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1 Slide 1 Slide 4 Measure Pressures within the Esophagus Evaluate Coordination of Muscles Presented by: Donna Dickinson, RN, Clin II, Manometry Specialist Bon Secours Richmond Health System Slide 2 Slide 5 Define Manometry List Three Primary Reasons for Obtaining Manometry Describe Patient Preparation and Technique to Perform Manometry GERD Dysphagia Atypical Chest Pain Slide 3 Slide 6 Identify Normal Motility Patterns Identify Abnormal Motility Patterns -Achalasia -Diffuse Spasm -Nutcracker Esophagus

2 Slide 7 Slide 10 Pre-procedure education decreases patient anxiety Provide brochure with written instructions and explanation of the procedure Pre-procedure telephone call Confirm appointment date/time Describe procedure in supportive, non-threatening language NPO 5 hours prior to procedure Address concerns Slide 8 Slide 11 Prior to the procedure: Verify NPO status Patient should be awake, alert and able to follow commands Provide a comfortable, relaxed environment Instill 1 cc numbing jelly into a nostril to provide topical anesthesia (using about 5 cc of lidocaine jelly 2% total) Ask the patient to sniff and swallow to facilitate numbing of the nasal passage and throat Gently insert the prepared manometry catheter into the anesthetized nostril, down the back of the throat and esophagus as the patient sips and swallows Position the catheter with 2 proximal sensors above the upper esophageal sphincter and 2 distal sensors in the stomach Slide 9 Slide 12 Explain the purpose of the procedure Describe how the procedure will be performed Review instructions that will be given during the test Emphasize importance of patient cooperation Answer questions Provide reassurance and emotional support Allow 1-5 min. acclimation period for the patient Provide comfort to your patient and review the next steps during this time Give the patient 5cc water and instruct them to swallow- Repeat for a total of 10 sips; each 30 seconds-1 min apart Remove the catheter and proceed with patient discharge

3 Slide 13 Slide 16 Basal Pressure mmhg Residual Pressure <12 mmhg 100% Peristaltic Contraction with each swallow Wave Duration 3-6 seconds Basal Pressure mmhg Residual Pressure <15 mmhg Slide 14 Slide 17 Slide 15 Slide 18 No Peristaltic Contractions Elevated Basal Pressure >45 mmhg Elevated Residual Pressure >15 mmhg

4 Slide 19 Slide 22 ACHALASIA DIFFUSE ESOPHAGEAL SPASM Slide 20 Slide 23 Slide 21 Slide 24 Intermittent Normal Peristalsis Simultaneous contractions > 20% but <100% Repetitive and Multi-peaked Contractions Prolonged Contractions > 6 seconds Prolonged Contractions > 6 seconds Elevated Wave Amplitude >155 mmhg May have Abnormal Relaxation Elevated Basal Pressure > 45 mmhg Elevated Residual Pressure > 15 mmhg

5 Slide 25 Slide 28 NUTCRACKER ESOPHAGUS Slide 26 Manometry and Motility Patterns 1. Measures esophageal pressures and muscle coordination 2. Most often used to evaluate GERD, Dysphagia, and Atypical Chest Pain 3. Requires Patient Understanding and Cooperation 4. Interpretation focuses primarily on Contractions, Waveforms and Duration, and Pressures Slide 27 Manometry. Gastroenterology: A Core Curriculum. 4th ed.: Society of Gastroenterology Nurses and Associates, Bredenoord AJ, Fox M, Kahrilas PJ, Pandolfino JE, Schwizer W, Smout AJPM. Chicago Classification Criteria of Motility Disorders Defined in High Resolution Pressure Topography. Neurogastroenterol Motil 2012:27(1): Spring 2012 High Resolution Manometry: The Next Generation Conklin J, Pimentel M,Soffer E, Color Atlas of High Resolution Manometry, New York, NY: Springer Science+Busines Media, LLC;2009 Kahrilas PJ, motor disorders in terms of high resolution pressure topography : what has changed? American Journal of Gastroenterology 2010, Motility and Manometry The SGNA-Doris Barnie Certification Review Course. 2 nd ed.:society of Gastroenterology Nurse and Associates,