Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Percutaneous Endoscopic Gastrostomy Tubes

Background Gastrostomy tube placement is used in patients who are unable to maintain adequate oral intake yet have an otherwise intact digestive system. This type of enteral tube is used for patients who will need long-term enteral feeding, generally defined as longer than 4 to 6 weeks. Multiple ways to obtain access to the digestive system exist, including radiologic, surgical, and endoscopic. The most commonly used…

Percutaneous Coronary Intervention

Background Percutaneous coronary intervention (PCI) is a mainstay of treatment for coronary artery disease (CAD). There are approximately 18 million Americans with CAD, and one American will have a myocardial infarction (MI) approximately every 40 seconds. A patient will classically present to the emergency department with chest discomfort along with other signs/symptoms that are suggestive of MI, which will prompt an electrocardiogram (EKG). If the EKG…

Patient-Controlled Analgesia

Background Pain management through patient-controlled analgesia (PCA) allows patients to self-administer predetermined doses of analgesic medication, typically through a computerized pump, eliminating the need for administration by a nurse or healthcare practitioner. This facilitates delivery of analgesia at shorter intervals and in smaller doses and reduces burden on nursing staff. You’re Reading a Preview Become a Clinical Tree membership for Full access and enjoy Unlimited articles…

Oxygen Supplementation

Background The practice of oxygen supplementation for hospitalized patients generally does not follow any standardized protocols. It is often a hospital norm that patients are provided supplemental oxygen regardless of their blood oxygen saturations (SaO 2 ). Until recently, many healthcare professionals believed that oxygen had little or no deleterious effects. However, recent publications indicate that supplemental oxygen use in patients with normal SaO 2 increases…

Nephrostomy Tubes

Background Percutaneous nephrostomy tubes (PCNs) are placed through the skin directly into a portion of the kidney, hence the name (percutaneous = pertaining to through the skin; nephrostomy = making an opening in the kidney). This procedure has four broad indications: relief of urinary obstruction, diagnostic testing, access for therapeutic interventions, and urinary diversion. In the hospital setting, the most common scenario related to PCN that…

Nasogastric Tubes

Background Nasogastric (NG) tubes are commonly called Salem sumps TM or abbreviated and called NG tubes. These tubes vary in diameter and length and can serve many purposes. NG tubes are inserted through the nare, down through the oropharynx, to terminate in the stomach. Hieronymus Fabricius ab Aquapendente, a 16th-century Italian professor of anatomy and surgery, is thought to be the first to use a silver…

Magnetic Resonance Cholangiopancreatography

Background Magnetic resonance cholangiopancreatography (MRCP) is a noninvasive special type of magnetic resonance imaging (MRI) that utilizes a powerful magnetic field and radio waves to produce detailed pictures of the hepatobiliary and pancreatic systems, including the liver, gallbladder, bile ducts, pancreas, and pancreatic duct. The word “cholangiopancreatography” is derived from Greek by combining “chole” (bile), “angio” (vessel), “pancreato” (pancreas), and “graphy” (write). MRCP was first described…

Lumbar Puncture

Background Lumbar puncture (LP), also called a “spinal tap,” is an invasive procedure performed to obtain cerebrospinal fluid (CSF) from the subarachnoid space in the spinal column. It requires the percutaneous insertion of a spinal needle between two lumbar vertebrae located in the lower back. LP is performed for two primary purposes: diagnostic and therapeutic. Most commonly, LPs are performed for suspected central nervous system infection…

Lower Extremity Venous Duplex Ultrasound

Background Diagnostic ultrasonography is the use of ultrasound to image anatomical structures. Ultrasound is sound waves that have a frequency above what the human ear can hear, or higher than 20 × 10 4 Hz. Diagnostic ultrasound is usually on the order of MHz, or 10 6 Hz. These sound waves are generated from an ultrasound probe, which houses a piezoelectric element that vibrates in response to electric…

Intravenous Access

Background Venous access is something that is often taken for granted. Establishing reliable venous access will facilitate a wide array of medical therapies and diagnostic exams. Currently, there are numerous types of intravenous (IV) access available, including peripheral IV (PIV), midline catheters, peripherally inserted central catheters (PICCs), non-tunneled and tunneled central venous catheters (CVCs), and completely implantable devices known as “ports.” Selecting the appropriate type of…

Implantable Cardiac Devices

Background The most common implantable cardiac devices are permanent pacemakers (PPMs) and implantable cardioverter defibrillators (ICD). PPM is placed in a patient with complete heart block or sinus node dysfunction leading to bradycardia. It takes over the “timekeeping” function of the sinoatrial node (located in the right atrium) and provides the necessary electrical impulses to maintain a normal heart rate. ICD is placed in a patient…

Hepatobiliary Scintigraphy

Background Hepatobiliary scintigraphy (hepatobiliary iminodiacetic acid or HIDA) is a noninvasive nuclear imaging test used to assess the patency of the extrahepatic biliary tree and gallbladder and the functionality of the liver and gallbladder. Radioactive tracer is injected into the bloodstream and transported to the liver where it is taken up and excreted into the biliary tree. The tracer is then taken up by the gallbladder…

Hemodialysis Access

Background There are several means of vascular access through which hemodialysis (HD) can be performed, including catheters, arteriovenous fistulas (AVFs), and arteriovenous grafts (AVGs). These accesses provide the means for large-bore cannulas to be placed, usually in both an artery and a vein, thus facilitating a large volume of blood to exit and return to the patient after passing through a dialysis machine. HD access catheters…

Hemodialysis

Background Hemodialysis (HD) is the process by which the solute composition of a solution (blood) is altered by exposing the solution to a second solution (dialysate) through a semipermeable membrane. Low-molecular-weight solutes easily interchange between the two solutions down a concentration gradient, but high-molecular-weight solutes will remain on either side of the membrane unchanged. Solutes pass through the membrane via two different mechanisms: diffusion and convection…

Gastrointestinal Endoscopy – Upper

Background Esophagogastroduodenoscopy (EGD) is a procedure that enables visualization and interaction with the upper gastrointestinal (GI) tract. It is called EGD because it uses a “scope” (an instrument for viewing; e.g., microscope, telescope) to access the esophagus (the “E”), stomach (gastric – the “G”), and duodenum (the “D”). It is also referred to as an upper endoscopy. EGD is one of the most common procedures performed…

Gastrointestinal Endoscopy – Lower

Background Colonoscopy is an endoscopic technique used to visualize the colon for screening, diagnostic, and therapeutic purposes. A sigmoidoscopy allows for visualization of the distal part of the large intestine between the descending colon and rectum. The suffix “-scopy” is derived from “skopía” meaning “to view.” Phillip Bozzini, an early 19th-century German physician, was the first to introduce a primitive scope (“Lichtleiter” or light conductor) to…

Gastrointestinal Endoscopy – Capsule

Background Capsule endoscopy (CE) is a noninvasive test that was originally developed to visualize abnormalities of the small intestine but may now be used to diagnose and monitor various disease processes throughout the entire gastrointestinal (GI) tract. The word “endoscopy” is derived from the Greek by combining the prefix “endo” meaning “within” and the verb “skopía” meaning “to view.” The discovery of CE technology dates to…

Gastric Emptying Study

Background Gastric emptying study (GES) is a noninvasive nuclear medicine test used to evaluate patients with suspected gastric motility disorders. As its name suggests, it is used to determine the amount of time required for the stomach to empty after a meal. The first GES to evaluate gastric motility was described in 1966 by Dr. G.H. Griffith and colleagues and consisted of “a standard breakfast of…

Endoscopic Retrograde Cholangiopancreatography

Background Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive test used to visualize the common bile duct (CBD) and pancreatic duct for diagnostic and therapeutic purposes in a variety of biliary and pancreatic disorders. The term endoscopic is derived from Greek by combining the prefix “endo” (within) and “scope” (to view). The term cholangiopancreatography is also derived from Greek by combining “chole” (bile), “angio” (vessel), “pancreato” (pancreas),…