7206 Intercollegiate-british society of gastroenterology national colonoscopy (ibnc) audit: are 'at risk' patients appropriately cannulated?

Introduction: Safe colonoscopy requires an understanding of sedation techniques. In 1991 the British Society of Gastroenterology (BSG) Endoscopy Committee recommended that cannulation should become standard practice for all endoscopic procedures. As part of the IBNC audit, venous access was assessed with regard to the status of the patient defined by the American Society of Anaesthesiology (ASA) Classification of physical status. 8902 colonoscopies were assessed in 73 units (44 District General, 10 Teaching, 5 Paediatric, 14 Private). Results: 95% of colonoscopies were carried out with intravenous sedation. Midazolam alone - 10.4%, Midazolam with Pethidine - 58.6%, Diazemuls with Pethidine - 9.0%, Midazolam with "other" - 14.9%. 8285/8902 (93.1%) of procedures were carried out with continuous intravenous access in situ throughout the colonoscopy. In 86.8% a plastic cannula was used and in 11.1% a butterfly was utilised. Oxygen was administered in 71% of procedures and a pulsoximeter was used in 93% of cases. `At risk' patients are defined as class 3-5 in the ASA classification (Classes 1-5). There were no Class 5 patients. There were 309/8902 (3.5%) patients in Classes 3 and 4. A plastic cannula or butterfly was used in 257/302 (85.1%) and 35/302 (11.6%) respectively. 7/309 (2.3%) class 3 and 4 patients did not have continuous venous access throughout the procedure, the reasons sited were `patient not considered at risk', and `no sedation given'. No reason was given for 2 patients. Oxygen was administered to 85.4% of `at risk' patients and a pulsoximeter was used in 96.1%. Conclusion: 93% of patients undergoing colonoscopy have intravenous access throughout their procedure and are given intravenous sedation. There are some `at risk' patients undergoing colonoscopy without intravenous access.