Chapters Transcript Video Using Zvu® for HRiM Acquisition This tutorial will describe the setup of a high-resolution impedance manometry study through the completion of the study. Welcome to the diverse a tech healthcare Z view tutorial. Siri's hr I am acquisition using Z View. The objective of this tutorial is to review the process of high resolution impedance Manama tree acquisition from set up through the completion of a study using Z View. The topics covered in this tutorial include the set up of a high resolution Manama tree study, automatic calibration of the probe, PRA placement, the protocol instructions for required an optional acquisition steps and the steps for properly ending the study. Details of certain features will be dealt with in their own tutorial. Begin on the Seaview home page. Select Patient Management on the Patient Management page, Select new patient or a study may be added for an existing patient. For a new patient, complete the patient section required fields are marked with an asterisk To start a new study for an existing patient, select the patient tile confirmed the patient information, then click the plus symbol in the study section. Once a workflow has been selected, most of the other fields will be activated. Select a probe if your facility has more than one once all desired and required fields air complete click safe. The study maybe set up now and acquired later. Or the probe can be calibrated now and the study acquired, preferably within four hours. To begin the calibration, click the acquire button in the verify. Acquire dialogue, verify the patient and the probe selected, if correct, click yes on each of the calibration screens. The instructions appear on the left. Many steps have additional details that can be seen if the cursor is hovered near the question mark symbol for that step. Click troubleshooting to show helpful hints for issues that may arise. For a particular step, Click back to return to the original instructions. When the right arrow turns blue, indicating that it is active. Click to advance to the next step. Follow the instructions given Onley click Skip if the calibration was previously completed for this probe within the last four hours. If a step fails, check the instructions and, if needed, check the troubleshooting hints. Use the left arrow to return to a prior step if needed. Complete each step in the instructions when moving the probe into or out of either calibration tube. Be careful. Toe lower the probe straight down into and lift straight up out of each tube until all sensors have cleared the lid before drawing the probe towards you. This will minimize undue stress on the sensors that can shorten sensor life during the pressure calibration step. Make sure all of the sensors air safely placed below the cap and the cap is securely tightened that the tip is not touching the bottom of the tube, although the tip can touch the tube wall as there are no sensors at the tip and that none of the gray sensors are touching the tube wall. Follow the protocol instructions to move through the automated calibration and calibration confirmation steps before moving on to the impedance and pressure verification steps. For the dry verification step, the probe can be removed from the pressure calibration tube and dangled in the air or left in the pressure calibration tube at zero. Pressure for the wet verification step, Lower the probe into the water verification tube so that the upper gray pressure sensor is just below the water level and hold the probe in this position. Try not to let any of the sensors touch the wall of the tube. Follow the steps for impedance and pressure verification. Once all steps are complete, click acquire to move on to the study. If the studies to be acquired later, click the patient management or home page icons in the upper left. Later this study CA NBI selected. After clicking the first arrow in the calibration screen, click the Skip button and skip again to advance through the calibration verification steps. To reach the acquire button, Click Acquire. To move to the acquisition protocol prior to probe insertion, Review the study expectations with the patient. Once the probe is inserted to 50 or 55 centimeters, check the screen. Identify the distal esophagus and the L. E s. The probe may now be pulled back a bit to bring the AL es close to the dashed horizontal line. The goal is to be able to see both the U. S and L. E S on the screen with a few sensors above the U. S and 2 to 5 sensors below the L. E s. If the esophagus is long, it is recommended to get the L. E. S in a good position, even if the US ends up quite high on the screen. Once position the probe can be taped, if desired. Follow the steps in the protocol. Use the plus and minus keys to select a probe depth. Once they probed up, this marked or a measurement is created. The recording starts automatically optionally. The recording could be started manually by clicking the green vertical bars. The pause symbol icon in the upper right. The red circle indicates the screen is being recorded from the probe. Depth step. Click the right arrow to advance to the next step in the protocol. The Protocol steps guide the procedure. Justus with calibration. There are additional details from many of the steps and troubleshooting hints if issues arise for a particular step. For additional details hover the cursor near the question mark symbol. The left arrow can be used to return to a prior step, the data area shows. With the pressure contour on at full capacity and the impedance contour over lane at a 50% opacity, the pressure or impedance capacities can be turned off, turned down or turned up at any time during the acquisition. Adjusting the opacity is will not affect how the final study appears. The next step is to make adjustments in the probe are with the left, click and drag to define the edges of the U. S and the L. E s with a left click and hold in a sphincter area. Both edges show it once. If a hernia suspected the bottom of the E G J area may be adjusted to the bottom of the coral diaphragm, the blue diamond in the L ES area could be set at the level of the high pressure of the L. E S. The blue diamond in the E g J area could be set at the level of the high pressure of the diaphragm. Once the probe are is adjusted, advanced to the next step. Coach the patient toe. Hold their swallows at this time. Advise them to breathe easily and fully. No shallow breathing, no holding their breath, No deep breaths. Wait for any dry swallows to complete and for a few quiet respiratory cycles to complete. After that click start resting. The resting measurement will auto except after 30 seconds or the accept button maybe clicked. Once there are 2 to 5 full quiet respiratory cycles recorded. Click the forward arrow to advance to the next step. Click start liquid swallow, then give five m Els of normal sailing. Give the sailing to the side of their mouth. Advise them to give one swallow effort once they have it together in their mouth. Giving less than five MLS. The patient may not be able to give a good swallow effort and giving more than five MLS. The patient is more likely to double swallow. Note the opening of the U. S with each swallow measurement. If the U. S opens more than once, this swallow should be canceled. Single swallow efforts are preferred for analysis. The next liquid swallow measurement should be started once the last US opening from a measured or dry swallow reaches the green vertical midline. This will ensure that the U. S openings are at least 20 seconds apart. If Barrys Tulsa's is seen, wait for the contraction to reach the L Es include one more respiratory cycle and then click accept. If needed. The measurement size could be adjusted during analysis. If no Paracelsus is seen, the measurement can be accepted after 20 seconds, using the timer in the upper right or the software will auto except after 30 seconds. Repeat these steps for 10 liquid swallows. The software will subsequently number the accepted measurements at any point in the study, a comment annotation may be added. There are buttons available to mark chest pain or dry swallow. If another comment is desired, click the comment button, then filling the comment field in the dialog box. If the same comment is needed later, click comment and select from the drop down list in the dialog box. These comments are saved for this study on Lee. A note may be added to any measurement. Once the measurement is large enough, the sticky note icon will show on the measurement title bar. Click on this icon and enter a note for this measurement, then click OK in analysis. This measurement will show with a pencil on the note icon indicating a note was created. Once 10 or more good liquid swallow measurements have been created and accepted, click the forward arrow to advance to the viscous swallow step. The process is the same for administering viscous swallows. Five MLS of viscous given 20 to 30 seconds apart. Once all desired viscous swallows have been acquired, click the forward arrow to move forward to the optional steps. If the standard protocol was selected in the workflow, the optional step will give instructions for acquiring a second resting measurement. Often the patient is calmer at the end of the study and better able to hold their swallows and breathe easily and fully during this measurement. If the optional steps are not necessary, arrow forward to the compensation step. If the extended protocol was selected, there are additional instructions available for other optional swallow types. These include solid, upright or multi rapid swallows. All some or none of the optional swallows may be given to create one of the optional swallow types. First, select the type. Instructions for obtaining one of the swallow types can be viewed by hovering the cursor near the question mark symbol for the corresponding type. For example, select solid, then click start solid swallow to start a solid measurement. 1 to 2 solid swallows may be given in the supine or upright position. The amount of material swallowed should be of the amount the patient can swallow. With one attempt, solid material can be brought in by the patient and is often a bit of the agent. The patient's struggles with, such as meat, bread or even marshmallows. After the swallow material is given, the patient should be instructed to give a single swallow effort. Wait for the contraction to complete with one more respiratory cycle before clicking, Accept or allow the software to auto, except after 30 seconds as before. Wait for the last US opening to reach the green vertical midline before starting the next measurement, creating one or two upright Swallows allows for evaluation of positional change as it relates to swallow, contraction and or relax ation pressures. Select upright click on start up right swallow. Give five MLS of sailing for a single swallow effort. The timing and spacing of thes swallows is the same as for the original liquid swallows. If one or more sets of multi rapid swallows is desired, select rapid, multi rapid swallows can be given in the supine or upright position. Click start multi rapid swallow. Give approximately two Emil's of sailing or water five times in quick succession, about two seconds apart. Each instruct the patient to swallow once when each liquid amount is given. Usually there's no contraction until the last swallow occurs. After the contraction reaches, the L ES allow for one more respiratory cycle, then click. Accept. There is no auto except for multi rapid swallows. Once all desired optional swallows are given, click the right arrow to advance to the optional second resting measurement as mentioned before, the patient may be calmer at the end of the study and better able to hold their swallows and breathe easily and fully. During this measurement, once all required and desired measurements have been created, arrow forward for the final step in the study. The probe may be removed with the patient in the supine or upright position untapped the probe. If the supplies grasp the probe near the patient's nose, instruct the patient to take in a deep breath, followed by a strong exhale or even a nose blow. Remove the probe quickly during the exhale or nose blow and suspend the probe in the air without touching any of the sensors. Reach back to the computer screen with your free hand and click capture compensation. After suspending the probe for a few more seconds, it can be set down on a towel or chucks. The software will prompt a wait for 20 seconds after the compensation button is clicked at this point, it is okay to click exit or after 30 seconds, the software will auto exit to the home page marking the completion of the study. This concludes the tutorial hr I am acquisition using Seaview. Created by
