This tutorial will describe how to use the acquisition tools, calibrate the probe, and acquire a high-resolution esophageal manometry study utilizing a small diameter probe in BioVIEW® Software.
high resolution impedance Manama tree small diameter Asafa Jill Manama tree. The small diameter high resolution impedance probe is primarily intended for pediatric studies, but may on occasion be used on adults as well. Upon completion of this tutorial, the participant will be able to describe how to use the acquisition tools. Calibrate the probe, start a new study, acquire AH high resolution impedance Manama tree study. Supporting tutorials, also found on the Santa University website, include catheter cleaning instructions for the Unicenter Pro acquisition tools. The event buttons are used to annotate events occurring within the study. These appear is a vertical line on the way form with the specific annotation on that line. The procedure prompts will give step by step guidance for each part of the acquisition. The measurement buttons are used to create a defined area for the computer. To make calculations thes appears a dashed box on the way form on the bottom of the display. Our procedure buttons the forward and backward buttons moved through the steps of the procedure. The freeze split buttons activate screen viewing options. The freeze button will freeze the entire display screen. You can then scroll backward through the recorded study, the split button will split the display screen in half, allowing both real time and frozen displays. At the same time, the Sink view button will provide a split view with a three dimensional view on the left side and contour view on the right side of the screen. The options button will allow choices for how the study is being displayed, such as background and wave form colors, channels to be displayed, motive display such as contour or way form mode. The help button will give more detailed instructions for each step of the protocol. The record button will start the recording of study data. When the study is recording, the record button will change to a stop button. The quick button will exit the study. There are 32 directional pressure sensors which spanned the esophagus on pediatric patients. The sensors will extend from the US through the L E s to allow for evaluation of swallows from initiation of the swallow through the closure of the L. A s on adults, there is a chance that the sensors will not completely spanned the US due to esophageal length. The zero mark on the catheter is located in the middle. Of the five channels used for L. E s analysis, the probe has 16 and Peter's channels spanning the probe. The four active impedance channels are located in the traditional locations for analysis, which are 5, 10, 15 and 20 centimeters above the high pressure zone of the L. A s during acquisition. The study will be displayed in the clouds view, or Contour mode, which will show the pressure and impedance data in a color plot. Impedance data is displayed above the pressure data during acquisition. To start your study, double click on the sandhill application's icon, then double click on the Insight acquisition icon. All protocols for high resolution esophageal catheters or probes will be found in the e f t slash h r i AM section of insight acquisition. To start a new procedure, click on the procedure button with the protocol highlighted. The protocol details will be a guide for the system set up. Note that with this probe you will have two different protocols to choose from. For pediatric patients, you may select the protocol for Asafa jail length less than 18 centimeters If using this catheter for an adult, select the protocol for Asafa. Deal length greater than 18 centimeters. Click on the calibrate button. Note that the software indicates the last time the catheter was calibrated. It is advisable to calibrate the probe before each study. For solid state probes, calibration is accomplished. Using millimeters of mercury pressure. Insert the probe into the calibration to always check. To be sure all sensors are visible in the calibration tube, then tighten the fitting. When the pressure gauge on the calibration tube reads zero millimeters of mercury, click OK on the screen. Make sure you are looking at the gauge to verify zero pressure. Now pump the gauge up to 100 millimeters of mercury. Refer to the gauge on the calibration tube, not what is on the computer screen. When the pressure gauge reads 100 click OK, validate the calibration values. All of the blue bars should be even at the top of the scale. When the calibration tube is pressurized to 100 click. Save the valid calibration values, then release the pressure on the calibration tube and remove the probe. Once the probe has been calibrated, select either start new patient or start existing patient For most procedures. Select start new patient start. Existing patient is usually utilized if the patient had a previous study. This will allow the studies to be saved. In the same folder. Complete the patient information. Note that only the name fields are required either that the touch screen or standard keyboards can be used to enter patient data. The drop menu fields can be edited to add frequently used selections. Refer to the Insider Ultimate User Manual for detailed instructions. The impedance verification screen will appear next. The next four slides will review the verification process. Fill the water calibration tube to the fill line with room temperature. Tap water. Immerse the probe, making sure that all sensors air submerged and the top pressure channel is just below the level of the fluid. It is important to assure that the sensors do not touch the walls or the bottom of the calibration tube. Note. If using tap water and the impedance does not react, sailing may be used for this step. When the probe is submerged in the water bath, the screen will indicate a drop in impedance as each sensor enters the water. Once all sensors air submerged, click the verify button. Just start the verification. Click Accept to complete the verification. It is not necessary to wait before pressing the accept button. The screen will move forward in the study once the verification has been accepted. While the probe is still in the water bath, the screen will display a smooth, radiant of color. If mark striping appears within the color, Grady Int carefully cleaned the sensors within alcohol's white and recalibrate the probe. Never submerge the probe in alcohol to start study. Intubate the patient to 50 or 60 centimeters, depending on the esophageal length protocol selected. This will position the distal sensors in the stomach. Create a gastric baseline measurement by clicking on the GPL button. A dotted line will define the measured area. The measurements should be approximately 15 seconds or 2 to 3 respiratory cycles in duration. Click accept to complete the measurement. The gastric baseline measurement is a reference measurement needed to calculate the L. A s or lower Safi Jill Sphincter pressure. The L E s or lower esophageal sphincter needs to be positioned with the high pressure zone where HPC on the black positioning line. This is necessary in order for the impedance sensors to be accurately placed to measure Bolas Transit, identify the high pressure zone of the L ES by finding the warmest color within the l ES Contour map. Reposition the probe by pulling back until the highest pressure area is on the reference line and adjust the probe depth indicator. Perform a test followed to confirm that the high pressure zone of the L E s is correctly positioned on the L E S P line. Readjust the probe if needed. Remembering toe. Also, adjust the probe depth indicator on the computer. When the probe is properly positioned. Tape the probe in place and click the forward arrow button to advance to the next screen. Create an L E S P and esophageal baseline measurement by clicking on the L E S P plus e B l button. A dotted line will define the measured area. The measurement should be approximately 15 seconds or 2 to 3 respiratory cycles in duration. Click Accept. To complete the measurement, it is important to instruct the patient not to swallow. For this measurement, performed 10 sailing swallows. Each swallow should consist of five ccs of sailing. Click on the sailing button to start the measurement and then administer the sailing. A dotted line will define the measured area. The measurement should be 20 seconds in duration. In order for the computer to be able to calculate Bullis clearance, a timer on the lower right screen is activated at the beginning of the measurement and will indicate when to accept the measurement by turning green click. Accept to complete the measurement. Wait 10 seconds before administering the next swallow. The timer will activate again and will turn green after 10 seconds, indicating when to administer this next swallow. The sailing measurement button will indicate the count of accepted measurements. When all 10 sailing swallow measurements are obtained, click the forward arrow button to advance to the next screen. Performed 10 viscous swallows. Each swallow should consist of five CCs of the viscous solution. Click on the viscous button to start the measurement and then administer the viscous solution. A dotted line will define the measured area. The measurement should be 20 seconds in duration. In order for the computer to be able to calculate bolas clearance, a timer on the lower right screen is activated at the beginning of the measurement and will indicate when to accept the measurement by turning green click, Accept to complete the measurement, then wait 10 seconds before administering the next swallow. A timer will activate again and will turn green after 10 seconds, indicating when to administer the next swallow. The viscous measurement button will indicate the count of accepted measurements. Notice that in some studies with adults or long esophagus, the probe needs to be repositioned for the U. S. Study in this case pulled the probe back 3 to 5 centimeters and give five additional swallows after all the lower body swallows are completed. Because bolas transit is not a value but evaluated with upper body swallows. Sailing or tap water can be used for these swallows. While still recording quickly excavate the patient without touching any sensors. Suspend the probe for approximately 15 seconds before stopping the recording to stop recording, click on stop, then quit. This will save the data. The probe can be disconnected at this time. Follow the manufacturer's guidelines in the catheter use manual for re processing or visit catheter cleaning instructions. Eunice Sensor tutorial on this sandhill website
