Detailed step-by-step clinical and technical tutorial on High Resolution Impedance Manometry, featuring Diversatek Healthcare's Zvu® software and probe.
I'm Linda Castell. We are going to show you today how to set up the high resolution impeded speedometer program and we will demonstrate a patient procedure. So to get into the program, we're going to double click or double touch the Diversitech zu icon. This brings up our main program. We're going to start by clicking patient management. This will allow us to enter the patient's name, their hospital number, the procedure we're doing and any symptoms that they have every bill that has a red dot needs to be filled in. So I'm going to start by putting in my patient's last thing and the first name, her date of birth. Um and I'm going to put in a medical record number that's optional. But in most cases you'll want to put in a medical record number. Now, I'm gonna choose my workflow by clicking the down arrow, my drop down menu. I have several different protocols here. Most likely you have one protocol for esophageal manometry. You may have another protocol for reflux. So I'm gonna click that protocol and then I'm gonna choose my pro. So on the right hand side, I'm gonna click the down menu and I'm gonna choose the probe that I want wish to use. So on the outside of the catheter, you have a serial number, make sure your serial number matches. So choose that protocol that pro and um under study tag. I'm going to put all my patients under a general study tag, but you can separate your patients if you wish and separate them by physician or um, if you have a, if you have a satellite office, you may want to separate your patients by different offices. But most, mostly you'll put all your patients under the general study tag. I'm going to put my name as by a who acquired the study. There's no, uh my name is not here. So I'm going to add my name. Yes. And I wish to add my name to the drop down menu. So I'm going to push the plus sign and now my name will be in the drop down menu. I'm going to choose my physician there again, there's no physicians in my list. So one of my physician's name is I'm going to add him into the list. So I'm going to click the positive symbol. The referring position is Doctor Tate. So I'm going to add her into the drop down menu and I'm also going to add in the patient's symptom. I reviewed the patient's symptoms and she has dysphagia. So I'm going to choose dysphagia as her symptom. We have several uh, symptoms already listed and you can add symptoms as well. I'm going to click dysphasia. So everything here is complete. I have all, all the fields with the red asterisk are complete. Everything is accurate. So I'm going to click save and this is a touchscreen. Sometimes it's easier to use your finger than maneuver the mouse. So now I'm going to acquire my study. I'm gonna click acquire. Please confirm that this is the right patient. Everything is correct here. So I'm going to click. Yes. Ok. So now it tells me a probe is not um detected. So the what I need to do now, he attached my catheter to the transducer cable on the transducer cable. There's a white arrow, the white arrow is going to connect to the right to the black arrow. You'll hear a click. So now I'm gonna install the computer. Ok? And I'm going to click acquire again. So now it knows it's gonna ask me if this is a correct patient. It is. Now the computer's gonna recognize this probe and let me progress. So all the steps to calibrate and to perform the procedure will be displayed. So it's telling me to make sure my connection is secure. It is. Now it tells me to press the greater than symbol to move on. So now it tells me to start my calibration by lowering my catheter into the calibration tube. We have two calibration tubes. We have a pressure calibration tube to calibrate the pressure sensors on our catheter, we have a water calibration is going to calibrate our impeded sensors. So I'm going to place my catheter into the calibration tube. We want to place the catheter straight down. We don't want to rub the sensors against the side of the calibration tube. So straight um down very vertical all the way down. So all of your sensors are well into the calibration too. And then we're going to tighten the lid of our calibration tube pretty tightly, so no air will leak out. So if I can move my catheter, it's not tight enough. And the next thing I wanna make sure is that none of my sensors are touching the sides of my calibration tube. It needs to be hanging free in the calibration tube. So the computer tells me step by step what to do. Tighten the the tube um securely. Now, press start auto calibration. So what the computer is going to do, it's going to put 100 millimeters of mercury into the calibration tube. It's going to accept that value and then release that pressure. So my greater than symbol is highlighted, that means I can progress on. Now, it tells me to confirm my auto calibration. I have a pressures on the right side. Right now, there's no pressure in my calibration tube. So my pressure sensors are in the middle of my graph when we pump the gauge back up to 100 millimeters of mercury. All 23 pressure sensors will go to the outer limits which is 100 millimeters of mercury. So I confirm auto calibration computers putting 100 millimeters of mercury into my calibration tube and all my sensors are going to the outer limits which is 100 millimeters of mercury. If any one of these sensors was red, that means that there the probe was maybe damaged or we didn't have a very good connection on my probe. So I would probably reconnect my catheter to my transducer cable and try to recalibrate. But all my sensors are working. I'm gonna progress on now. It tells me to capture a dry value. The computer wants to know what a dry environment feels like and then it wants to know what a wet environment feels like. And the esophagus is a wet environment. So I'm gonna take my catheter out of my pressure transduce my pressure calibration tube. I pulled it straight out. So I didn't rub any of my sensors against the lip of the calibration tube. I'm gonna capture a dry value. You can do this with the catheter in the calibration tube or you can suspend your catheter in air. Now, it's instructing me to capture a wet value. So I'm going to put my catheter into my water calibration to make it sure I don't rub my sensors against the side of my caliber creation tube. Make sure all my sensors are immersed and make sure that they're not touching any of the walls of my calibration tube and I'll capture with values. So now what I see on my screen are my own values by this is by impedance channels. They're all purple right now because they're all in water which has a, a low electrical resistance. Now I'm gonna take my catheter out of the calibration tube straight up vertically and my colors change to blue, which has a high electrical resistance, the air. So this is what it should look like if I calibrate it accurately. So now I'm ready to progress. Now, the computers uh has all five of my calibration steps highlighted. I completed all five. Now, I want to acquire my information and I start acquiring information. It's not recording right now. I have two green bars under the recording icon. That means I'm pausing. So I'm not recording, but I like to be in this screen when my patient comes in and when I start to pass the catheter because I want to see my pressures as I'm passing the catheter, but we're not recording yet. So, what I'm going to do now is I'm going to have my patient come into the room and I'm going to give her her, her instructions. So, Claire, I'm Linda, I'm gonna be performing this procedure with you. How are you doing today? I'm ok. I'm a little nervous. Ok. That's understandable. This is a procedure. You've never had, you probably don't know too much about it. That's a real, under, that's a very common to be a little bit anxious right now. But I'm going to explain the procedure to you and I will get you through this procedure. Ok. So this is a procedure to measure how well the muscles in your esophagus are functioning when you swallow those muscles contract and they push food and liquids in front of it and it prevents reflux from coming back up. So we're going to be measuring how strong those contractions are and how coordinate they are to try to determine why you're having troubles with food getting stuck. So, what I'm going to do is I'm going to put some numbing medication into one of your nostrils. It's lidocaine jelly that you sniff back, that's going to take the edge off the sensation. Then I'm gonna pass a small tube through your nose into your esophagus. It typically takes me about 10 seconds to pass the tube. And while I'm doing that, it feels weird, I'm gonna be honest with you. It feels a little unnatural. So hang in there for those 10 seconds, you may feel a little pressure in the back of your nose as I'm making that turn, but it just feels a little unnatural. You're also going to heal the tube in your throat because you have nerves there. Most people tolerate that fine. But some people get just a little gaggy initially. But that subsides very quickly. So, again, just hang in there for a little bit. For me, it gets a little easier. A little, a little easier as your body starts to get used to the tube. Some people tell me it feels like the tube is stuck in their throat. It's not, it's just your nerves telling you that something's there. The tube is all the way into your stomach. So, um, just kind of give us a minute for your body to get used to the tube. I promise you, it gets a little bit easier. So I'll pass the tube with you sitting up. Then I'm gonna lay you on your, on your back. And every 30 seconds, I'm gonna give you a small sip of Saline about a teaspoon in your mouth. Clear everything with one swallow and try very hard not to swallow again. Try and get you that next swallow 30 seconds later. So every 30 seconds we're going to do, um, some swallows. So we'll probably do 10 swallows, 10 good swallows. Then we're going to switch to a thicker solution. We're gonna challenge you with something just a little thicker. Same, um, idea there. Every 30 seconds, I'm gonna give you a swallow. Just clear everything with one swallow. After that, we're going to do some more, um, swallows to kind of help with our assessment. We're gonna sit you up and we're going to do some swallows with you sitting up and, um, and then a, another, another swallower, you drink a, a fair as a large amount of, of water all at once, as fast as you can. So I gave you a lot of information. Uh, I'm going to be telling you step by step what I'm doing. Ok. Do you have any questions for me? Not yet, but, um, do you have any allergies to lidocaine or novocaine? No. Ok. Do you care which nostril I passed the tube down? Um, I think, ok. Can you breathe out of the right side a little bit better? Ok. That's good. Ok. Right. So what I'm gonna do is I'm just gonna tuck this around you right there so I don't spill anything on you. Here's some tissues. If any of this numbing medicine drips out, just pat it dry. I don't think you'll need this but if you get just a little gag and you need to spit, that's just, that's what that's for. We'll just set it there because I doubt you'll need it. Ok? So this is the uh bar can jelly. It's pretty thick. I'm gonna put a small amount in your nostril. I want you to moderately sniff it back. Don't do a real forceful sniff because sometimes it burns or stings just a little bit. Ok? So I'm gonna put just a little bit into your nostril. See here here for me. See this here, but you may wanna just park up your left side so it goes up a little farther. It's very good. OK? Let me give you just a couple of seconds. I'm gonna give you just a little more, a little more. See what's this system for me? You the head. So this is water. Grab on to this water when I tell you to put the straw to your lips and give me one sip and swallow one right after the other. So it'll be sip, swallow, sip, swallow, sip, swallow. That's gonna help the tube go down and you're not gonna feel it in your throat so much. If you're swallowing the water, I'll tell you when to start swallowing and I'll tell you when to stop. So look straight ahead for me. I want your chin just um kind of straight, just parallel to the floor. Very good. I'm just gonna angle this tube just straight back. What you here? I know it feels weird. You're doing really, really good and I is gonna make a little turn right here. You're gonna be a little turn now, tuck your chin down by your chest, put the straw to your lips and start swallowing. Sip, swallow, sip, swallow, sips, swall. You're doing great. We're almost there. You're doing awesome, almost there. It's gonna start getting better any second you're doing also. You're doing awesome. OK. I'm at 45. That's where I need to be good. How are you doing? I know it's gonna get easier. I promise you, it's gonna get easier. All right. So what I'm gonna do now is I'm gonna lay you on, on your back, just go ahead and get nice and comfortable for me. So I'm just gonna pull out this tube just a little bit so I can get an exact perfect position right there. No. Check it all good. That's good. Just gonna take that to your nose, right. So just think about nice easy breaths. Get your brain somewhere else pretty soon. I'm gonna be asking you not to swallow. So maybe try to think that I not swallowing quite so much. So my pro death is at 43 ok? We're just gonna give you a couple more seconds to kind of get used to the tube and then we're gonna get started. Ok? So my first measurement is without you swallowing. So for the next 20 or 30 seconds, don't swallow and start a measurement and now we are gonna start these swallows. So every 30 seconds I'm going to give you a swallow. Open up your mouth. Take one big swallow good and try not to swallow again until I can get you the next swallow. The more said g swollen. Doing great. Yes. So you swallow twice that time. That's ok. But try next time just to swallow one time, a big swallow. Does it feel like everything's going down? So, so we're half done with the first set of liquid swallows. You're doing great. We're making really good progress here. You swallowed there. So, I'm gonna wait another 30 seconds and I'll get you a saline. Swallow the second son. All right. Well, hold on. Mhm. We're done with those first set of swallows. Liquid swallows. Now we're gonna move to the thicker solution. We're gonna challenge you a little bit with something thicker. Move on. I wait just another 20 seconds or so. So just one swallow of this as well. Big swallow for me. This one sw doing OK. Feel like everything's going down. OK? Swallow. I've done with these five more swollen. That one of the thick solution swallowed. OK? We're gonna move on and do the next step. So this is the rapid swallows. Um I didn't explain this one to you before, but what we're going to do next is I'm going to give you five swallows very quickly about two seconds apart to swallow one time. Every time I give you a swallow after the fifth one, I'm gonna tell you don't swallow again. All right. Yeah. Fine, sir. But don't swell again. Just wanna make sure you've cleared all that and then we're gonna do the next step. Ok? The next step is with you sitting up. So I'm gonna have you sit at the side of the bed so you're facing me, ok? And I need you back as straight as you can be good. You know, one big swallow. This one swollen, one more of these. Ok? The next one I'm gonna give you a little bit of water to drink. I need you to drink it through the straw and try to drink it. Um, as fast as you can come in and I'll tell you when to start. Ok? Go ahead and start drinking. I want you to try and drink this within 30 seconds. If you can, you got, it's small. It's perfect. Awesome. Thank you. And don't swallow again. Ok. We're done. Have to do um we have to do a theo study because all of our sensors are in the right spot. So we're gonna skip that step. We don't have to do that one. Ok? Now I'm gonna take the tape off. You can swallow whenever you want to um take a deep breath for me. It's gonna be a little weird. There you go. You're not a measurement of this tube outside your body. You did. Awesome. How was it? It was sorry. You did a great job so you can eat and drink whenever you want to. Um just for about a half an hour or so. You might not have the next half an hour or so. Just gentle nose flows. Um You could irritated, you know, just a little bit. Um your nose is gonna be n another hour so it's gonna feel kind of big and bulky stuff. It just feels that way. Ok. Ok. Uh Thank you. Your doctor will get these results. And let you know the next plan is ok. Thank you. You awesome. Thank you.
