Pain procedures in GI suite

[fentanyl patch]

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I've been approached by an ASC that does only endo/colonscopy. They want to start interventional pain, but don't want to commit to a dedicated suite (shares are very cheap). They want me to start doing procedures in their GI suite, but the thought of doing spine procedures in a room where 30 colonoscopies were performed the day before is unnerving.

Any thoughts or experience in this setting??

 

[SSdoc33]

It's a sh$tty idea.

Seriously. No.

 

[Ducttape]

As long as you aren't leaving exposed needles in the counter, and they do usual cleaning, what's the concern?

 

[willabeast]

i did fluoro procedures in a gi suite for years, no problems.

 

[hyperalgesia]

I used to share a suite with GI too. No issues and no big deal. If it were not clean, you wouldn't even want to do GI in it. We're doctors, there are no coodies.

 

[geauxg8rs]

I it was spelled cooties? We need to work on our medical Precision to prepare for icd-10

 

[miamidoc2b]

is this a serious question?

 

[hyperalgesia]

I it was spelled cooties? We need to work on our medical Precision to prepare for icd-10

I curse icd10!

 

[Taus]

Doing spine injections or anything in the GI sweet gives me the heebie jeebies...

 

[emd123]

It's a sh$tty idea.

Like x 1,000

 

[emd123]

All fine and good until ID calls you and says, "This guy's epidural culture grew out EColi, and smells like poop, too. I know the ASC shares were cheap....but geez, guy?"

 

[Ducttape]

then why did you do LPs/spinal taps and knee aspirations and suturing in ER rooms where you just drained a pilonidal abscess, treated a patient for c diff, or had been wearing a mask 5 min ago for someone who might have had bird flu, for all you knew?

and dont tell me you didnt - cause i worked in ERs. you cant get a "sterile" procedure room even if were the hospital prez that was in that gown...

 

[hyperalgesia]

The only way fecal material could contaminate your injection, assuming sterile technique is used, is if fecal material falls from the ceiling. That could happen in the OR too bc they don't scrub the ceilings as far as I know. Anyway, colonoscopies aren't done with patients' asses in the air, the pts are covered for god sake.

 

[emd123]

then why did you do LPs/spinal taps and knee aspirations and suturing in ER rooms where you just drained a pilonidal abscess, treated a patient for c diff, or had been wearing a mask 5 min ago for someone who might have had bird flu, for all you knew?

Because you had no other choice.

 

[SSdoc33]

The only way fecal material could contaminate your injection, assuming sterile technique is used, is if fecal material falls from the ceiling. That could happen in the OR too bc they don't scrub the ceilings as far as I know. Anyway, colonoscopies aren't done with patients' asses in the air, the pts are covered for god sake.

sh@t gets EVERYWHERE during a colonoscopy. on the table, on the walls, on everyone in the room, on the lead, on the floors, on the scope, on the tv, on the lights, on the clock, on the phone, on the computer. you simply CANT clean it all. im not a germaphobe, but i dont like to even be in a GI suite, let alone perform spinal procedures in one.

 

[Ducttape]

sh@t gets EVERYWHERE during a colonoscopy. on the table, on the walls, on everyone in the room, on the lead, on the floors, on the scope, on the tv, on the lights, on the clock, on the phone, on the computer. you simply CANT clean it all. im not a germaphobe, but i dont like to even be in a GI suite, let alone perform spinal procedures in one.

this is coming from the guy who doesnt mask for epidurals? please.....

 

[SSdoc33]

this is coming from the guy who doesnt mask for epidurals? please.....

touche'

 

[emd123]

...because infection control and sterilization protocol in GI suites can't ever fail:

"E. coli outbreak at hospital associated with contaminated specialized GI endoscopes"

http://www.eurekalert.org/pub_releases/2014-10/tjnj-eco100214.php


"2 deaths... 179 potentially exposed"

http://www.latimes.com/business/la-fi-hospital-infections-20150218-story.html#page=1

 

[hyperalgesia]

sh@t gets EVERYWHERE during a colonoscopy. on the table, on the walls, on everyone in the room, on the lead, on the floors, on the scope, on the tv, on the lights, on the clock, on the phone, on the computer. you simply CANT clean it all. im not a germaphobe, but i dont like to even be in a GI suite, let alone perform spinal procedures in one.

You sound like someone with PTSD after being hit with a **** grenade. If you forget the heebie jeebies, and do an ESI in a GI room, even if it's covered in feces, using sterile technique, the probability of an infection is positively miniscule.

 

[pastafan]

I had to do the majority of my procedures in an endo suite for 8 years. No infections.

 

[Ducttape]

...because infection control and sterilization protocol in GI suites can't ever fail:

"E. coli outbreak at hospital associated with contaminated specialized GI endoscopes"

http://www.eurekalert.org/pub_releases/2014-10/tjnj-eco100214.php


"2 deaths... 179 potentially exposed"

http://www.latimes.com/business/la-fi-hospital-infections-20150218-story.html#page=1

INSIDE the scope.

i will change my mind after you post videos of you putting an endoscope on top of a sterile field, and flush the scope onto a Touhy and use that for a procedure.

fyi, because we are not helping the OP - i dont know about all the financials, but isnt this a great way to get in to the ground floor, and eventually get your own dedicated suite?

 

[SSdoc33]

You sound like someone with PTSD after being hit with a **** grenade. If you forget the heebie jeebies, and do an ESI in a GI room, even if it's covered in feces, using sterile technique, the probability of an infection is positively miniscule.

ill admit that i have never seen an infection from a procedure done in a GI suite. but, the several i have been in have been pretty dirty and gross. also, it seems like the injectionists who end up in these suites do maybe a few interlaminars a week, and arent all that skilled. certainly thats not the case all the time, but get yourself a dedicated procedure suite if you can.

 

[emd123]

INSIDE the scope.

i will change my mind after you post videos of you putting an endoscope on top of a sterile field, and flush the scope onto a Touhy and use that for a procedure.

fyi, because we are not helping the OP - i dont know about all the financials, but isnt this a great way to get in to the ground floor, and eventually get your own dedicated suite?

It might be fine. The guys who've worked in GI rooms would know. I haven't. If it's sterile and your patients are okay with it, then go for it.

 

[lonelobo]

this is coming from the guy who doesnt mask for epidurals? please.....

Hope he doesn't have E. Coli coming out of his mouth

 

[jabreal00]

sh@t gets EVERYWHERE during a colonoscopy. on the table, on the walls, on everyone in the room, on the lead, on the floors, on the scope, on the tv, on the lights, on the clock, on the phone, on the computer. you simply CANT clean it all. im not a germaphobe, but i dont like to even be in a GI suite, let alone perform spinal procedures in one.

This is a silly comment. I am a GI doc. My wife is Pain-Anesthesia. Where we work GI and pain share the same suite. Counter to laypersons idea, colonoscopies are done only in those who have a prep, ie no stool in the colon. If stool is encountered the procedure is generally aborted because the mucosa cannot be visualized.

 

[SSdoc33]

This is a silly comment. I am a GI doc. My wife is Pain-Anesthesia. Where we work GI and pain share the same suite. Counter to laypersons idea, colonoscopies are done only in those who have a prep, ie no stool in the colon. If stool is encountered the procedure is generally aborted because the mucosa cannot be visualized.

Clearly, as a GI doc, you do not have the ingrained revulsion to feces like the rest of humanity. However, there is a difference in putting a camera in the dirtiest part of the body and putting a needle in the cleanest, most sensitive part (CNS). You are just asking for trouble if you do the shots in a GI suite.

Also, just because there is no stool, there is still saline that is crawling with gut bacteria

And, correct me if I'm wrong, aren't colonoscopies used for colonic pseudo obstruction and debunking chronic constipation? Internship is coming back. Oh snap!!

 

[fentanyl patch]

This is a silly comment. I am a GI doc. My wife is Pain-Anesthesia. Where we work GI and pain share the same suite. Counter to laypersons idea, colonoscopies are done only in those who have a prep, ie no stool in the colon. If stool is encountered the procedure is generally aborted because the mucosa cannot be visualized.

As an update, I bailed on the GI suite proposal. After talking to a bunch of GI friends, they did reassure me that the only place of possible contamination is the bed itself, so I guess if the beds are switched out that would be reasonable and it seems like GI / pain actually happens more commonly than I thought out there.

Maybe I'm being overly cautious in this NECC/thin ice climate. Also, I wasn't able to find any other high volume specialist that does cases in a GI suite in general (like ENT, podiatry, etc), so why would we?

 

[lobelsteve]

The simple answer is would you let your family get an ESI or SCS trial in the GI suite. No way for me.

 

[emd123]

Clearly, as a GI doc, you do not have the ingrained revulsion to feces like the rest of humanity

. Like x 1,000 lmao

 

[emd123]

As an update, I bailed on the GI suite proposal. After talking to a bunch of GI friends, they did reassure me that the only place of possible contamination is the bed itself, so I guess if the beds are switched out that would be reasonable and it seems like GI / pain actually happens more commonly than I thought out there.

Maybe I'm being overly cautious in this NECC/thin ice climate. Also, I wasn't able to find any other high volume specialist that does cases in a GI suite in general (like ENT, podiatry, etc), so why would we?

In others words it turned out to be a "sh¡tty" idea. Lmao. No pun intended

 

[jabreal00]

And, correct me if I'm wrong, aren't colonoscopies used for colonic pseudo obstruction and debunking chronic constipation? Internship is coming back. Oh snap!!

Not typically at an ASC. Those type of patients are typically admitted to a hospital. Conservative management (IVF, electrolytes repletion, NGT), neostigmine if conservative measures don't work. Colonoscopy last resort. Generally at ASCs or outpatient GI suites, it's bread and butter procedures: EGD and screening colos. And yes my threshold for revulsion to stool is much higher than most (except general or colorectal surgeons).

 

[SSdoc33]

Not typically at an ASC. Those type of patients are typically admitted to a hospital. Conservative management (IVF, electrolytes repletion, NGT), neostigmine if conservative measures don't work. Colonoscopy last resort. Generally at ASCs or outpatient GI suites, it's bread and butter procedures: EGD and screening colos. And yes my threshold for revulsion to stool is much higher than most (except general or colorectal surgeons).

That's true. Forgot about the colorectal guys.

Btw, is 2 girls 1 cup still on the Internet? Nsfw. Definitely nsfw