This tutorial will guide you through using the acquisition tools, calibrating the probe, starting a new study, acquiring an HRAM Study, and proper handling and cleaning of the probe.
high resolution in erectile Manama Tree acquisition tutorial. 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 a high resolution and erectile nanometer study, describe proper handling and cleaning of the high resolution probe. The acquisition tools will be found along the left hand side of your display screen. The event buttons air used to annotate events occurring during the study and will appear is a vertical line on the tracing. The procedure prompts will give step by step guidance for each part of the study. The measurement Buttons air used to create a defined area for the computer to make calculations. These will appear as a dashed box on your tracing additional procedure. Buttons will be found at the bottom of your display. The claus or Contour button will display the data in color. Wave forms can be used with or without the contour display. The sink field button will split the screen into both a three dimensional display and contour display of data being acquired, and there will be more information about sink view. At the end of this tutorial, the help. Button will give more detailed instructions for each step of the protocol, and the quit button will exit the study and save the data. The High Resolution Pro contains 23 pressure sensors. Inter balloon sensor will measure interrupted pressure during the compliance study. The rectal pressure sensor is useful in identifying if the patient is using their abdominal muscles inappropriately during portions of the study. The in a canal radio sensors are positioned every centimeter and will span the entire anal canal when the probe is in its final location. Each sensor is comprised of four directional sensors rotated 90 degrees to measure the posterior left interior and right quadrants of the sphincter. The external reference channel will be located one centimeter outside the Anal Verge. This channel is not used in calculations but enables visibility of the distal border of this sphincter. The Baseline Positioning Band will be placed at the Anal verge so that all pressure sensors are positioned in the rectum. When the probe is pulled back for positioning of the radio sensors in the sphincter, the Anal Verge Positioning Band will be visible at the anal opening. The posterior alignment strip will be used to position the probe so the posterior left anterior and right sensors are properly aligned. To start the study, double click on the sandhill application icon, then double click on the Insight acquisition icon. The anal rectal motility protocols will be found in the anal rectal high resolution Anal Manama Tree section of inside acquisition. To start a new procedure, click the procedure button. Highlight the desired protocol by selecting the probe that you will be using at the bottom. The protocol details will be a guide for the system set up. Click OK. Be sure to calibrate the probe before every procedure. Insert the probe into the calibration tube, making sure that all sensors air visible in the tube and dangling free. The sensor should not touch the wall of the calibration tube. Attach a 60 cc syringe to the infusion port on the probe and close the stop cock by turning the off position to the probe. In order to maintain a good seal, tighten the top of the calibration tubes of the toe probe is snug. Calibrate the probe using zero and 100 millimeters of mercury pressure. Click on start pressure calibration Follow the screen prompts when the pressure gauge read. Zero click OK, pump gauge up to 100 millimeters of mercury pressure. Hold the pressure, then click. OK. Note that the blue bars should be even at the top of the scale. When the calibration tube is pressurized. 200 millimeters of mercury click. Save the valid calibration values before releasing the pressure. Remove the probe from the calibration tube, then carefully slide the balloon over the tip of the probe, covering both grooved rings. On the end of the probe, attached the rubber bands to secure the balloon at the grooved points. Inflate the balloon with approximately 60 cc's of air to check for leaks, deflate the balloon. After completing the calibration, you will select either start new patient or start existing patient. For most procedures, you will select start a new patient. Existing patient is usually utilized if the patient had a previous study. This will allow the studies to be saved in the same folder completely. A patient information on Lee. The name fields will be required that additional information could be added at this time. The drop menu fields can be edited to add frequently used information. Refer to your Insight User manual. For detailed instructions, insert the probe into the anal canal with the posterior alignment. Strip in line with the patient's spine. Advanced the catheter so the Baseline Positioning Band is at the anal Verge. This will position all the sensors in the rectum. Allow approximately five minutes for the probe to accommodate to body temperature before starting the procedure. When all the sensors were placed in the rectum, the Contour screen will display blue click on the baseline measurement button to acquire erectile baseline measurement. Ah black dotted box will outline the measured area. The measurement should last for about five seconds. Click Accept to end the measurement. To ensure an accurate baseline value. The patients should not be moving or talking during the measurement. Baseline measurements are required in order to calculate. Next. Pull the probe so the Anal Verge Positioning Band is at the anal opening. The external sensor will now be visible outside the anal opening. You may secure the probe with tape. The radio sensors will now spanned the Anal canal and are oriented in four quadrants. Toe allow the measurement and assessment of sphincter length, pressure and symmetry. The anal canal pressure will be visualized is an increased color band. The warmer the color, the higher the pressure, the longer the sphincter, the wider the color band will appear. When the probe is correctly positioned, most of the Contour map will show an increase in pressure. If you're unable to visualize the pressure, you may need to make your color range more sensitive by adjusting the color range scale to change the color. Assigned to a lower pressure, slide the arrow down from the top of the color scale. This will intensify the color at lower per. The resting pressure measurement provides information about the tonic pressure exerted by the pew barked Alice Internal anal sphincter and external anal sphincter. During periods of rest, click on the resting measurement button on the lower left of the screen. Ah black dotted box will appear outlining the measured area. To accept the measurement, click the accept button. It is preferable to see a small amount of blue on the bottom and top of the graph during this time, indicating at the rectal sensor and balloon sensors are correctly positioned in the rectum and the most distal station of sensors is positioned at the anal Verge. Squeeze pressure measures the patient's ability to increase the sphincter pressure voluntarily. The external anal sphincter and the pupil work tallis muscle will contribute to this squeeze pressure, and during this time, both pressure and symmetry will be measured and assessed. Click the squeeze button to start squeeze, measurement and then ask the patient to squeeze. As the pressure in the anal canal increases, the color intensity should increase. Ah black dotted box will outline the measured area. A timer will display at the lower right of the screen. When the timer reaches five seconds, instruct the patient to relax, then end the measurement by clicking the accept button. It is important to start the measurement box before asking the patient to squeeze and to end the measurement after the patient relaxes in order for the beginning and end of the maneuver to be included in the measured area. To advance to the next step in the procedure, click the greater than button at the bottom of your screen. The Squeeze duration study will evaluate the patient's ability to maintain increased pressure for 45 seconds. To begin the measurement, click the duration button and ask the patient to squeeze and hold. The black dotted box will outline the measured area, and a timer will appear in the lower right hand corner of your screen. When the timer reaches 45 seconds or when a decrease in pressure is observed, you may instruct the patient to relax, then click. Accept to end the measurement. Note that your patient may need encouragement to maintain the squeeze during this period. Next rare or rectal anal inhibitory reflex study is a neurological tests which will measure the internal anal sphincters response to balloon inflation in the rectum. The internal anal sphincter should relax during the study. To begin the rare measurements rapidly inflate and deflate the balloon with 30 cc's of air is a trial to help your patient detect how the inflation's will feel Next, instruct the patient to then indicate any time they feel the same sensation during the study before beginning the measurements or any time during the study and optional sham or simulated inflation can be done to verify the patients responding correctly, click on the rare measurement button, open the stop cock to the infusion port on the probe and rapidly inflate 10 cc's of air into the balloon, then deflate the balloon observed for a decrease in pressure. It's seen by decreased color intensity in the anal canal. A normal response will be seen with the volume of a least 20 cc's of air. The color intensity will increase in the balloon channel during balloon inflation. The patient response should be noted by clicking on the positive sensation or negative sensation buttons on the top left of your screen. To accept the measurement, click accept. Once the pressure returns to the resting value, change the balloon volumes in the bottom left of the screen to 20 ccs and repeat the rare measurement. Inflation is repeated. Increasing the balloon volumes intense. CC increments up to 60 ccs. When all the rare measurements are completed, click the greater than button to advance to the next section of the study. The PUSH study assesses the Pew Bark Tallis and external anal sphincter response to pushing as an in an attempt to defecate, pushing results in abdominal compression Para Neil descent and anal relax ation. It is normal to observe a decrease in pressure as expressed by a decrease in color intensity. To begin the measurement, click on the push button and ask the patient to push or bear down, as though trying to push the probe out or to have a bowel movement. The black dotted box will outline the measured area to accept the measurement. Click on accept. Note that you should see a decrease in pressure as indicated by a decrease in color intensity in the anal canal. If an increase in color intensity is seen, this indicates a paradoxical response. It is normal to see an increase in color intensity in the balloon channel as the patient bears down the slow sensation study will assess the patient sensation director filling before starting the study. Instruct the patient to tell you when the balloon inflation is first felt, then steadily and gradually inflate the balloon at a rate of two cc's per second. This is to avoid rectal compliance. When the patient indicates their first sensation, adjust the balloon volume in the lower left of the screen to the volume in the balloon and click on the first sense button at the top left of the screen. Next, instruct the patient to indicate when there is an urge to defecate while continuing to fill the balloon at the same rate when the patient indicates an urge, end to the urge balloon volume and pressed the urge event button. If desired, you may continue on and ask the patient to instruct you when they feel a urgent need to defecate. That doesn't subside when the patient indicates this. Enter the maximum tolerable balloon volume. Impressed the max Tolerable Event button, then opened the balloon stop cock to deflate the balloon. Do not exceed the volume of 200 mills for patient comfort. Press the greater than button to advance to the next step. The rectal compliance study measures the ability of the rectum to expand in order to accommodate increasing volumes. It's important to measure the rectal pressure after the rectum has time to comply to the added volume. Inflate the balloon with 50 cc's of air. Turn the stop cock to lock the air in the balloon. Wait for the timer in the lower right hand corner to reach 30 seconds. When the timer turns green at 30 seconds, click on the rectal compliance measurement button on the lower left of the screen. Ah, second timer will now activate except this measurement, when the timer reaches 15 seconds and turns green. Open the stop cock and add an additional 50 ccs of air to the balloon. Wait 30 seconds before starting the rectal compliance measurement. Repeat thes measurements until 200 cc's total volume is infused into the balloon or to patient tolerance for patient comfort. Do not exceed 200 ccs. Open the stop cock to release the air in the balloon press. Stop to end the recording and quick to end the study, you may gently remove the probe toe. Activate the sink View feature Anytime during the study, click on the button at the bottom of your screen. This will split the screen into real time in a three dimensional display. The sink view three dimensional graph is on the left, and the act of data will display on the right immediately following the procedure. The probe should be cleaned by following the manufacturers and your facilities. Disinfection guidelines. Please view the cleaning video for more information
