1. Bishop, Tiffany CGRN

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To the Editor,


After enjoying my recent trip to Dallas for the SGNA annual course, I felt the need to start sharing with you some of my own personal experiences as a gastroenterology nurse. I have been practicing nursing in endoscopy for 9 years and have always found it to be very interesting.


I was indirectly involved in one particular case which involved assessment and treatment of a postprocedure complication. Perforations do not occur often. I can recall one case in my practice, when a physician was just inside the sigmoid; the patient had a vagal response and the fiber optic image went dark. After retracting the colonoscope and administering atropine to the patient, the physician grew concerned that the patient's colon was perforated. The physician terminated the rest of the procedure and explained to the patient that the patient would need an x-ray to rule out a perforation. He also took a picture of what looked on endoscopy to possibly be a perforated sigmoid or a questionable diverticulosis.


In recovery, the patient received an abdominal x-ray report of "NO FREE AIR." This is usually a relief to hear, but in this case, the patient was discharged home, somewhat symptomatic after only having a brief sigmoidoscopy. My biggest concern here was with her assessment. Should we have been more persistent in our observation? Does "NO FREE AIR" mean for certain there is an absence of a perforation? Could the physician have diagnosed perforation with endoscopy alone?


In fact, the patient was contacted with a postprocedure follow-up phone call which resulted in her return to the emergency room. There it was determined her case was clearly a perforation of the rectosigmoid. She recovered from surgical repair and was not resentful of the experience in any way. This is an example of a case where the postprocedure phone call was a saving grace. While some things simply come to you after experience, I know this case will only add to my confidence level in assessment of complications.