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PREPARATION

Equipment and setup

Equipment

Specifications

EVIS EXERA III BRONCHOFIBERVIDEOSCOPE BF-MP190F

EVIS EUS UNIVERSAL ENDOSCOPIC ULTRASOUND CENTER EU-ME2

PROBE DRIVING UNIT MAJ-1720

ULTRASONIC PROBE UM-S20-17S

SINGLE USE BIOPSY FORCEPS FB-433D

SINGLE USE CYTOLOGY BRUSH BC-205D-2010

Preparing the system

Connecting the ultrasonic probe

 

To connect the ultrasonic probe to the probe driving unit, hold the probe with the connecting pin facing up and insert the probe straight into the probe driving unit. You might not be able to disconnect the ultrasonic probe from the probe driving unit if the probe is connected with the connecting pin facing in a different direction.
Be sure to turn off the Endoscopic Ultrasound Center when connecting or disconnecting the ultrasonic probe.

Setting the Endoscopic Ultrasound Center

Scan direction : INVERSE
Gain value : 15
Contrast value : 5

■ GAIN

The gain (brightness) of the ultrasound image can be adjusted in 20 steps (0-19).

■ CONTRAST

The CONTRAST buttons adjust the contrast of the B mode ultrasound image.
The contrast can be adjusted in eight steps (1 – 8).

■ DIRECTION

The DIR button switches whether the ultrasound image is displayed as the view from the distal end of the ultrasound scope/ probe (NORMAL) or as the view from the insertion direction (INVERSE).
Press the DIR button to switch the viewing direction of the ultrasound image.

2-2 Patient pretreatment & premedication

Preliminary medication No food and drink 4 hours before the examination. If the patient takes antiplatelet and/or anticoagulation drug(s) orally, these should be stopped beforehand to avoid affecting the bronchoscopic examination.
Local anesthesia Anesthetize the pharynx using 4% lidocaine (2 to 5 mL) with a nebulizer. Spray the lidocaine in sync with the patient’s exhalation. If lidocaine pools in the oral cavity, have the patient expectorate into a gargle basin as required.
Sedation Dilute 50 μg of fentanyl (5 mL of the solution obtained by diluting 50 μg of fentanyl (prepared by diluting fentanyl 1 Ap [100 μg, 2 mL] in 8 mL saline) and 2 mg of midazolam (prepared by diluting midazolam 1 Ap [10 mg, 2 mL] in 8 mL saline) in saline. Once the patient is in the supine position on the examination table, inject the solution intravenously. The amount should be adjusted according to the build, age, general status and visceral condition of the patient.
During bronchoscopy For intratracheal anesthesia during the procedure, perform a bolus injection of 2% lidocaine (1 mL per administration) from the instrument channel of the bronchoscope. Depending on the degree of coughing and pain, you can also administer 20 μg fentanyl and 1 mg midazolam solution by intravenous injection. Oxygen should also be administered as required to maintain an SpO2 value of at least 90% on the percutaneous arterial blood oxygen saturation monitor.
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