleeding or perforation.
- Provide clear instructions for recovery, including dietary restrictions and follow-up care.
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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