This tutorial will guide you through using the acquisition tools, calibrating the probe, starting a new study and acquire an anorectal study with a disposable GIM-6000A probe.
anal rectal Manama Tree acquisition with the Clinical Innovations 6000 catheter. Upon completion of this tutorial, the participant will be able to describe how to use the acquisition tools, calibrate the clinical innovations air charged catheter, start a new study and acquire a new erectile Manama tree. Study. The indications for performing an anal rectal Manama tree study includes symptoms of fecal incontinence, difficulty passing stool, anal pain and pre surgical evaluations. Pressures obtained from the catheter are plotted on a graph in millimeters of mercury pressure. The X axis plots, duration and the Y axis plots. Amplitude the higher way form on the why axis reflects increased pressure, such as a voluntary squeeze attempt. The duration of an action such as the squeeze is reflected on the X axis. This is an air charged disposable catheter. It ISS single use. The four channel circumferential catheter is used to span the entire sphincter in pediatric patients and works well for rare and sensory evaluation. But it does not provide quadrant data. The Stimson's device is used for recording pressure inside the anal rectal balloon. The device was with its attached to being will come pre assembled a 60 CC syringe with a three way stop cock will be provided with Stem cents unit. Connect the Lord Lock syringe to the female end of the Stimson's extension tubing. Position the stop cock arrow toward the tubing. Connect the anal rectal catheter to the male end of the stem sense Extension tubing. Connect the transducer cable into the respiratory channel on the Insight sensor Pack front panel. Next, connect the color coded channels to their corresponding. Lure lock connections on the cable. Place the catheter with all sensors below the stopper inside. Insert the stopper into the calibration tube. The calibration stopper has two sides, a large bore and a small bore used to small bore. For the 6000 probe. Insert the stopper with the catheter into the calibration tube. The stopper slits should be flushed with each other to ensure a good seal. The connection slides on the cable should be in the open position, then pressurized the calibration tube to 50 millimeters of mercury to remove air from the sensors. Move the colored lovers into the charge position with the pressure maintained a 50 millimeters of mercury. This instills a small amount of air into the sensors in order to detect pressure, you will see the sensors puff up slightly. The levers air to remain in the charge position for the calibration and the entire procedure. Release the pressure in the calibration tube and still 5 to 10 cc's of air into the rectal balloon and lock it in with a stop cock. Leave the catheter in the calibration tube and proceed with calibration as instructed on the Santel system. Anal rectal motility procedures will be found in the anal rectal h r a m section of insight acquisition. Select this button to start a new procedure. Click the procedure button with the protocol highlighted. The protocol details will be a guide for the system set up. Click OK with the catheter in the calibration to the Stimson's device should be connected to the catheters below. Import the off position of the three way stop cock should be turned toward the balloon port. Calibrate with every procedure. Use zero and 100 millimeters of mercury Click start pressure calibration Note. The calibration program will indicate the last time a probe was calibrated. Follow the screen prompts when the pressure gauge reads zero click OK following the screen prompts. Pump the gauge up to 100 millimeters of mercury and hold the pressure. Then click OK. Verify that all the bars air of equal height at 100 millimeters of mercury. Press the Save the Valid calibration button, then release the pressure in the calibration tube and removed the catheter. Once the catheter has been calibrated, select either start new patient or start existing patient. For most procedures, select start new patient started. Existing patient is usually utilized if the patient has had a previous study. This will allow the studies to be saved in the same folder. Complete the patient information on Lee. The name fields are required is the touch screen or standard keyboard can be used to enter patient data. The drop menu fields can be edited to add frequently used information. Refer to the User Insight manual for detailed instructions. A brief explanation of the procedure should be provided prior to the procedure. Decrease patient anxiety by explaining that it is an easily tolerated procedure and usually the only discomfort is the sensation to defecate. Take a brief history, including latex allergy and perform a digital exam. A digital exam lubricates the anal Canal and gives the clinician an initial evaluation of the sphincter pressures. And if the patient understands how to squeeze and push, let's review the acquisition tools. The event buttons air used to annotate events during the study. These will appear is a vertical line on the tracing with the specific annotation. The procedure prompts will give step by step guidance for each part of the acquisition. The measurement buttons air used to create a defined area for the computer to make calculations thes will appear is a dashed box on the tracing the probe depth button issues when moving the catheter to indicate the new location. The balloon volume is used to indicate the amount of air in the balloon during rare slow sensation and compliance on the bottom of the display or procedure buttons. The forward backward buttons advanced the protocol and measurement boxes through the procedure. If you wish to skip a portion of the protocol, just press the forward button. The freeze button was freeze the entire display screen, allowing you to scroll backward through the recorded study. The split button will split the display screen in half, displaying both real time and recorded data at the same time, the Sink view button will split the screen into both a three dimensional display and real time display of data being acquired. The options button will allow choices for how the study's being displayed, such a speed of display or motive display the help button will give more detailed instructions for each step of the protocol, and the record button will start the recording of the study data. When the study is recording, the record button will change to stop. The quick button will exit from the study and saves the data. The procedure will consist of several smaller studies. As you begin each sub study, give the patient appropriate instructions to assure their cooperation. Depending on the age of the patient, some of these studies may be omitted. The forward button can be used at any time to advance the protocol during acquisition, lubricate the but balloon with the water soluble lubricant. Avoid putting lubricant below the balloon to decrease slipping of the catheter. Insert the catheter so all sensors are positioned in the rectum approximately 6 to 8 centimeters from the anal verge. With the catheter inserted, place a piece of tape in a location on the left buttock to be used as a guide, so you can easily see that the catheter has been moved. This alleviates the need to lift the right buttock with each half centimeter pull of the catheter. Oh will reduce movement artifact on your tracing. Be sure to note how far from the anal verge the tape is located, so you can calculate your catheter depth from this external marker. Wait approximately five minutes before starting the procedure to allow the patient to accommodate the catheter. Zeroing the channels will allow you to visualize the rectal pressure on the zero reference line. Obtain a rectal baseline free of artifact. This measurement is a reference for the computer so it can accurately calculate anal sphincter resting pressure above the rectal pressure. Pull the catheter in half centimeter meter increments until the distal sensor or Channel five has been pulled into the highest pressure zone. At this time, take a resting pressure measurement. The resting pressure measurement should be taken in a quiet area without artifact. When taking a resting pressure measurement, avoid measuring the pull artifact spike created with probe movement as an option, rusty measurements could be taken at each half centimeter pull as the sensors air moved from the rectum into the sphincter. As an option, you can inflate the balloon with 10 cc's of air before doing the squeeze study. This will allow the display of interrupt all pressure. This is helpful during the squeeze. Study to determine if a patient inappropriately uses their abdominal muscles. To help recruit and maintain the squeeze. Start the measurement before the patient initiates the squeeze and accept the measurement when the pressure returns to baseline after a 3 to 5 seconds squeeze attempt. If more than one is done, these should be short squeeze attempts to avoid causing any sphincter fatigue. The squeeze duration is a long squeeze hold that evaluates the voluntary squeezed for fatigue. The goal is to see if the patient can maintain more than a 50% increase in their resting pressure when squeezing for 45 seconds. Start the squeeze duration measurement before the patient initiates the squeeze and ended When the pressure returns to resting pressure after the squeeze attempt with the distal sensor in the highest pressure area, proceed with the rectal anal inhibitory response or rare study. The rare study assesses the presence of a functioning My own Terek plexus to rule out her springs disease. Rectal sensation to rapid distention can also be assessed during this test. For older patients, a 30 cc test inflation is performed to help the patient focus on what rectal distension feels like so they can appreciate and sent smaller volumes. Instruct the patient to tell you when they feel a similar sensation over the next several minutes. Then you will inflate the balloon without informing the patient. When the inflation's occur in younger patients, the test sample is omitted and the patient is not asked for sensation response. The rare study will begin with small volumes and continue with increasing volumes. Be sure to change the balloon volume with each inflation prior to starting the measurement. Measurements taken during this study will assess the relaxation of the internal sphincter, annotate the patient's sensation response to each volume. If the patient is old enough to respond, the external anal sphincter typically contracts at the initiation of rectal distension. Ah, momentary rise and pressure may be seen with volumes of greater than 30 cc's of air. There should be little delay between the time of inflation and verbalizing a positive response. The Push study evaluates the external anal sphincter in pupil work. Callous response to pushing as if attempting to defecate, instruct the patient to push as if attempting to defecate. If the maneuver results in a paradoxical response, instruct the patient how to correctly perform, maneuver and repeat the push measurement. A normal response to pushing is decreased pressure in the anal canal. An increased interrupt all pressure. Another evaluation of rectal sensation may be performed with slow inflation of the rectal sensation balloon at a rate of two cc's per second. The patient is asked to indicate when they feel the first sensation. When this volume has reached stop inflation and set the balloon volume. Then press the first sensation button. Continue filling the balloon until they indicate and urge to defecate, marking this with the correct balloon volume, then annotate their maximum tolerated volume if desired. The maximum tolerated volume is optionals since this could be assessed during the rectal compliance study. Also, the rectal compliance study evaluates how well the rectum accommodates increasing volumes of distension. Do not perform the study. If you suspect the patient has a non compliant rectum from colitis, practice diverting colostomy or poor rectal distension tolerance during the rare study in the adult, her older pediatric patient and still 50 cc's the air into the rectal stimulation balloon at a fairly rapid rate. Turn the stop cocks so the off position is pointed towards the balloon. This will cause the balloon to remain inflated. Wait 30 seconds after the inflation then obtained a 15 2nd measurement. This allows the rectum to accommodate the volume before measuring the pressure exerted against the balloon. Instill in additional 50 ccs into the rectal balloon one minute after the previous inflation. There is now a volume of 100 cc's in the balloon. Wait 30 seconds after the installation, then take a 15 2nd measurement. Continue in this manner to a volume of 200 CCS, or until the patient complains of an urgency that does not subside. Balloon volume annotations with each inflation are recorded on the wave form as well as a 15 2nd measurement 30 seconds after the balloon Inflation. The study is now complete. Deflate all the air from the stimulation balloon and removed the catheter. Dispose of the catheter
