CYST4 Use cystodiathermy via flexible cystoscope

Overview

This standard covers the use of a flexible cystoscope and diathermy equipment to control small bleeding points, to facilitate the detachment of tissue or to destroy small areas of tissue within the bladder through the application of heat. This standard covers cystodiathermy procedures using a flexible cystoscope for adults only.  Paediatric services are excluded. Users of this standard will need to ensure that practice reflects up to date information and policies. Version No 1

Knowledge and Understanding

You will need to know and understand:

1. the types and use of irrigation fluids
2. the indications and contra-indications for cystodiathermy
3. the complications of undertaking cystodiathermy using flexible cystoscopy and the appropriate remedial strategies
4. the sensations resulting from use of heat cauterisation
5. the function, specification and performance characteristics of diathermy equipment
6. the safe operation of diathermy equipment in accordance with national and local policies and guidelines
7. the importance of timely equipment fault recognition and local procedures for dealing with these
8. equipment capabilities, limitations and routine maintenance
9. the manufacturer’s guidelines for preparation, checking and use of diathermy equipment
10. the limits of one’s own knowledge and experience and the importance of not operating beyond these

Performance Criteria

You must be able to do the following:

1. check the patient’s history for contra-indications and special precautions for the use of diathermy
2. ensure all required diathermy equipment is available and safety checks have been satisfactorily completed
3. check the location and availability of emergency equipment
4. prepare and introduce the diathermy compatible cystoscope into the urethra
5. during the procedure identify requirement for cystodiathermy
6. explain the intended procedure to the patient, its reason and purpose and the possible sensation during the procedure
7. ensure only diathermy compatible irrigation fluid is being used
8. request assistant to prepare the patient for diathermy ensuring that this is completed
9. monitor the patient’s condition and needs throughout the procedure
10. ensure the diathermy wire is properly connected to the diathermy machine and pass the free end of the wire through the appropriate channel of the cystoscope
11. identify the wire as it enters the field of vision and position the end onto the area to be treated
12. ensure foot controls are positioned so that they are easily and comfortably accessible
13. adjust the diathermy controls according to the procedure to be performed
14. deliver treatment in short bursts until the desired effect is achieved, maintaining safe practice
15. switch off the diathermy machine on completion of the treatment, withdraw the wire, disconnect it from the main machine and hand it over for cleaning
16. undertake a final examination of the bladder and the treated sites before withdrawing the cystoscope
17. fully withdraw cystoscope, maintaining irrigation until withdrawal is almost complete
18. document the outcomes of the procedure and record all decisions made
19. recognise the need for the immediate management of acute emergencies associated with the procedure and respond appropriately
20. recognise when you need help and/or advice and seek this from appropriate sources

Additional Information

This National Occupational Standard was developed by Skills for Health. This standard links with the following dimension within the NHS Knowledge and Skills Framework (October 2004): Dimension: HWB7 Interventions and treatments