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-6000D probe.
anal rectal Manama tree acquisition. This tutorial will guide you through the protocol and acquisition Oven Anal Rectal Manama Tree procedure when using a solid state air charged or waterproof used catheter. Upon completion of this tutorial, the participant will be able to calibrate the catheter, start a new study and acquire a study. Supporting documents and videos that could be found on the Santa University website include the Kononsberg catheter cleaning instructions and an anal rectal sample policy and procedure. Anal Rectal Manama Tree measures pressures throughout the rectum and anal canal and annotate rectal sensation. The indications for performing an anal rectal Manama tree study includes symptoms of fecal incontinence, difficulty passing stool, anal pain and pre surgical evaluations. Pressure is 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 elevated way form on the X axis reflects increased pressure, such as a voluntary squeeze attempt. The duration of an action such as a squeeze is reflected on the X axis Catheters, which provides separate quadrant tracings, will display from the top to bottom as posterior left anterior and right this is an example of a four channel, radio configured solid state catheter, the Belounis single use, and is tied on with two oh silk searcher or dental flaws. Other types of catheters that will use the same protocol include air charged and water perf used. This is an example of an air charge disposable catheter. This catheter is available with either four circumferential sensors spaced 40.7 centimeters apart or with four Radio Lee placed directional sensors. It is single use. Yeah, the four channel directional radio sensors provide individual quadrant information. This catheter is helpful and evaluating for sphincter asymmetry in the adult or pediatric patient. The four channels 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 stem sense devices used for recording pressures inside the anal rectal balloon. The 60 cc syringe, with a three way stop cock, will be provided with a stem cents unit. Connect the lure lock syringe to the female end of the stem cents extension tubing with a stop cock arrow pointing towards 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 Insights Sensor Pack front panel. The next six slides will describe an additional calibration step specific to the air. Charge Disposable catheters only. You may skip ahead to slide number 17. If you are using a solid state or waterproof used catheter, connect the color coded channels to their corresponding Laura Lock connections on the cable. Place the catheter with all sensors below the stopper. Insert the stopper into the calibration tube. The calibration stopper has two sides. Ah, large bore and a small bore. Use the large bore for the GM 6000 d probes. Use a small bore for the GM 6000. A probes Insert the stopper with a catheter into the calibration tube. The stopper slits should be flushed with each other. The connection slide should be in the open position. Pressurized the calibration tube to 50 millimeters of mercury pressure to remove air from the sensors. Move the colored lovers into the charge position with the pressure maintained at 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 lovers air to remain in the charge position for the calibration an entire procedure. Release the pressure in the calibration tube in still 5 to 10 cc's of air into the rectal balloon and lock it in with a stop cock. Then proceed with calibration has instructed on the Santel system. Anal rectal motility protocols will be found in the anal rectal hr am 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. Select the proper protocol and click OK. Notice that the protocol in this example may be different than the protocol listed in your system. Insert the catheter into the calibration tube. The stem sense device should be connected to the catheters Balloon port and the off position of the three way stop cock should be turned towards the balloon port. Yeah, calibrate the catheter before every procedure for solid state and air charged catheters, You zero and 100 millimeters of mercury pressure for water per fused catheters. You zero and 50 cm of water click start pressure calibration. The calibration program will indicate the last time the probe was calibrated. Follow the screen prompts when the pressure gauge reads zero click OK, then pump the gauge up to 100 millimeters of mercury pressure and hold the pressure click OK. Verify that all the bars are of equal height at 100 millimeters of Mercury Press to save the valid calibration button, then release the pressure in the calibration tube and remove the catheter. Once the catheter 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 on lee. The name fields are required. Either 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 Insight User Manual for detailed instructions. Air charged in water per fused catheters will have pre attached balloons for solid state catheters. Attached the disposable rectal stimulation balloon after calibration secure the lower end of the balloon with dental floss or searcher. It is then optional to slide the tip of the balloon onto the tip of the catheter and secure with flaws or searcher in the upper notch. Before beginning the procedure, obtain a brief history from your patient, including latex allergy. Prior to starting the procedure, provide a brief explanation to the patient. You could decrease the patient's anxiety by explaining that it is an easily tolerated procedure, and usually the only discomfort is the sensation. To defecate. Perform a digital exam. This will lubricate the anal canal and gives the clinician initial evaluation of the sphincter pressures. And if the patient understands how to squeeze and push, the procedure will consist of several smaller studies, which include arresting study, a squeeze study, a rectal anal inhibitory response, study or rare sensation, study, push maneuver and compliance. Study. As you begin each sub study, give the patient appropriate instructions to assure their cooperation. Let's review the acquisition tools. The event buttons air used to annotate events occurring during the study. Thes will appear is a vertical line on the tracing with the specified annotation. 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 will appears a dashed box on the tracing. The probe depth button is used when moving the catheter to indicate the new location, and the balloon volume button is used to indicate the amount of air in the balloon during your rare slow sensation and compliance studies on the bottom of the display. Our procedure buttons the forward backward buttons, advanced 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 will 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 a few 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 is being displayed, such as speed of display or motive display. The help button would give more detailed instructions for each step of the protocol. The record button will start the recording of study data when the studies recording the record button will change to a stop button. The quit button will exit from the study and saves the data. Yeah, lubricate the balloon with the water soluble lubricant. Avoid putting the lubricant below the balloon to decrease slipping of the catheter. Insert the catheter so all sensors are positioned in the rectum in the orientation or line or inflation port are pointing posterior early or in line with the patient's spine. In adults, this position is approximately 7 to 10 centimeters from the Anal Verge, with a catheter inserted 7 to 10 centimeters. Place a piece of tape in a location on the left buttocks 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 buttocks with each one centimeter pull of the catheter and 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. Yeah, pull the catheter out one centimeter at a time, indicating the probe depth with each pull at six centimeters. Obtain erectile baseline measurement. This measurement is a reference for the computer so it can accurately calculate anal resting pressure above rectal pressure. The measurement is most accurate at six centimeters, when the sensors air closer to the sphincter and away from rectal folds, make sure that your baseline measurement is free of artifact. Yeah, map the resting pressures of the anal sphincter by obtaining measurements every centimeter throughout the anal canal. Press the down arrow with each change in catheter depth. Continue pulling 20 centimeters. This will cause the way forms to drop almost to zero. If there remains pressure on two or more sensors, verify that you are at the proper location. By rechecking your positioning at the Anal Verge, continue pulling the catheter to zero centimeters. This will cause the way forms to drop almost to zero. If there remains pressure on two or more sensors, verify that you are at the proper location by rechecking your position at the Anal Verge. Not all of the pressure sensors will return completely to the zero access. Because of buttock pressure against the sensors. Reinsert the catheter with all sensors in the rectum. Inflate the balloon with 10 cc's of air to allow the display of interrupted pressure. This is helpful during the squeeze. Study to determine if a patient is inappropriately using their abdominal muscles to help recruit and maintain the squeeze. Inserting the catheter to a depth of six centimeters and then pulling to a depth of five before taking your first measurement will take the tension off the sphincter and reposition the rectal balloon pulled back to five centimeters. Wait for the pressure wave to return to normal resting pressure, avoiding any pull or motion artifact before starting the squeeze measurement. Start the measurement before the patient initiates the squeeze and accept the measurement when the pressure returns to baseline after a five second squeeze attempt. These should be short squeeze attempts to avoid causing any sphincter fatigue. Assess the pressure in the rectal balloon channel as the patient squeezes. If the patient is using their abdominal muscles, the pressures will increase as in this example, discourage the patient from squeezing their entire body when you see this pattern, instead instructing them to squeeze on lee pelvic muscles on subsequent attempts. At the completion of these squeeze measurements, position the probe in the highest pressure zone for the remainder of the study. This is usually found at 1 to 2 centimeters from the Anal Verge, with a catheter placed in the high pressure zone. The next maneuver would be the squeeze duration. This is a long squeeze hold, which evaluates the voluntary squeeze for fatigue. The goal is to see if the patient can maintain more than a 50% increase in the 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 sensors in the high 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 is also assessed. During this test, a 30 cc test inflation is performed to help the patient focus on what rectal distension feels like so they can appreciate and sent small 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, the rare study will begin with small volumes and continue with increasing volumes such a balloon volume to 10 CCS. For the first inflation, be sure to change the bloom volume with each subsequent inflation. Prior to starting the measurement, measurements taken during the study will assess the relax ation of the internal sphincter annotate the patient's sensation response to each volume. Yeah, the external anal sphincter typically contracts that the initiation of rectal distension, a momentary rising pressure is seen with volumes greater than 30 ccs. There should be little delay between the time of inflation and verbalizing a positive response. Yeah, the push study will evaluate the external anal sphincter and pupil work. Tallis 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 performed the maneuver and repeat the push measurement. Another evaluation of rectal sensation may be performed with the slow inflation of the rectal stimulation balloon at a rate of two cc's per second. The patient is asked to indicate when they feel the first sense. When this volume is reached, stop inflation and set the balloon volume, then pressed the first sensation button. Continue filling the balloon until they indicate an urge to defecate. Marking this with the correct balloon volume, then go on to annotate their maximum tolerated volume if desired. The maximum tolerated volume is optional since this can be assessed during the rectal compliance study. Yeah, the sensation volumes will be annotated with the event lines. Thes event lines will reflect the assigned to balloon volumes for each sensation. Normal first sensation is 40 to 60. CCS urged 80 to 1 20 maximum tolerated. Volume is greater than 200. No measurement is taken during this portion of the study, Director Compliance study will evaluate 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, product itis diverting colostomy or poor rectal distension tolerance during a rare study Yeah, in the adult patient and still 50 cc's of air into the rectal stimulation balloon at a rapid rate, turn the stop cock off position toward the balloon. This will cause the balloon to remain inflated. Wait 30 seconds after the inflation, then obtain 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 CCS 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 complaints 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 Yeah, the study is now complete. Deflate all the air from the stimulation balloon and removed the catheter removed a disposable stimulation balloon before cleaning. If using a disposable air charged catheter, the whole catheter can be disposed of. Follow the manufacturer's guideline for re processing the solid state and water profuse catheters. Cleaning instructions can also be found in the Santa University tutorials. Yeah.
