Position of the Patient and Examiner
- There are various possible options when positioning the patient and examiner.
- In particular, when performing rigid endoscopy the angle of the endoscope and the chosen position determines what you will see.
- Various criteria should be considered:
- The position of the patient (sitting or lying)
- The instrumentation (flexible or rigid endoscope, handling preferences, type of camera)
- Ensure comfortable examination body level
- Does the patient have a pronounced gag reflex?
- Are there features of special interest around the anterior commissure or posterior larynx?
- The expected duration of the examination
- For more: See Tips and Tricks/Special Positioning of Endoscope or Patient
|Sitting||Standing opposite the patient|
|(Standing behind the patient)|
|Sitting higher than the patient|
|Sitting at the same level as the patient|
|Sitting lower than the patient|
|Standing at the head of the bed (rare cases)|
Table 4.1: Possible variations of position of patient and examiner
When choosing your position for examination ensure that the monitor is within easy line of sight - avoid extreme head rotation to either side for longer examinations.
Adjust the height of both chairs – it is usually more comfortable for the examiner to sit in a slightly higher position than the patient.
The examiner’s arms should be adducted during prolonged endoscopy procedures.
The examiner’s elbows should be comfortably flexed.
Position of the Patient and Examiner: Rigid Endoscopy
Rigid endoscopy with a 90° or with a 70° endoscope can be performed either from a standing or sitting position.
In some countries, it is common for both the examiner and patient to sit.
However, when using some cameras, it may be easier to stand while the patient remains seated.
While seeking a particular view, it may be necessary to alter the normal positions for examination.
The most comfortable position for the examiner will depend on the manner in which the endoscope is gripped:
Position of the Patient and Examiner: Flexible Endoscopy
Examinations with flexible endoscopes can be performed while the examiner is either sitting or standing.
Especially for longer procedures, e.g. examination of swallowing, it is sometimes more comfortable for the examiner to stand in order to reduce the strain on their arms.
Another possibility for flexible endoscopy is to stand behind the patient so the examiner and patient can watch the monitor. We are not fond of this technique because the examiner cannot see the patient’s face, and is therefore unable to check their reactions, e.g. an impending vagal response.
Patient sitting, examiner standing: Two alternative styles for grasping the endoscope’s handpiece. Look at the levels of their heads: The head of the examiner is held in a slightly higher position than that of the patient.
Patient sitting, examiner standing: Three alternative ways to grasp the endoscope handpiece
The Patient in Supine Position
Flexible endoscopy is more ergonomic and thus easier to perform than rigid endoscopy when the patient is lying in a supine or semirecumbent position.
The examiner may sit or stand as appropriate, using whichever position is the most comfortable.
Posture of Examiner – How to Do It
For both rigid and flexible endoscopy it is important to find a neutral, comfortable (i.e. not tiring) position, especially for the arms, head, and back.
The examiner’s elbows should not be abducted, nor held any higher than necessary.
The examiner’s arms should be adducted during long endoscopy exams.
During protracted examinations, standing may be a more comfortable option for the examiner.
The distance between the examiner and patient should not be so great as to prevent the examiner from sitting or standing upright with a straight back and neck.
Make sure that the monitor is positioned so that the examiner can see the screen and the patient with a minimal amount of head turning.
Position of Examiner’s Legs and Feet
Foot pedals may be required during some examinations in order to operate recording, stroboscopy, laser, etc.
Be prepared to reach all necessary foot pedals.
Sit or stand up straight.
Avoid getting your feet tangled in cables.
There are several options for where to place your feet when sitting opposite a patient. When using a foot pedal, the patient’s knees should be facing the examiner, who can then arrange his own legs to the left or to either side of the patient’s knees.
Check that the distance between examiner and patient is small enough to permit both to sit upright.
Examiner – How NOT to Do It
Example of nonergonomic posture:
Note the bent back and arms held high and abducted.
Note the distance between the examiner and the patient.
Also note the wide angular change in direction required to view either the patient or the monitor.
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