Preparing a patient for sigmoidoscopy: algorithm of actions, indications and contraindications

In the article, we will consider what is the preparation of a patient for sigmoidoscopy. The algorithm will also be described in detail.

Sigmoidoscopy is an endoscopic examination, during which the mucous membranes lining the rectum and distal sections of the sigmoid colon are examined. Carry out a study using a special device called a sigmoidoscope. It is a tube having a length of 25 to 35 cm. Its diameter is 2 cm. In addition to the tube, the device has an apparatus forcing air, a light, and lenses.

Description

In Russia, sigmoidoscopy has been performed since the 19th century. In modern medicine, this manipulation is widely used to detect pathological changes in the intestine.

Through this study, a specialist examines the intestinal mucous membranes located 15-30 cm from the rectal opening. During the procedure, it is possible to detect a variety of pathologies or confirm their absence. In addition, during its conduct, sampling for biopsy, that is, histological examination of tissues under a microscope, is possible. Also, the procedure can be a preparatory manipulation before conducting other intestinal examinations, for example, colonoscopy, irrigoscopy.

The algorithm for preparing the patient for sigmoidoscopy will be presented below.

Indications for

The main indications for the study are as follows:

1. Preparation before the subsequent examination of the intestinal cavity (colonoscopy, irrigoscopy).
2. If there is a suspicion of a prostate tumor in men or a tumor in the pelvic organs in women.
3. Chronic forms of hemorrhoids (during the study, the state of internal hemorrhoidal nodes is assessed).
4. Chronic forms of rectal pathologies that are inflammatory in nature (for example, chronic paraproctitis).
5. Violation of the stool (changing the nature of the stool, prolonged constipation).
6. Isolation of pus, mucus from the rectum, intestinal bleeding.
7. Suspicion of oncological pathology of the sigmoid or rectum.

In addition, sigmoidoscopy can be a medical procedure, for example, if a small polyp is present in the rectum. So, they can remove it.

Contraindications

Before you begin preparing the patient for the study (sigmoidoscopy), you need to find out if there are no contraindications to it.

The main obstacle to the procedure is the patient’s serious condition (for example, with severe cardiovascular pathologies, severe forms of respiratory failure, impaired cerebral circulation). In such cases, the risk of sigmoidoscopy usually exceeds the feasibility of the procedure.

Relative contraindications

The procedure is relatively contraindicated if the patient has acute inflammatory pathologies in the area of ​​the rectal opening (for example, acute paraproctitis, acute hemorrhoids, accompanied by thrombosis of the nodes, anal fissures).

In emergency situations (with profuse intestinal bleeding that provokes loss of consciousness), a study can be prescribed (taking into account vital indications) to almost every patient.

The algorithm for preparing the patient for sigmoidoscopy in nursing is important.

Equipment

This manipulation is carried out in an office that is specially equipped for sigmoidoscopy. As a rule, the study is carried out without the use of anesthetics, since it is almost painless. In some cases, local anesthetics are allowed, for example, if the patient has an anal fissure or traumatic injury in the area of ​​the rectal opening. Intravenous anesthetics are used in exceptional cases, if the patient insists on this.

Before starting sigmoidoscopy, a digital examination of the rectum is necessary. During the manipulation, the patient can occupy the knee-elbow position (kneel, resting on the elbows), or lie on the left side.

The sigmoidoscope tube is abundantly lubricated with petroleum jelly or other special means that promote better gliding, and then injected into the anus by 4-5 cm. Subsequent administration is carried out by controlling the procedure with the eye, while pumping the device with air. This is necessary to straighten the folds of the mucosa. The patient should be explained in advance that as the apparatus tube is inserted, he may feel the urge to defecate. This situation is the norm. At a distance of 12-14 cm, as a rule, a bowel curve is located. At this point, the rectum passes into the sigmoid. When the sigmoidoscope tube reaches this area, the patient should relax as much as possible to facilitate the passage of the apparatus. Air injection in the device during the procedure can cause the patient discomfort and pain in the lower abdomen. If the patient experiences severe pain, the study is stopped.

Liquid feces, mucus, blood, which impede a detailed study of the mucous membranes, are removed using an electric suction device. During sigmoidoscopy, a specialist can take biomaterial, which is then sent for cytological or histological examination. Tissue sampling is carried out using a cotton swab, a special brush, biopsy forceps. In the course of histological examination, the benignness of the neoplasm is determined, if any was found.

Also, the procedure can be carried out for therapeutic purposes. For example, to remove polyps in the intestine using a coagulation loop.

Probable complications

In rare cases, sigmoidoscopy can cause bleeding (for example, after removal of polyps, biopsy biomaterial sampling), intestinal perforation. If perforation occurs, the patient is prescribed an urgent surgery.

Algorithm for preparing a patient for sigmoidoscopy

For a detailed examination of the mucous membranes before the study, the patient must properly prepare. The rules are governed by nursing regulations. What does preparation of the patient and instruments for sigmoidoscopy involve?

Only tubes and heads of a rectoscope are sterilized, the remaining parts are wiped with alcohol.

Diet

Compliance with dietary restrictions. The patient should abandon the use of rough foods, fruits, vegetables a couple of days before the study. In some medical institutions, sigmoidoscopy is performed exclusively on an empty stomach. Bowel cleansing is carried out in a variety of ways. The choice of method depends on the preferences of the specialist.

Bowel cleansing

There are several generally accepted cleaning methods in the algorithm for preparing a patient for sigmoidoscopy:

1. Cleansing enema. It should be carried out the first time in the evening on the eve of the study, then in the morning, 3-4 hours before the procedure.
2. The use of laxatives taken orally (for example, “Fleet”, “Forlax”, “Fortrans”, “Dufalac”).
3. The use of special microclysters with a laxative effect ("Microlax"). You can use a laxative immediately before sigmoidoscopy. This reduces the preparatory period. The patient should use 2-3 tubes with a laxative half an hour before the study.
   

What else does preparing a patient for sigmoidoscopy in nursing involve?

The patient should carefully prepare for the procedure, since an insufficient degree of bowel cleansing can cause uninformative results. A combination of laxatives and cleansing enemas is allowed. This approach is relevant if the patient has difficulty with bowel movements.

We examined the algorithm for preparing a patient for sigmoidoscopy in nursing.