Guidelines for Patients with Renal Failure Undergoing Endoscopic Procedures

Endoscopy Unit Documentation

Guidelines for patients with renal failure undergoing endoscopic procedures

Renal Registrar pager: #6394 Peritoneal Dialysis Nurse Specialist: ext. 21219 / bleep 07659 539116 Haemodialysis Unit: ext. 21208 Department of Renal Medicine Outpatients: ext. 21231

1. Procedure booking Topic Rationale GP or referring physician should let Endoscopy know in To allow arrangements to be made for the the referral letter, if patient has advanced renal failure patient, such as hospital admission in the or is on dialysis. Renal unit, if required.

Patients with renal failure who phone the Endoscopy To assess if the patient requires hospital Unit should speak to a registered nurse. admission for their procedure, allow patient to ask questions and refer the patient on to the Department of Renal Medicine if necessary. For patients on haemodialysis, endoscopy should be This allows the patients to follow their done on a non-dialysis day normal schedule, and their biochemistry to be optimal for the procedure. Many patients with renal failure are also diabetic (see To prevent patient from becoming appropriate guidelines). Diabetic patients should be hypoglycaemic during procedure. advised either by letter or phone that they should not take their diabetic medications whilst they are fasting prior to their test. Renal patients should be advised to bring in their To ensure that they take these medications medications with them. following their procedure. Insulin Dependent Diabetics with renal failure should be To ensure that blood sugar level is within advised to check their blood sugar levels before they normal limits prior to patient leaving home. leave home to come for endoscopy.

2. Pre procedure: Topic Rationale No antibiotic prophylaxis required over & above normal The risk of procedure-induced infection is endoscopic practice for haemodialysis patients. not higher in patients on haemodialysis

Patients on peritoneal dialysis should be " drained To reduce the possibility of the peritonitis. out" prior to endoscopy. If patients are unable to do this themselves, help should be sought from the PD nurses or ward 206. Invasive colonoscopic procedures (biopsy / polypectomy ) may cause peritonitis ( in glucose-rich PD fluid ) so prophylactic antibiotics are recommended. The combination of Ampicillin (1g iv) & Gentamycin (80mg iv) is adequate; alternatively a single dose of cephalosporin (eg cefotaxime or ceftriaxone) before procedure.

Please Note: The information contained within this document is under Copyright and has been prepared by the Endoscopy Unit for the sole purpose of informing Clinical Staff of the protocols and Guidelines adopted within this unit and should not be freely distributed. Disclaimer The Endoscopy Unit have made all reasonable efforts to ensure the accuracy of the information on this site, but can take no responsibility for your use of it. Nor can the Endoscopy Unit take responsibility for anything contained in other linked sites. The purpose of the site is informational and educational, and it is not a substitute for medical advice. If you are in any doubt as to your medical condition, or if you are in need of advice, you should consult your doctor or other health professional.

Endoscopy Unit Documentation

Bowel preparation can be a problem because of high To ensure that patient does not become volumes. In that respect a low-volume preparation fluid overloaded or suffers from electrolyte (Moviprep) should be used (Fleet should be avoided as abnormalities prior or during the procedure. it can worsen renal failure). Moviprep is also preferred if All bowel preparations can cause diabetic. If high volumes of fluid are needed for hyponatraemia. preparation (Klean-prep), patients may need to be prepared in the Renal unit, under observation & extra dialysis may be necessary to remove excess fluid. Patients with renal failure undergoing conscious To ensure venous access if any sedation should have a venflon in situ. AV fistulas for complications. haemodialysis should not be used as IV access. In order to facilitate with fistula formation it is important to use the dorsum of the hand of the dominant arm wherever possible.

3. During procedure: Topic Rationale Metabolites of opiates are retained in Chronic Renal Failure and are To ensure patients extremely sedating. If pethidine or fentanyl need to be given, half of the with renal failure are recommended dose for the size of the patient should be used. Midazolam not being over- & Buscopan dose does not need any adjustment. sedated.

4. Nurses: Topic Rationale Nurses should be aware that patients with chronic renal failure might To ensure the signs are suffer complications from fluid overload and arrhythmias due to recognised and allow for swift electrolyte disturbances; therefore careful monitoring during and medical intervention if after procedure is justified. required. Department of Renal Medicine and/ or renal Registrar may be To allow access to specialist contacted at any time if required. advice.

Prepared by Dr P Gibson, Consultant in Renal Medicine, RIE Dr J Plevris, Consultant Gastroenterologist, RIE Feb 2007