EZ EM PROTOCO2L 6400 - CO₂ Volume Display; Terminating Gas Flow & Shut-Down Procedures

PROTOCO
2
L
TM
Colon Insufflator User Manual
Page
20
2.
Insufficient Distention:
It is not uncommon for some colonic segments to
appear inadequately distended in either the prone or supine positions. In
particular, inadequate distention of the transverse colon may occur in hea
vier
patients in the prone position. To improve distention:
a.
Check to make sure that the flow of
CO
2
has not paused (i.e. that the
FLOW STOP/RUN button is illuminated).
b.
Check the Administration Set tubing for kinks, closed clamps, excessive
colonic fluid,
or anything that could block the flow of CO
2
into the
patient.
c.
Remind the patient to breathe orally.
d.
Instruct the patient to relax his/her abdominal muscles.
e.
It may be necessary, particularly for the heavier patient, to use pillows or
foam positioning b
locks underneath a patient’s sternum and/or pelvis to
improve colonic distention while in the prone position. By elevating
these portions of a patient’s anatomy, the abdominal cavity should
distend more freely and redistribute the patient’s weight on the C
T table
.
f.
If necessary, additional CO
2
(up to 2 Liters) may be added by pressing
the FLOW STOP/RUN button.
3.
Lower than expected volume of
CO
2
:
A stabilized volume of less than 2 Liters
of CO
2
in the initial scanning position is generally an indication of in
complete
distention of one or more colonic segments. If this occurs, perform the following
steps:
a.
Roll the patient onto either side to redistribute the CO
2
in the colon.
b.
Raise the pressure to 25 mm Hg.
c.
A drop in the pressure as indicated on the pressure
display on the front
panel will indicate the opening of the segment in question, and will be
accompanied by an increase in the volume of CO
2
.
d.
Continue with the rolling maneuver until the volume reaches at least 2
Liters.
4.
Higher than expected volume of
CO
2
:
If the volume pauses at 4 Liters, one of
the following conditions may be present. A scout image should be taken
immediately to evaluate.
a.
Pneumoperitoneum
–
If free intra
-
peritoneal air is observed, or if
colonic perforation is suspected, immediately
discontinue insufflation by
disconnecting the administration set from the insufflator. Provide
appropriate medical attention.
b.
Small bowel reflux
–
If reflux is evident and distention is acceptable,
proceed with study. If additional CO
2
is required, it ma
y be added by
depressing the FLOW STOP/RUN button, under the supervision of a
physician. If small bowel reflux is observed, completing the study as
quickly as possible will help to minimize the reflux.
c.
Leakage around rectal tube
–
If the colon is not f
ully distended, and no
small bowel reflux is evident, it may be due to leakage around the rectal
tube. If not already inflated, the physician should consider inflating the
rectal balloon on the rectal tube. In addition, ask the patient to squeeze
his/her
muscles to retain the rectal tube. If additional CO
2
is required, it
may be added by depressing the FLOW STOP/RUN button.