The unit should be located near the radiology de­partment since many of the procedures will require x­ray services. It is cheaper to use established radiologyfacilities than to construct new ones in the unit.

Special areas for recovery of patients should bedesignated. These areas should have draperies forprivacy and may include a place for the family to sitand observe the patient while recovering. Thereshould be a reception area for patients and for familymembers who wait for patients undergoing the pro­cedures.

Toilet facilities are required within the unit and inclose proximity to the table on which the patient willlie while receiving an enema.

A scale should be available to weigh patients so thatthe proper amount of medication can be determined.A refrigerator is essential to preserve photographic filmand the many pharmaceuticals which require cooling.

There are few formal training programs for GI as­sistants in the United States. The Society for Gastroin­testinal Assistants (SGA) and the American Society forGastrointestinal Endoscopy (A/S/G/E) at the presenttime are developing criteria for such programs. Thesemay be established in conjunction with a university sothat the university's facilities may be utilized for thetraining program. The program should include bothdidactic lectures and hands-on experience. It maybecome necessary to develop certification boards toestablish that the various training programs are effec­tive. Currently the SGA is working on a program forindividual certification of assistants.

A GI laboratory should have an appointed director.This director should receive authority from the hospi-

The gastrointestinal assistant in the GIlaboratory

lois Pound, RN, CIA

The role of the gastrointestinal (GI) assistant in theestablishment of the Gllaboratory involves coordinat­ing many and varied activities. The primary concern ofthe GI assistant is to have these activities ru n smoothlyand efficiently both for the benefit of the patient andthe endoscopist. 1

In order for a gastrointestinal laboratory to run ef­ficiently it is necessary to have available a well trainedphysician, a properly trained GI assistant, modernequipment, and an adequately furnished laboratoryarea. Fortunately today most hospital administratorshave accepted the GI diagnostic unit as an importantfunctioning part of their hospitals. They understandthat the presence of such a unit will improve careadministered to their patients in this vital area of

From Northridge Medical Center, Northridge, California.Reprint requests: Lois Pound, RN, Northridge Medical Center,

Northridge, California 91325.

32

tal community and administration. The person chosenmust be an accomplished endoscopist and must havethe designated responsibility for evaluating the quali­fications of the physicians who will use the laboratoryand selecting the personnel who will staff it. It is alsothe director's responsibility to evaluate new proce­dures that may be introduced into the laboratory'sactivities. The director is responsible for budgetingand other financial matters relating to the hospitaladministration. There must be a periodic review of theactivities of the laboratory to be sure that it is beingutilized appropriately. The A/S/G/E has definedguidelines that address many of these areas. 1

-3

The types of procedures to be performed in thelaboratory will depend mainly upon the facilities andskilled people available. Many laboratories will beonly endoscopy suites. As the laboratory expands,other procedures such as manometry, gastric and pan­creatic secretion tests, small bowel biopsy, and esoph­ageal dilitation may be added. It is extremely impor­tant that studies are not attempted without adequatepersonnel and equipment as poorly performed pro­cedures will discredit the laboratory.

REFERENCES1. Guidelines in training in endoscopy. Manchester, MA,

A/S/G/E2. Guidelines for standards of practice in gastrointestinal endos­

copy. Manchester, MA, A/S/G/E3. Guidelines for the establishment of a gastrointestinal area in

hospitals and private offices. Manchester, MA, A/S/G/E4. SCHAPIRO M, KURITSKY J: The Gastroenterology Assistant: A Lab­

oratory Manual, Ed. 2. Van Nuys, CA, GI Diagnostic Laboratory,Valley Presbyterian Hospital

medicine. It will increase business for the hospital andhelp to defray the cost of hospital operation. Aproperly trained GI assistant is essential for a well runlaboratory. Training programs to date have consistedmostly of "on the job" training under the supervisionof a gastroenterologist. The Society of GastrointestinalAssistants (SGA) and the American Society for Gas­trointestinal Endoscopy are currently developingguidelines for such training. We hope that within thenext several years there will be many formal trainingprograms organized across the country.

It is important that a properly trained GI assistantknow how to handle emergencies that may developin the GI laboratory. The assistant must understandthe use of emergency drugs and be responsible forseeing that emergency equipment is kept in goodworking condition and is readily available to the staffof the laboratory should an emergency occur.

Because of the costs of medicine in general and ofendoscopic equipment in particular it has becomeimportant that the assistant have some knowledge ofcost containment. The GI laboratory supervisor is nowrequired to handle such tasks as budgeting, purchasingof equipment, inservice educational programs, and

GASTROINTESTINAL ENDOSCOPY

administration of other personnel assigned to the GIlaboratory. Because of this SGA is now consideringcertification of GI assistants who have establishedtheir capabilities in these areas.

Recording and reporting are essential parts of theservice of the GI laboratory. The documents and sys­tems used should be designed around the needs ofthe local unit. Assistance in determining how theseshould be developed can often be obtained by visitingnearby units and by looking at other sections of thehospital to see how similar problems are managed.Daily documentation of procedures performed,charges submitted, and the like leads to a log thatsimplifies year-end data collection for essential reportsto administration. In large hospitals this may be furthersimplified by utilizing a computer.

It is essential that each laboratory evolve a distincttechnique for scheduling and recording appointments.Careful communication between physicians, officesecretaries, hospital ward secretaries, and the labora­tory is important if problems are not to arise. Directtelephone scheduling is essential to the busy practi­tioner and can be easily carried out during the workingday if a proper format for scheduling has been devel­oped.

The design of a patient information brochure aboutthe various procedures is helpful to the patient, thephysician, and the GI assistant. With better under­standing by the patient of what is required for proce­dure preparation, poorly prepared patients will notarrive at the laboratory. Other medical centers mayprovide brochures for a new laboratory and the textcan be modified to suit the local situation.

The GI assistant is responsible for the storage andcataloging of film strips, slides, and prints. Slides andprints may be stored in notebooks identified by yearand procedure. A photograph of the patient's namemay be obtained immediately before or after a seriesof endoscopic photographs so that the slides can beidentified on their return from the developer. Properprocessing and storage of photographic records areessential if patient records are to be separated andkept readily available for the use of the physiciansutilizing the laboratory. A slide filing system whichworks well has recently been reported. 2

Cleaning and disinfecting procedures must meetcurrent standards. A variety of disinfecting protocolshave been developed. 3

-6 Two widely used disinfecting

agents are glutaraldehyde and the iodophors. Glutar­aldehyde has the potential problems of inhalationtoxicity and direct skin irritation if not properly used,but it has the advantage of being reusable for periodsup to 4 weeks after activation. 5 lodophors are lessirritating but must be discarded after each use. Theiodine derivative in the iodophors tends to discolorthe vinyl cover of the endoscopes.6 Regardless of thedisinfecting solution chosen, prior thorough mechan-

VOLUME 28, NO 1, 1982

ical cleansing of the endoscope is the most importantfactor in decreasing transmission of infection.4

It is essential that facilities for endoscopic cleaningand disinfecting be available in the laboratory. Thebasic needs include a double sink area and a pegboard over the sink for hanging the endoscopes inorder to air dry them following cleansing. Trays mustbe available so that the various pieces of equipmentcan be placed in the disinfecting agents. An areashould be available for scrubbing biopsy forceps andcytology brushes, which because of their constructionfeatures are difficult to adequately disinfect and clean.For surface cleansing of accessories, it is advisable touse steam under pressure or gas sterilization, particu­larly if a patient with hepatitis has been examined.Endoscopes and ancillary equipment should be pe­riodically cultured to ensure that the cleansing meth­ods are successfu I.

Proper storage of equipment is a must in everylaboratory to prevent early breakdown and avoid ex­pensive repairs. Small drawers are preferrable so thatdifferent equipment can be isolated and thus foundmore easily. Locked cabinets especially designed andconstructed to store endoscopes are necessary. Thelonger length colonoscopes require the cabinet to beat least 7% to 8 feet in height. All instruments shouldbe stored in a rack that allows them to hang in adraining position. This rack should be designed withfront-loading capabilities. An area should be availablein the cabinet for storage space for ancillary equip­ment. Shelves in the back may be used to accommo­date cameras, biopsy forceps, electrosurgical equip­ment, diagnostic trays, and the laboratory library. Aplace should also be available for storing cases inwhich the instruments are transported out of the unit.

It is essential that equipment be mobile since en­doscopies are so frequently performed in other areasof the hospital such as ICU and radiology. A threeshelf metal cart can hold everything needed to per­form endoscopic proc.edures,7 including light source,suction machine, endoscopes, snares, forceps, camera,medications, and a fully stocked emergency tray.

REFERENCES1. lournal of the Society of Gastrointestinal Assistants. 1:23, 19772. WAYE JD: A slide filing system for endoscopic teaching purposes.

Gastrointest Endosc 27:17, 19813. AXON ATR, PHILLIPS I, COTTON PB, AVERY SA: Disinfection of

gastrointestinal fibre endoscopies. Lancet 1:656, 19744. MONCADA RE, DENES AE, BEOGUIST KR, fiELDS HA, MURPHY BL,

MAYNARD IE: Inadvertent exposure of endoscopic patients toviral hepatitis B. Gastraintest Endosc 24:231, 1978

5. GEENEN jE, PFEIFER M. SIMONSEN L: Cleaning and disinfection ofendoscopic equipment. Gastrointest Endosc 24:185, 1978

6. DUNKERlY RC, CROMER MD, EDMINSTON CE, DUNN GO: Practicaltechnique for adequate cleansing of endoscopes. CastraintestEndosc 23:148, 1977

7. SANDERSFIELD RT, SANDERSFIELD GW, CASKEY PE, SANDBERG RJ,PHilLIPS Sf: Have scope, will travel. Gastrointest Endosc 23:216,1977

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