This tutorial will describe how to use the acquisition tools, calibrate the probe, start and acquire an esophageal manometry study in BioVIEW® Software.
SA Fujio Manama Tree Acquisition. This tutorial is intended for use with the clinical innovations four Channel air charged probe. Upon completion of this tutorial, the participant will be able to describe how to use the acquisition tools in the Sand Hill software, calibrate the clinical innovations probe, start a new study and acquiring Asafa Geo Manama tree. The event buttons are used to annotate events occurring within the study. Thes Pierre as a vertical line on the wave form with the specific annotation on the line. The procedure prompts 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. These will appear is a dashed box on the way form. On the bottom of the display, a procedure buttons the forward backward buttons will move 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 freeze displays. At the same time, the options button will allow choices for how the study's being displayed, such as background in wave form colors, channels to be displayed or motive display such as contour or way for mode. The help button will give more detailed instructions for each step of the protocol, and the record button will start the recording of this study data. When the study is recording, the record button will change to stop. The quick button will exit from this study. The Clinical Innovation Catheter has four circumferential air charged sensors connect the color coded channels to their corresponding lure LA connections on the cable. This is the calibration tube that will be used for the clinical innovation catheters. Place the catheter with all sensors below the stopper, then insert the stopper into the calibration tube. The calibration stopper has two sides, a large bore in a small bore used small bore. For the esophageal probe, insert the stopper with a catheter into the calibration tube. The stopper slits should be flush with each other to prevent air leak with the color coded lower connections in the open position, pump the gauge to around 50 millimeters of mercury to pressurize the calibration tube and remove the excess air from the sensors with the calibration to pressurized, moved the connectors into the charge position with the pressure maintained at 50 millimeters of mercury. Once the sensors have been charged, they should stay in this position for the procedure. Now open the software sandhill. To complete the calibration procedure, double click on the sandhill application's icon, then double click on the Insight acquisition Icon Protocols for Pressure only. Catheters will be found under the esophageal section of Insight acquisition. To start a new procedure, click on the procedure button. Select the protocol for the catheter you are using with the protocol highlighted. The protocol details will be a guide for the system set up. The catheter needs to be calibrated prior to the procedure. Use millimeters of mercury pressure for this calibration. With the probe in the calibration tube, make sure the pressure gauge on the calibration to breed zero, then click OK on the screen. Make sure you are looking at the gauge to verify zero pressure and not on the computer screen. Now pump the gauge up to 100 millimeters of mercury. Pressure referred to the gauge on the calibration tube, not what is on the computer screen. When the pressure gauge reads 100 millimeters of mercury, 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 millimeters of mercury, click. Save the valid calibration values. 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. Note that on Lee the name fields air required. If the touch screen or standard keyboards can be used to enter patient data. The drop menu fields can be edited to add frequently. Use selections. Refer to the Insight User Manual for detailed instructions. To start the study. Intubate the patient to 60 centimeters. This will position the distal sensors in the stomach. Zero. These distal channels four and five. This will allow you to see when you've entered into a pressure area, then begin recording. The distal baseline could be taken at 60 centimeters, but often the gastric baseline measurement is taken after pulling back about 5 to 10 centimeters before Channel four enters the L. E s. Create a gastric baseline measurement by clicking on the GPL button. Ah, yellow box will define the measured area. The measurement should be approximately 15 seconds in duration. Click Accept to complete the measurement. Even though the yellow box will extend through all channels, the baseline is being measured on Lian Channel five. The gastric baseline measurement is a reference measurement needed to calculate the lower esophageal sphincter pressure. Continue pulling the probe by one centimeter, pulls until Channel four starts to rise off of baseline. Once this happens, slow the pulls down to half centimeters and wait 2 to 3 breast between each movement or pull. Change your position depth with each change. Once the Channel four sensor has dropped out of the L ES and is in the body of the esophagus, press the next button to move the protocol forward. Continue pulling by half centimeter increments until Channel five is located in the high pressure zone of the L. E S channels. 23 and four can be zeroed at this time by pressing the Z in each channel prior to taking the L. E s resting pressure and esophageal baseline measurement. After you take the L E S P E B l measurement, the protocol will move forward to the next step, start the wet swallow measurement, then give the patient five ccs of room temperature water. Ask them to swallow one time and to accept the measurement when the L. E S has closed, then wait 20 to 30 seconds before giving the next follow. Ah, yellow clock will appear in the lower right hand corner. After you end the measurement, this clock will turn to green at 30 seconds. So you will know you've waited long enough. If the patient dry swallows in between the wet swallows, you must wait 20 to 30 seconds after the swallow to do the next measurement. After all, 10 wet swallows air completed. Continue pulling the catheter by half centimeter until the distal sensor exits the L. E s. Then move forward in the protocol by pressing the greater than button. Now pull the catheter by one centimeter at a time until the proximal channel enters the U. S. When you see the rise off baseline indicating the distal us. Stop pulling and reinsert the catheter one centimeter. So the proximal sensor is located one centimeter below the U. S. This will position the sensor in the striated muscle of the upper body for evaluation. Note that this upper body study is an optional piece. If you choose not to do this portion of the study, then stop the recording press. Quit and pull the probe out of the patient with the proximal sensor positioned one centimeter below the U. S. Take another esophageal baseline measurement. Even though the yellow measurement box will cover all the channels, this baseline is only being measured in the most proximal sensor. Channel two Capture five water swallows. Start the measurement. Give the patient five ccs of room temperature. Water asked them to swallow one time and the measurement when the proximal sensor way formed on Channel two returns to baseline or zero. You do not need to wait for the contraction wave to go all the way through the body of the esophagus. As this measurement is on. Lee being recorded in the most proximal sensor. The clock will appear in the lower right hand corner when you end the first measurement. Ignore this timer. There is no required re polarization for this muscle type so additional What swallows conf? Ah, low rapidly after the upper body What swallows air completed. You can advance the protocol by pressing the greater than button. This will take you to the U. S. Study press OK on the pop up window. If you wish to proceed with the U. S. Study, this is an optional piece. Set the patient up on the bedside. This portion of the study is done in a sitting position. The screen will now change to show and record on Lee, the two most distal sensors following the screen prompt. Pull the catheter back 10 centimeters from the location used in the upper body. Study as an example if your upper body depth was recorded at 37 centimeters, then pulled back to 27 centimeters and changed the catheter depth indicator to reflect this location. Capturing Asafa Jail baseline measurement. This is the only measurement that will be created here in acquisition. The rest of the measurements will be added at the time of analysis. Pull the catheter by one centimeter increments until the proximal sensor moves through the U. S. Pressure then drops back to baseline when the distal or lower sense sensor starts to show a rise off baseline, slow the poles down to half centimeter increments. Continue pulling the probe until the distal sensor passes through the highest pressure area and starts to drop back down but doesn't not go all the way down to the baseline. Stop here. Give the patient 3 to 5. What swallows Using five ccs of room temperature water. You do not need to wait for muscle recovery, and the measurements will be created in analysis. When the swallows air completed, stop the recording, then press quit to exit the software program, remove the probe and dispose of it.
