Confirm patient's identity and procedure to be performed
2
Check patient's vitals and anesthesia readiness
3
Implement appropriate intravenous access
4
Administer sedative or general anesthesia
5
Place the patient in the suitable position
6
Introduce endoscope into the patient's mouth and guide it to duodenum
7
Identify papilla of Vater
8
Perform sphincterotomy if required
9
Introduce guide wire into bile or pancreatic duct
10
Inject contrast and take X-ray images
11
Identify and remove/blockage or stones if any
12
Take tissue sample if necessary
13
Withdraw the endoscope carefully
14
Transfer patient to recovery room
15
Monitor patient's recovery from anesthesia
16
Review procedure findings and images
17
Approval: Surgeon
18
Communicate results to the patient and discuss further plan
19
Document all procedure details, findings, and patient communication
20
Clean and decontaminate the endoscope
Confirm patient's identity and procedure to be performed
Ensure that the patient's identity matches the procedure to be performed. Verify the necessary details such as the patient's name, date of birth, and medical record number. Confirm the specific procedure and discuss it with the patient to alleviate any concerns or questions.
Check patient's vitals and anesthesia readiness
Assess the patient's vital signs such as heart rate, blood pressure, and oxygen saturation levels. Ensure that the patient is stable and ready for the procedure. Verify the anesthesia readiness by checking the patient's fasting status and conducting necessary pre-operative tests.
1
NPO
2
Clear liquids
3
Light meal
4
Regular diet
Implement appropriate intravenous access
Establish intravenous access for the administration of medications and fluids during the procedure. Select an appropriate site, such as the forearm or hand, and ensure proper disinfection and technique when inserting the intravenous catheter.
1
Forearm
2
Hand
3
Back of the hand
Administer sedative or general anesthesia
Administer sedative medications or general anesthesia to ensure patient comfort and relaxation during the procedure. Monitor the patient closely for any adverse reactions or complications that may arise from anesthesia.
1
Sedative
2
General
Place the patient in the suitable position
Position the patient appropriately to facilitate the endoscopic retrograde cholangiopancreatography (ERCP) procedure. Consider factors such as accessibility, patient comfort, and visualization of the target area. Ensure the patient's safety and stability throughout the positioning process.
1
Supine
2
Left lateral
3
Prone
1
None
2
Headrest
3
Knee bolster
4
Armrests
Introduce endoscope into the patient's mouth and guide it to duodenum
Insert the endoscope through the patient's mouth and advance it carefully towards the duodenum. Guide the endoscope using gentle movements and avoiding any discomfort or injury to the patient. Monitor the patient's tolerance and respond to any indications of discomfort or complications.
1
Apply lubricant to the endoscope
2
Insert the endoscope through the mouth
3
Advance the endoscope towards the stomach
4
Navigate through the stomach to the duodenum
Identify papilla of Vater
Locate the papilla of Vater, a small opening in the duodenum where the bile and pancreatic ducts empty into. Identify the landmark and visualize its appearance through the endoscope. Take note of any abnormalities or variations for further investigation if necessary.
1
Located at 5 o'clock position
2
Small opening with surrounding duodenal tissue
3
Visible bile and pancreatic ducts entering the opening
Perform sphincterotomy if required
If indicated, perform a sphincterotomy, which involves making a small incision at the papilla of Vater. This procedure helps to improve the flow of bile and pancreatic fluids, allowing better access for diagnostic or therapeutic interventions. Ensure appropriate hemostasis and monitor for any complications.
1
Yes
2
No
Introduce guide wire into bile or pancreatic duct
Insert a guide wire through the endoscope and navigate it into the bile or pancreatic duct. Confirm proper placement and movement of the guide wire using fluoroscopy or endoscopic imaging. Handle the guide wire delicately to avoid any injury or dislodgement.
1
Bile Duct
2
Pancreatic Duct
Inject contrast and take X-ray images
Inject a contrast agent into the bile or pancreatic duct and obtain X-ray images to visualize the internal structures and identify any abnormalities or obstructions. Monitor the patient's response to the contrast injection and ensure adequate imaging techniques.
1
Water-soluble
2
Oil-based
Identify and remove/blockage or stones if any
Identify any blockages or stones within the bile or pancreatic ducts and determine the appropriate intervention. Use specialized tools and techniques to remove or alleviate the obstruction. Ensure careful manipulation to avoid injury or further complications.
1
Stones
2
Strictures
3
Tumors
4
Other
Take tissue sample if necessary
If indicated, obtain a tissue sample from the suspicious area or lesion for further examination. Use biopsy forceps or other appropriate tools to collect the sample carefully. Ensure meticulous hemostasis and monitor the patient for any post-biopsy complications.
1
Yes
2
No
Withdraw the endoscope carefully
Remove the endoscope from the patient's gastrointestinal tract, paying attention to gentle withdrawal and avoiding any trauma or discomfort. Clear the airway if necessary and observe the patient's response during the process.
1
Gradually withdraw the endoscope
2
Monitor patient's breathing and airway
3
Assess for any signs of trauma or bleeding
Transfer patient to recovery room
Arrange for the safe transfer of the patient to the designated recovery room. Ensure the patient's comfort and privacy while being moved. Communicate any relevant information or instructions to the recovery room staff.
Monitor patient's recovery from anesthesia
Continuously monitor the patient's vital signs and level of consciousness during the recovery phase. Assess the patient for any post-anesthesia complications or discomfort. Provide appropriate interventions or medications as required.
Review procedure findings and images
Review the findings of the endoscopic retrograde cholangiopancreatography (ERCP) procedure. Analyze the X-ray images, endoscopic views, and any collected tissue samples. Compare the results with pre-procedure expectations and document any significant observations.
1
Normal
2
Abnormal
Approval: Surgeon
Will be submitted for approval:
Identify and remove/blockage or stones if any
Will be submitted
Communicate results to the patient and discuss further plan
Share the procedure findings and any identified issues or abnormalities with the patient. Ensure clear and understandable communication, addressing any questions or concerns. Discuss the recommended further plan or interventions as necessary.
Document all procedure details, findings, and patient communication
Record comprehensive documentation of the endoscopic retrograde cholangiopancreatography (ERCP) procedure. Include details such as the patient's demographics, procedure steps, findings, and any communication with the patient. Ensure accuracy, clarity, and adherence to the relevant documentation standards.
Clean and decontaminate the endoscope
Thoroughly clean and decontaminate the endoscope after the procedure. Follow the established cleaning protocols and use appropriate disinfectants. Pay attention to all the endoscope's components, ensuring they are properly cleaned and ready for subsequent use.
