Gastroenterological Endoscopy. Группа авторов

The Endoscopic Examination Room

      5.8.1 Size of the Rooms

      A continuous point of discussion is the minimum size of an endoscopic procedure room. A general or multipurpose endoscopy room, primarily intended for GI endoscopy, should have a floor surface area of not less than 30 m². For rooms with X-ray facilities, a minimum room size of 36 m² is recommended (

Fig. 5.3).¹⁷ The requirements of recommended procedure room size have changed over the last years. According to the British Society of Gastroenterology, from 1990 a room measuring 25 to 30 m² was considered adequate if there was sufficient storage space outside the room for endoscopes and additional equipment.⁴ The corresponding American recommendation was an area of approximately 6.25 × 4.75 m or 30 m² in size, as appropriate.⁷ In a 2015 consensus statement of the German digestive society, a minimum room size of 30 m² is recommended. For rooms with X-ray, the minimum size is 36 m².

      In addition to the size of the procedure room, other general requirements should be met. The width of the entrance and corridors should be sufficient to allow for the transportation of beds, stretchers, and wheelchairs. It must be possible to turn beds around in the corridor. The standard door width should be 1.28 m, and the opening should have sliding doors. An “engaged” or “in use” sign as well as signs for “Laser” or “X-ray” should be present on the entrance doors to endoscopy rooms, where appropriate. The floor material in the procedure room must be fluid resistant and easy to clean and must conform to anesthetic and high-frequency electrical requirements (e.g., nonconducting).

      Fig. 5.3 Concept of a procedure room in more detail. The ground floor size is 38.5 m². In addition to a ceiling supply unit with two monitor systems, fitted cupboards (right side), a computer documentation area (upper left corner), changing room (UK) and toilet (WC) are integrated.

      5.8.2 Equipment

      The endoscopy room should contain a mobile examination table with adjustable height and positioning, a desk and chair, radiography viewing space, a work surface with a sink and cupboards, and waste containers for the various types of waste. There should be facilities for proper hand disinfection and storage of protective clothing and equipment. Storage space for accessories should be available in the endoscopy room or in an adjacent storage area.¹⁴

      There should be fitted cupboards for endoscopes and ancillary equipment, and washing facilities for staff and equipment. The procedure rooms should be equipped with high-quality video screens for viewing digital images.

      It is essential to have piped oxygen gas and suction facilities as well as pressured air. Insufflation using CO₂ is becoming routine for interventional endoscopic procedures and is increasingly used also during routine endoscopy. Thus, CO₂ outlets positioned close to the endoscopic processor should be considered in order to avoid CO₂ supply via gas cylinders. Placement of oxygen and suction outlets has to be well considered as the lines to the patient or the endoscope should not cross the working area or the floor. Thus, suction should be close to the endoscopic processor and oxygen close to the patient’s head.

      Sufficient power outlets are necessary in the procedure room to ensure flexible working conditions and so that auxiliary equipment can be used safely. The electric sockets can be either wall-mounted or attached to the ceiling supply units. The electric sockets should be connected to various circuits. Some power outlets should also be connected to the hospital’s emergency energy supply. Sockets used for endoscopic light sources and the video processor as well as the surveillance monitors should have an uninterrupted emergency power supply. The compressed air supply, intravenous fluids hooks, suction lines, and connections for closed circuit television should preferably be fixed to the ceiling, to prevent cables crossing the floor.

      Within the endoscopy room, air conditioning and temperature control must be optimal. If there are outside windows, then blinds or blackout facilities are needed. Ceiling lighting should be bright, but easily dimmed. There is a new trend to use colored lights such as blue or green light for procedure rooms, as blue light increases the contrast and facilitates viewing of the monitor image while still having enough surrounding light for handling and controlling the patient. Various functions of the endoscopic procedure room (room light, video recording, picture documentation, video switching and video streaming, video sources for the monitor, communication) can be handled with touch screen–based devices. There are several commercial systems which offer such functionality as complete room service package (e.g., Endo-Alpha by Olympus, OR1 by Storz). Other optional features such as writing surfaces and dictation facilities depend on the report generation management (see documentation).

      Cubicles, or at least curtained-off partitions and washing facilities, should be available for patients who have undergone sigmoidoscopy or colonoscopy.

      5.8.3 Monitor Systems and Anesthesia

      Surveillance monitors are mandatory in each procedure room for optimal patient safety during the procedure, as well as during the recovery period. The monitor display should be positioned in such way that it can be easily viewed and controlled. The monitor system should consist of a noninvasive blood pressure measurement, a pulse oximeter, and an ECG. There is some debate as to whether CO₂ monitoring should be performed during endoscopic procedures.¹⁷ Due to the high rates of artifacts of current systems, no specific recommendations for the use of CO₂ monitoring can be given. The positioning of the monitor should also consider that cables and lines connect to the patients, and these should not cross the working areas of the endoscopist. A positioning of the monitor system opposite to the endoscopist near the video monitor is a possible solution, which avoids these problems (

Fig. 5.4). The suction equipment may be either free-standing or placed on a trolley or incorporated in a ceiling supply unit (

Fig. 5.4). As in most operating rooms, documentation of the vital parameters (respiratory rate, heart rate, blood pressure, medication administration) is increasingly carried out via digital online recording of the respective parameters. The implementation of an IT-based documentation of monitoring data has to be taken into account and a separate computer workplace in the procedure room close to the patient has to be planned for the anesthetist or personnel performing sedation and monitoring.

      In addition, there should be a resuscitation equipment within the unit. A resuscitation trolley should be in the endoscopy room or easily available. In some units, it has been found convenient to place markers on the floor so that mobile equipment is placed correctly.

      As general anesthesia has changed mostly to intravenous agents, the installation requirements for general anesthesia have decreased. However, the needs of the anesthesiologist should be considered during the primary planning. There should be anesthesiology trolleys or equipment and infrastructure (pressure air and oxygen sockets, IT connections) to accommodate the needs of the anesthetist. Preferentially, the X-ray room should be equipped with such facilities.

      Fig. 5.4 Example of an endoscopic room for upper GI endoscopy with optimized positioning of video monitors and surveillance monitors.

      5.8.4 Video Integration and PC-Based Documentation