SKILLS CLINICAL RIGID SIGMOIDOSCOPY (PROCTOSCOPY) Endoscopic view of a healthy rectum (right); and a rectum with haemorrhoids (far right) SPL WHAT IS IT? PERFORMING A RIGID SAFETY CONSIDERATIONS CONSIDERATIONS ■ A rigid tube (or proctoscope) SIGMOIDOSCOPY During the procedure: ■ There is debate about the use of accompanied by a light source used ■ A nurse should be available ■ Observe the patient’s tolerance of rigid sigmoidoscopy in a modern to examine the rectum and sigmoid throughout the procedure to support the procedure, for example pain; gastroenterology/coloproctology colon in investigations into lower and monitor the patient and to assist ■ Provide reassurance, commentary service. With the increasing gastrointestinal (GI) complaints. and chaperone the endoscopist. and support; availability of outpatient flexible ■ The procedure is usually ■ The patient is placed in a left ■ Watch out for any unexpected sigmoidoscopy, a more thorough and performed in the outpatient clinic, lateral position. events such as vomiting, effective test, many outpatient increasingly by nurse practitioners. ■ A digital rectal examination is cardiorespiratory depression and clinics are using rigid sigmoidoscopy ■ It may also need to be performed carried out, using a lubricant, to vasovagal reactions; less frequently. on the ward, for example before a ensure there is no obvious ■ Assess and document the patient’s barium enema (McLatchie and obstruction to a proctoscope. status on completing the procedure. REFERENCE Leaper, 2002). ■ Equipment such as the light source McLatchie, G.R., Leaper, D. J. (eds) and air insufflation are checked. After the procedure: (2002) Oxford Handbook of Clinical INDICATIONS ■ The proctoscope is lubricated and ■ Document all care given and any Surgery. Oxford: Oxford University ■ As a diagnostic tool for patients inserted into the anus. unusual events that occur; Press. with symptoms such as lower GI ■ A light source is attached to the ■ Provide written instructions bleeding or a change in bowel habit. proctoscope. regarding diet, medications, activity WEBSITES ■ To evaluate or follow up colitis in ■ Air may be insufflated to aid restrictions, follow-up and potential British Society of Gastroenterology: the rectum or descending colon. vision. complications. www.bsg.org.uk ■ Biopsies may be taken. CONTRAINDICATIONS POTENTIAL RESULTS Cancer Research UK (for patients): ■ Painful perianal area. ■ Normal mucosal appearance. www.cancerhelp.org.uk/help/default. ■ Pregnancy. ■ Proctitis. asp?page=2820 ■ Neoplasm. PATIENT PREPARATION ■ Rectal polyps. FURTHER READING ■ Full explanation of the procedure ■ Fissures. Bateson, M., Bouchier, I. (1997) should be given. ■ Haemorrhoids. Clinical Investigations in ■ Having such an intimate Gastroenterology. London: Kluwer examination in an often busy and POTENTIAL COMPLICATIONS Academic Publishers. crowded clinic can be distressing for ■ Abdominal discomfort. some patients. Privacy and dignity ■ Rectal bleeding. The information given serves as a should be maintained at all times. general reference. Nurses should ■ Verbal consent must be obtained. Endoscopic view of a sigmoid consult their individual trust policies colon with a benign polyp ■ Bowel preparation is rarely used. SPL on clinical procedures. NT 29 July 2003 Vol 99 No 30 www.nursingtimes.net 27.