The Tube October 2023

Volume 49 Issue 2 October 2023

INSIDE Endoscopic Submucosal Dissection (ESD) Spotlight on a Team: Te Matau a Māui Hawke’s Bay Gastroenterology Team Helpline Activity in a High-Volume Inflammatory Bowel Disease Centre

OLYMPUS CORNER WELCOME TO THE OLYMPUS CORNER 2023 NZ Gastro Conference Olympus is a proud sponsor of the 2023 NZSG and NZgNC Annual Scientific Meeting in Rotorua.

We look forward to meeting with key industry leaders in Endoscopy to share knowledge, experiences, and industry updates.

On show at the Olympus exhibitors’ booth, will be the Olympus EVIS X1 platform and ENDO-AID – the Olympus Artificial Intelligence technology. Attendees will have the opportunity to have some hands-on experience with the Olympus systems, using a simulated colon model.

You can experience our newly launched EU-ME3, Olympus’ mid-range, compact processor. Ideal for both EUS and EBUS procedures with improved visualisation, enhanced operability and new features such as Shearwave Quantification.

We also have a range of innovate endoscopic devices on display including ERCP, EUS and ESD product solutions to suit your needs, including Olympus’ VisiGlide 2 ERCP guidewires, CleverCut 3V sphincterotomes and our Dual Knife J for ESD procedures. Come and experience Olympus’ latest technology for yourself!

See you in Rotorua and don’t forget to visit the Olympus booth.

What is Olympus Continuum?

Olympus Continuum is a comprehensive platform of educational programs and training experiences designed to help healthcare professionals broaden their clinical expertise and enhance their procedural skills. The courses, classes, programs, events, and resources within Olympus Continuum are designed to help physicians, surgeons, nurses, technicians, and biomeds perform at their best and deliver the highest levels of patient care.

What Olympus Continuum does is connect the continuum of care with the continuum of learning. A truly blended experience, Olympus Continuum maximizes offsite pre-learning, hands-on onsite training, and offsite post-learning to support healthcare professionals across every stage of their career.

Ross D. Segan, MD, MBA, FACS Chief Medical Officer, Olympus Corporation

These products are not available for purchase by the general public.

Upcoming Olympus Continuum Courses: TJF-Q190V Cleaning In-Service Webinar Wednesday 18th Oct | 2.30pm - 3.30pm NZST The Olympus Continuum team is dedicated to educating the specialists of tomorrow. Olympus Continuum offers courses and webinars for reprocessing and endoscope training, specific topics include infection control, reducing the risk of cross contamination, and other adverse events related to the reprocessing of flexible endoscopes and surgical instruments.

Getting started is easy—simply visit the website, locate your regional LMS site, and register for Olympus Continuum. From there, you’re ready to take part in leading-edge courses and programs, utilise a variety of online educational materials, and take advantage of resources designed to help you strengthen your standard of care.

TJF-Q180V Cleaning In-Service Webinar Wednesday 18th Oct | 3.30pm - 4.30pm NZST Gastroscope & Colonoscope Cleaning In-Service Webinar Wednesday 8th Nov | 2.30pm - 3.30pm NZST EUS Cleaning In-Service Webinar Wednesday 8th Nov | 3.30pm - 4.30pm NZST Endoscopic Retrograde Cholangiopancreatography (ERCP) Auck - Wednesday, 15th Nov | 12.30pm - 5pm NZST These ERST courses will provide participants with an overview of the procedure and recommendations for reprocessing Olympus flexible endoscopes.

To book, visit: https://learn-nz.olympus.co.nz and register.

If you would like more information on Olympus products and services, please contact your local Sales Specialist or Olympus New Zealand Customer Service on 0508 659 6787.

OLYMPUS NEW ZEALAND LIMITED 28 Corinthian Drive, Albany, Auckland

Customer Service: 0508 659 6787 www.olympus.co.nz QR 07.640 October 2023

Contents

Committee Chairperson

Merrilee Williams merrilee.williams@southerndhb.govt.nz

NZNO NZGNC Chair Report

Secretary

Sydney International Endoscopy Symposium

6-7

Exploring the Removal of Submucosal Tumours (SMTs) with Submucosal Tunnelling Endoscopic Resection (STER), and the Benefits over Surgical Intervention

8-9

Nurse Endoscopist Sub Specialty Group Report

10

Committee Members

New Zealand Hepatology Nurses Annual Report

12

Marian O’Connor - IBD Specialty marian.o’connor@tdhb.org.nz

Endoscopic Submucosal Dissection (ESD)

14-15

Spotlight on a Team: Te Matau a Māui Hawke’s Bay Gastroenterology Team

16-17

Holly Weale secretaryofnzgnc@gmail.com

Treasurer

Kirsten Arnold treasurerofnzgnc@gmail.com

Jessica Southall - Hepatology Specialty Jessica.Southall@cdhb.health.nz Karen Kempin - Nurse Endoscopist Karen.kempin@huttvalleydhb.org.nz Kiran Joseph - Registered Nurse kiran.joseph@southerndhb.govt.nz Julia Anderson - NZNO Professional Nurse Advisor Julia.Anderson@nzno.org.nz

Life Members • Kaye Hay • Kate Bydder • Barbara Miller • Marie Fitzsimons

Advertisers

Olympus Boston Scientific Cooper Medical Fresenius Kabi Whiteley Obex Ecolab

Fundamentals of Endoscope Reprocessing and Practical Skills Assessments – NZ

18

Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD)

20-22

Auckland Regional Endoscopy Nurses Study Day 2023

24-25

Gastroenterology Nurse Leaders Day

Justin Augustine - Registered Nurse justin.augustine@wcdhb.health.nz

Page(s)

2, 48 4, 19 10 13, 38 23, 39 27 33

Printer

Croft Print 1 Lunns Road, Middleton, Christchurch Phone 03 343 2270

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26

Percutaneous Endoscopic Gastrostomy (PEG)

28-31

Inflammatory Bowel Disease Sub Specialty Group Report of the NZ IBD Nurses Committee as Sub-Committee to NZgNC

32

Helpline Activity in a High-Volume Inflammatory Bowel Disease Centre

34-35

NZNOCSTN Conference 2023

36-37

Annual General Meeting of the NZNO Gastroenterology Nurses College

40-41

Tube Writing Guidelines for Authors

42-43

Gastroenterology Units in New Zealand

44-46

MANTIS Clip TM

NZNO NZGNC October 2023 Chair Report As we near the end of the year, you’re probably well underway with thinking about Christmas, summer sun, and 2024! But the best is yet to come!

NZ Gastroenterology Annual Scientific meeting in Rotorua in December is our biggest hurrah annually, and the programme this year is looking fantastic.

Tania Waylen - Nurse Convenor is working away in the background with her team to make magic happen. I hope we see you there.

formation of the Inflammatory Bowel Diseases sub specialty group. Marian has had an extended time on the committee and we are so grateful for the wealth of experience she has brought, and shared.

Our secretary Holly will also finish her extended term with the committee - Holly has been such a pleasure to have in the committee, and I’m so grateful for her time, expertise, and excel spreadsheets.

As promised, we also have our first edition of ‘Spotlight on a team’- with the wonderful team from Hawke’s Bay first up. Please get in touch if you would like to share your team next- we would love to hear from you.

The committee hosted our annual Gastroenterology Leaders day in Wellington last month, and I think we all agree this was a great success, and the opportunity to get together was again invaluable. See inside the journal for photos.

I’m going to keep my chairperson intro here quite brief, as this is one bumper issue that I hope you’ll learn lots from. Share it with your teams.

We have some positions coming up on the college committee this December, including committee members and secretary.

Happy reading and learning!

I’d like to thank Kiran Joseph for her commitment over her term, and wish her well with her continuing post graduate study. Also finishing their term are Marian O’Connor who has been integral in the

Merrilee Williams Your Chairperson

Greater Wellington Region GE Nurse Network Meeting IS POO THE ANSWER? Dr Sophia Sava Wednesday 25 October 2023 6.30-8.30 pm Bowen Hospital, Crofton Downs

RSVP: Karen.kempin@huttvalleydhb.org.nz

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Sydney International Endoscopy Symposium (SIES) March 2023 Nichola Olds-Read Speciality clinical nurse. National Bowel Screening Programme.

Te Whata Ora - Waitaha Canterbury Nichola.olds-read@cdhb.health.nz

In March 2023 I had the privilege of being selected and funded to attend my first Sydney International Endoscopy Symposium (SIES). I thank the New Zealand Gastroenterology Nurses College (NZgNC) for their patience, financial support and the Endoscopy / Gastrointestinal unit manager at Te Whata Ora - Waitaha.

Healthcare leaders face a multitude of priorities which also includes providing strong educational support and a commitment to their employees to further their knowledge and skills. Education historically has been provided within a curriculum that is teacher centred or focused however research has shown that a more student focused approach fosters a deeper approach to learning (Richardson, 2005; Stanley & Dougherty, 2010). Education in the format of a conference fosters and benefits the students, nurses and doctors in a myriad of ways. The benefits include the acquisition of knowledge and practical ideas, establishing professional networks and maintaining past connections and staying abreast of current practices. The conference environment also enables the exploration of job opportunities and in my case volunteering opportunities.

question and answer opportunity with an expert panel, and delegates can also visit the sponsors at the trade stands in the auditorium. The organisers have remained relevant and understand the demographic trends influencing their target industry. There was entertainment in the form of Professor Michael Bourke’s witty repertoire, interactivity, short sessions and the technology and production was characteristically professional. In order to foster the deep learning experience for the student the educator needs to focus on how the information is delivered and not what information is given (Andreou, Papastavrou & Merkouris, 2014). Open and direct verbal communication interactions were the preferred method from the delegates to the SIES chairperson, organisers and experts whilst they performed a range of live endoscopy procedures.

The education focus takes place for all the students and delegates in the form of live transmissions from the endoscopy suites at Westmead Hospital forming the foundation for the entire two-day programme. The endoscopy demonstrations cover a range of new techniques and technologies. The core fundamentals of endoscopy are also comprehensively covered. A common goal for teachers and educators is to become more proficient as providers of education and learning, whilst choosing the best strategy and educational theory to support the learners needs (Bradshaw & Lowenstein, 2014; Limbach & Waugh, 2010; Penn, 2008). The Westmead organisers understand the core concepts as providers of education ensuring everyone experiences what is considered best practice and demonstrates how to implement those strategies.

The extensive catalogue of the research publications dating back to 2008 are varied, readily available and support the strong clinical educational approach to endoscopy for Australia and New Zealand. The research guides many of our practices in Christchurch and it is important to make the necessary implementations to new and updated practices within our work environments. The Christchurch gastrointestinal unit aligns many of our policies, position statements and guidelines based on what was learned and gleaned in the conference environment. The complex procedures and experts extensive experience was readily shared over the course of the two days from the variety of national and international experts. Westmead is considered a tertiary centre and very complex cases and patients are sent from around the Australia to Westmead due to the experience and expertise of the nursing and medical teams.

The symposium commenced in 2008 at Westmead Hospital and is now the second largest gastroenterology and endoscopy meeting in Australia. The conference organisers have considered their learners motivations for attendance and the attendee’s preferences for this conference design.

The format for the conference takes the participants and students on a two-day showcase of live demonstrations, a

The topic of particular interest was the discussion around the clinical assessment of the selection of patients for 6

endoscopic submucosal dissection (ESD) versus surgery, and whether surgery posed more risk and complications in certain areas of the bowel than ESD or endoscopic mucosal resection (EMR). Endoscopic mucosal resection was also discussed in length reflecting on past practices and the advancements with new technology and updated research classifications. The various histology classification models that are used throughout the upper and lower gastrointestinal tract and updated statements based on Westmead research were very heavily supported by the medical teams throughout the entire conference. The key messages were; know your equipment, do not panic, and there is no ‘I ‘in team as the live demonstrations were delivered with expertise to the delegates. The collaborative team work approach was very insightful, professional and evident as the online team completed the endoscopy procedures.

The ability to provide education within an already fiscally and time poor environment has been shown to be very challenging as the paradigm shift for evidenced based research exists across many modern learning environments (Stanley & Dougherty, 2010). A question arises when balancing outcomes and experiences with cost. What is the valid return on investment sending staff to conferences in a post Covid-19 environment? Conferences provide an opportunity to present delegates work confidently and effectively, connect informally and meet a wide range of disciplinary colleagues in social spaces until in some cases late into the evening. Academic conferences are valued venues for disseminating knowledge; staying current, connecting with potential research collaborators, learn about funding opportunities and networking for new job opportunities.

References: • Andreou,C., Papastavrou,E. & Merkouris,A. (2014).

Learning styles and critical thinking relationship in baccalaureate nursing education: A systematic review.

Nursing Education Today, 34,362-371 doi:10.1016/j. nedt.2013.06.004 • Bradshaw,M, & Lowenstein,A. (2014).Innovative teaching strategies in nursing and related health professions (6th ed.). Burlington,MA: Jones and Bartlett Learning

Despite the hiatus of the Covid-19 pandemic ceasing all international gatherings Westmead returned with a vibrant successful meeting for 2023, registering a large contingent from around the globe. SIES provided an opportunity to deliver a memorable conference environment for all delegates confirming a vital part of academic life. Delegates capitalized on the opportunity to reconnect, striking up conversations courageously and networking after using so many digital and online platforms previously through the lock down environment. People attend conferences for various reasons and Westmead is one that should be attended, to contribute, collaborate and connect.

An academic conference is a valued environment for disseminating current scientific knowledge and encourages feedback, supports forward thinking and ensures a discipline remains visible.

• Limbach,B.,& Waugh,W. (2010). Developing higher level thinking. Journal of Instructional Pedagogies, 3, 1-9.

• Penn, B. (2008).Mastering the Philadelphia,PA: F.A Davis Company

teaching

role.

• Richardson,J. (2005). Students approaches to learning and teachers’ approaches to teaching in a higher education. Educational Psychology, 25(6), 637-680 doi: 10.1080/0144341050034472 • Stanley,M., & Doughterty,J.P. (2010). A paradigm shift in nursing education: A New model. Nurse Education Perspectives, 31, (6), 378-380

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Exploring the Removal of Submucosal Tumours (SMTs) with Submucosal Tunnelling Endoscopic Resection (STER), and the Benefits over Surgical Intervention Amy George Registered Nurse. Bachelor of Nursing, PGDip in Health Science Gastroenterology Day Unit , Christchurch Hospital Amy.george@cdhb.health.nz

In March this year I was fortunate to receive funding from New Zealand Gastroenterology Nurses College (NZgNC) to attend that Sydney International Endoscopy Symposium (SIES) for the first time. As a reasonably new recruit to gastroenterology nursing, it was an incredible opportunity to meet and mingle with medical and nursing experts in the gastroenterology world and observe demonstrations of new techniques and products. I learnt a great deal and enjoyed observing live video therapeutic endoscopic procedures, and hands-on nursing workshops. In particular, the live sessions were a unique experience, and I found the submucosal tunnelling endoscopic resection (STER) procedure for the treatment of submucosal tumours (SMTs) interesting and exciting as it is a relatively newer technique and not yet routinely performed in New Zealand.

Endoscopic images of submucosal tumours in oesophagus (left) and gastric body (right).

Description of STER procedure Submucosal tunnelling endoscopic resection of a submucosal tumour was reportedly first performed in 2012 and inspired by digestive endoscopic tunnel technique (DETT) (Du et at., 2019). The technique has proven to be more effective with oesophageal SMTs compared to cardia SMTs, which are more challenging to resect due to their larger size and irregular shape. The STER procedure is performed under a general anaesthetic and, as it is similar to peroral endoscopic myotomy (POEM) procedure, it is usually performed by an endoscopist who is skilled at POEM. A single-accessory gastroscope with a transparent cap is used. The endoscopist begins by injecting a dye mixture approximately 3-5cm proximal to the SMT with an injection needle. An incision is then made and using a triangular knife and argon plasma coagulation unit (ERBE), a tunnel is created in the submucosal layer to about 2cm distal from the tumour. Once the tumour is fulling exposed, a hybrid knife is used to completely dissect the tumour along the tumour capsule, and then removed fully intact from the tunnel. The tunnel is then inspected, and electrocoagulation performed if any bleeding concerns. The tunnel is then closed, starting distally, with endoscopic clips (Du et l, 2019).

Submucosal tumours Submucosal tumours (SMTs) are a diverse group of lesions originating from beneath the mucosa in various gastrointestinal tract segments. They manifest as discreet mass-like formations beneath the mucosal lining, occurring within the submucosal lining beneath the surface epithelium and connective tissue. Submucosal tumours can be found through the whole digestive tract, though most commonly occur in the stomach and oesophagus. They often pose diagnostic and therapeutic challenges due to their obscure nature and variable clinical presentations (Dzhantukhanova et al., 2019). Histologically, SMTs exhibit a diverse array of cellular compositions, including smooth muscles cells, nerve tissue, adipocytes, and fibroblasts, and may originate from the muscularis mucosae or deeper muscular layers.

The clinical implications of SMT’s are manifold, ranging from innocuous incidental findings to overtly symptomatic manifestations. Primarily SMTs are benign tumours and often management is follow-up observation, however some have the potential to become malignant. While most SMTs remain clinically silent, others may provoke symptoms such as gastrointestinal bleeding, obstruction, and pain.

Additionally, the growth patterns and biological behaviours of SMTs may vary widely, posing significant challenges for accurate prognosis and tailored therapeutic approaches (Nishida et al., 2013).

Follow-up care is ward admission for monitoring, and the patient is nil by mouth for 24-48 hours, before progressing diet. Prophylactic antibiotics can be given for up to 48 hours post procedure, along with proton- pump inhibitors.

Possible complications to monitor for in the first few day’s post-procedure are pneumothorax, haemorrhage, subcutaneous emphysema and pulmonary infection.

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A. Mucosal Incision B. Submucosal Tunneling C. Tumour Resection

D. Finish Resection and Hemostasis E. Mucosa Closure

Benefits of STER verse surgical intervention

References

Submucosal tunnelling endoscopic resection represents a significant departure from conventional surgical resection due to its minimally invasive nature. The method used avoids the need for large incisions and reduces the risk of complications associated with traditional surgery, such as wound infections, hernia, and post-operative pain.

Studies have shown that STER is associated with shorter hospital stays and faster recovery times compare to surgical resection (Hou et al., 2020).

• Du, C., Chai, N.L., Ling-Hu, E.Q., Li, Z.J., Li, L.S., Zou, J.L., Jiang, L., Lu, Z.S., Meng, J.Y. & Tang P. (2019).

• Submucosal tunneling endoscopic resection: An effective and safe therapy for upper gastrointestinal submucosal tumors originating from the muscularis propria layer.

World Journal of Gastroenterology, 25(2), 245-257. doi: 10.3748/wjg.v25.i2.245.

• Dzhantukhanova, S., Starkov, Y., Solodinina, E. & Zamolodchikov, R. (2019). The smart approach to surgical treatment of submucosal tumours based on preoperative EUS-typing. Annals of Laparoscopic and Endoscopic Surgery, 4(81), http://dx.doi.org/10.21037/ales.2019.06

While surgical resection of SMTs requires the removal of a portion of the gastrointestinal tract which can lead to functional impairments and altered bowel habits, STER allows for the preservation of a greater extent of the healthy mucosal and muscular layers. This minimizes the risk of postoperative complications such as stenosis and altered motility (Zhang et al., 2021).

• Hou, X., Chen, T., Cai, J., Wu., & Zhou, P. (2020).

Submucosal tunnelling endoscopic resection for small upper gastrointestinal submucosal tumors originating from the muscularis propria layer. Surgical Endoscopy, 34(6), 2682-2689

Additionally, there are inherent risks associated with surgical resection of SMTs, such as bleeding, infection, organ injury, and anaesthetic complications. STER has demonstrated a lower incidence of these adverse events, leading to reduced morbidity and mortality rates (Zhu et al., 2019). A study by Liu et al. (2022) found that the rate of major complications was significantly lower in the STER group compared to the surgical resection group, highlighting the safety profile of the endoscopic approach.

• Liu, Q., Zhong, Y. S., Chen, Q. Y., Chen, Y. N., He, L. Q., Luo, T., …& Wu, H. Y. (2022). Submucosal tunnelling endoscopic resection for the treatment of upper gastrointestinal submucosal tumors originating from the muscularis propria layer: a large consecutive series.

Surgical Endoscopy, 36(1), 265-273 • Nishida, T., Kawai, N. Yamaguchi, S. & Nishida, Y. (2013).

Submucosal tumours: comprehensive guide for the diagnosis and therapy of gastrointestinal submucosal tumours. Digestive Endoscopy, 25(5), 479-489, https:// doi.org/10.1111/den.12149

While STER offers numerous benefits, it is essential to consider patient selection and tumour characteristics when determining the appropriate treatment approach.

Submucosal tumours with specific features, such as large size, suspected malignancy, or difficult anatomical locations, may necessitate surgical resection. Therefore, careful assessment and individualized treatment planning are crucial to achieve the best outcomes. Within New Zealand, the cohort of patient’s who would benefit from this procedure is relevantly small, however on discussion with interventionist gastroenterologists in my department, it is definitely a treatment that will be offered in the near future when appropriate.

• Zhang, Y., Huang, J., Yao, L. Q., Qian, Y. Q., Liu, Y., Wang, Y. H., …& Zhou, P. H. (2021). Submucosal tunnelling endoscopic resection vs thoracoscopic enucleation for large oesophageal leiomyomas: a randomized controlled trial. Gastrointestinal Endoscopy, 94(1), 58-66 • Zhu, L., Chen, P., Ji, F. & Wang, X. (2019). Comparison between submucosal tunnelling endoscopic resetion and thoracoscopic enucleation for the treatment of esophageal submucosal tumours originating from the muscularis propria layer: a randomized controlled trial.

Surgical Endoscopy, 33(7), 2150-2157 9

Nurse Endoscopist Sub Specialty Group Report The Nurse Endoscopist subgroup held its first Zoom meeting on 9 August, with all those who have expressed interest in the NE subgroup invited. The group includes current and potential future nurse endoscopists. Items discussed at this Zoom included training for new nurse endoscopists, selfnomination for executive roles on the subgroup committee (2 x co-chairs and secretary), Nichola Griffiths update on her NPTP program and a discussion regarding 2024 MECA negotiations for the senior nurse scale and whether there should be a submission for additional recognition and remuneration for nurses undertaking complex diagnostic tests.

There is a plan for a face to face meeting in Rotorua before the Annual Scientific Meeting on 5 December, organised by Tania Waylen, which will include a tutorial with the invited ASM nurse speakers from the UK, who are both nurse endoscopists.

committee for confirmation. The groups next activities will be to work on a logo and map out what nurse endoscopist training might include. Our next meeting is planned for October via Zoom.

The final draft of the subgroup Terms of Reference have been circulated and will be submitted to the NZGNC

Questions and expressions of interest to join the subgroup can be emailed to nzgncnesubgroup@gmail.com

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Coeliac New Zealand Honorary Patron, Dr. Simon Chin alongside Coeliac NZ warmly welcomes everyone to this year’s exciting annual conference in Auckland, the theme being “Living Coeliac Safe-Challenges and Successes”.

The conference will be of interest to the general public as well as health professionals. For the first time, delegates will also be able to attend the Gluten Free Food Festival.

Knowledge of coeliac disease continues to evolve, challenging health professionals to keep up to date. Therefore, our expert medical and dietetic panel will have a plenary session (for doctors, dietitians, nutritionists, and other health professionals). Topics include atypical presentations, monitoring after diagnosis, and dietetic considerations of the gluten-free diet. There will be ample time for discussion with a Q&A session afterward.

The main conference continues along the similar themes but widening the scope of knowledge.

Guest speakers include: • • • •

•

Tania Clifton-Smith – a physiotherapist with over 30 years’ experience and specialising in the field of breathing dysfunction.

Professor Andrew Day – a leading paediatric gastroenterologist based in Christchurch with a strong clinical and research interest in Coeliac Disease.

Dr Karen Faisandier – a clinical psychologist who runs a holistic practice in Wellington which integrates psychological, nutritional and lifestyle strategies for patients Bob Anderson and Jason Tye-Din from Australia – our medical experts, who will give a “fireside” discussion of the latest research and trends including the future of the glutenfree diet and clinical trials.

Husband and wife team Gastroenterologist Dr Kamran Rostami and registered NZ dietitian Adele Rostami will present separately on the medical and dietetic management of non-responsive coeliac disease.

The full agenda is available at: https://coeliac.org.nz/conference-2023/ Tickets for the medical seminar $40+ fee and an additional $75 + fee for the main conference using the early bird offer available until 18th September. Don’t delay purchase your tickets today! https://www.eventfinda.co.nz/2023/coeliac-new-zealand-conference/auckland/manukau-city 11

New Zealand Hepatology Nurses Annual Report

New Zealand Society of Gastroenterology Annual Scientific Meeting Rotorua, 7th December 2023 Committee: Judith McLaughlin (Chair), Bridget Faire (Secretary), Jessica Southall (NZgNC liaison), Jacqui Stone, Susan Gale The group has focused on three main projects this year.

1. The main focus this year has been the progression of the knowledge and skills framework. The committee has met face to face twice this year, and with the wider group of hepatology nurses prior to conference. We hope to publish these in the New Year and then start work on guidelines to support these.

2. We updated the Terms of Reference (TOR) to align with the NZgNC TOR. 3. We have contributed articles to the Panui and Tube magazine each edition, and these have focused on updated guidelines and best practice.

With the establishment of Te Whatu Ora Health NZ, we are looking forward to national guidelines and working with the NZ Society of Gastroenterology to establish these. Some of us have been involved in the writing of national health pathways documents relating to liver disease.

Going forward, we are refocusing our efforts on writing guidelines to support our knowledge and skills framework. These are intended to be used by nurses working in a variety of settings from primary care to prisons to the transplant unit.

The focus for 2023 has been on education for our hepatology nurses. We have continued to progress the development of a knowledge and skills framework. Twelve nurses accepted the opportunity to participate in professional development for nursing patients with advanced liver disease, funded by the subgroup.

We have also raised awareness of the group by contacting key stakeholders so that we may be consulted on matters affecting patients with or at risk of liver disease.

ABBVIE put on a nurse’s education day focusing on working towards HCV elimination. There were presentations of results from various regional pilots in point of care testing for hepatitis C antibodies and lookback data. We took the opportunity to raise awareness of the group, and membership has continued to grow.

Dr Amanda Chen spoke at the meeting and introduced herself as part of the hepatology special interest group of NZSG and that we plan to work in close partnership moving forward. We have created a hepatology nurses gmail account, nzhepng.chair@ gmail.com, as a point of contact going forward.

We funded our committee members membership to the Australasian Hepatology Association.

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Continued over page 13

Endoscopic Submucosal Dissection (ESD) Jonathan Realista & Gino Borromeo knife, hook knife, IT knife, or Triangle Tip Knife. Snares of various sizes in case it becomes a hybrid procedure. Distal Caps as per the endoscopist’s preference. ERBE™ for diathermy and other miscellaneous equipment (Waitemata DHB, 2022).

Te Whatu Ora - Waitemata Endoscopes have come a long way since the days of rigid scopes, to flexible scopes. From looking at an eyepiece, to looking at a screen. Evolving to having control wheels with real-time views of your GI tract. Gone are the days of a monitor the size of a microwave oven with RCA cables plugged at the back (yellow, red, and white jacks, ask your senior nurses). Say hello to high definition 4k screens utilising HDMI cables. Even a zoom feature with more than 100x magnification to boot. All these cool features to provide better, if not, the best images to date.

Truly amazing! Together with these wonderful innovations, also comes advancements in endoscopic practices. What used to be purely diagnostic procedures now has developed into interventional possibilities even to an extent in which surgery can be the second option, or even avoidable. An example of this is an Endoscopic Submucosal Dissection (ESD) ESD is a resection technique developed to remove larger lesions, lesions that won’t lift due to fibrosis. Lesions at risk, or of submucosal invasion. It aims to achieve higher rates of “en-bloc” resection (removal of an entirety of a lesion/tumour without violating its’ capsule) compared to an Endoscopic Mucosal Resection (EMR), thus allowing accurate pathology staging and avoid missing important histological features (Pimentel-Nunes et al, 2012).

The selection process for patients undergoing ESD is precise.

Usually they have had a previous endoscopy procedure for assessment and planning and a follow up procedure for the ESD. Another example is from an outcome of a multi-disciplinary team (MDT) meeting. ESD is a long and complex procedure depending on size and location of the lesion; but in an experts’ hand, the procedure may be shorter.

As soon as an appointment is confirmed with the booking clerks, an ESD information sheet is then sent to the patient. This enables them to have a better understanding about the procedure.

The patient will also know in advance if their procedure is to be done under general anaesthesia or sedation. Commonly, the proceduralist is in contact with the patient through clinic appointment or through telephone consult.

As per the Te Whatu Ora – Waitemata ESD policy, equipment that we need to perform an ESD (but not limited to) are: lifting solution, primarily gelofusine combined with methylene blue.

Spraying solution for better evaluation of the lesion like acetic acid or indigo carmine. ESD knives like the Olympus™ Dual

Set up: 1. Prepare the lifting solution: 1.1 Insert a 20G yellow needle into the port of the Gelofusine bag and then place a Smartsite connector onto the needle so that the mixture can be drawn up easily. Draw up 2 mL of Methylene blue 50mg/10mL using a luer lock syringe with a filter needle. Remove the filter needle and inject it into the Gelofusine 500 mL bag to create the mixture. Label the bag.

1.2 In a different 10 mL luer lock syringe, draw up 10mL of Adrenaline 1:10,000. Label the syringe.

1.3 Draw up 9 mL of the Gelofusine and Methylene blue mixture using a new 10 mL luer lock syringe. Then add 1 mL of the drawn up Adrenaline 1:10,000 (use a filter needle to push adrenaline into the luer lock syringe) to make up 10 mL of lifting solution. Label the syringe – GAM (Gelofusine, Adrenaline & Methylene blue) 1.4 Attach the GAM mixture 10 mL syringe into the sclerotherapy needle and prime.

2. Prepare the chromoendoscopy solution: 2.1 Draw up 20 mL of Acetic acid 3% in a 20mL luer lock syringe.

Label the syringe. (DO NOT DILUTE) 2.2 Draw up 5mL of Indigo Carmine 4mg/mL and add to 15 mL of sterile water which has been placed in a clean plastic container (to make a 0.1% solution). The total volume of the diluted Indigo Carmine solution will be 20 mL. Label the container.

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rest of the day. Not to sign any documents, avoid activities that requires coordination or balance. Basically, to have the rest of the day resting. We also recommend that they can resume their normal activities the following day.

Another part of our discharge instructions is, if they have unusual symptoms like fever, chills, chest pain, difficulty breathing, or any bleeding of more than 1 table spoon, to go straight to any A&E or ED or to contact their GP and bring their respective procedure report with them.

In 2022, Dr. Cameron Schauer with the help of his mentors and fellow gastroenterologists published the first reported ESD case in a New Zealand Centre with the aim to evaluate ESD outcomes in North Shore Hospital, Auckland. In 29 ESD procedures, two perforations were identified and sealed at the time of endoscopy, and no cases of delayed bleeding, perforation, or mortality was reported. The study concluded that based on the facts shown, it’s an achievement clinically.

Efficiency and safety were also being adhered. For future improvements, comparison, a much bigger study, and a longer clinical follow up to endorse outcomes are to be considered (Schauer et al, 2022).

Research and publicized studies of endoscopic procedures have been instrumental in further developing and guiding certain practices to be standardised, and in the development of evolving equipment to be efficient and cost-effective. It is through collaboration and discussion that these things are achieved.

Third space endoscopy like POEM, STER and especially ESD are all performed in North Shore Hospital and is minimally invasive compared to open surgery. It is safe to say that the ever-evolving endoscopy is the future for interventions.

REQUIREMENTS 1 2

Discuss scope and equipment preference with the doctor.

Lifting solution: Gelofusine 500 mL, Adrenaline 1:10,000 (10mL ampoule), Methylene blue 50mg/10mL

3

Spraying solution: Acetic acid 3%, Indigo Carmine 4mg/mL (5mL ampoule)

4

ESD knives: Dual knife KD655L, Hook knife KD620LR, IT knife2 KD611L, RX needle knife, TT knife

5 6

SNARES: Acusnare, hexagonal, braided, snaremaster FOR SPECIMEN • Formalin pot & cork tile (as per the size of the lesion) COLLECTION: • 25G needle – orange needle which is used for pinning out specimen • Ruler – Used for measuring the specimen • Floss • Patient labels and specimen book

7 8 9 10 11 12 13 14 15 16 17 18

Coag-grasper Haemostatic Forceps Sclerotherapy needles Biopsy forceps (normal and hot) Haemostatic clips (Resolution and Ultra), OTSC clip Distal attachment cap or the Fuji Film DH-286R Hood 10 mL luer lock syringes and drawing up (filter) needles Smartsite connector and 20G yellow needle Medication labels Rothnet & Polyp trap Electrosurgical unit (ERBE), additional water pump OFP-2 (optional) Sterile water & plastic containers ProVationMD and OBS application – for recording (ensure that it’s working before the start of the procedure)

Note: Not all equipment will be used but needs to be readily available.

3. Attach ERBE’s Omega Plate on the patient (ensure to check for any metal ware from the patient beforehand).

4. Set the electrosurgical unit’s (ERBE) settings according to doctor’s instructions. Otherwise, use the ESD settings on the ERBE machine 4.1 Marking of lesion BLUE pedal settings: soft coag, effect 4, watts 80 4.2 Dissection YELLOW pedal settings: Dry cut, effect 3, watts 30 BLUE pedal settings: Swift coag, effect 4, watts 30 There are a few important reminders that need to be taken into consideration when performing and assisting ESD. Firstly, always maintain the visibility of the lesion via the screen. Another will be to ensure clear and concise communication between the proceduralist and the nurse. Then, appropriate pinning of the specimen onto the cork tile so that pathologist can verify the specimen’s margin are unblemished of any cancer cells. However, here at North Shore Hospital, the last but not the least vital thing that we take into account is ensuring the video application for recording is working properly. Proceduralist needed this for reporting purposes.

These patients are usually monitored overnight in the ward before they are cleared for discharge. However, in instances whereby they are discharged on the same day after the procedure, we always advise the patient that they are not allowed to drive, that they must have a responsible adult with them at home for the

Reference: • The procedures of H-ESD. (A-E) The schemas show each step of the H-ESD... | Download Scientific Diagram (researchgate. net) • http://staffnet/QualityDocs/Quality%20Documentation/ S4%20Medicine%20and%20Health%20of%20Older%20 People/Gastroenterology/%5bP%5d%20Endoscopic%20 Submucosal%20Dissection%20(Adults)%20Feb22.pdf • Pimentel-Nunes P, Dinis-Ribeiro M, Ponchon T, Repici A, Vieth M, de Ceglie A, et al. Endoscopic submucosal dissection: European Society of Gastrointestinal Endoscopy (ESGE) Guideline [Internet]. Vol. 47, Endoscopy. Georg Thieme Verlag; 2015. p. 829–54.

• Schauer C, Pandey R, Minato Y, Muramoto T, Ohata K, Khan I. • Endoscopic submucosal dissection: the first reported experience from a New Zealand centre. www.nzma.org.nz/ journal; 2022 Feb 25. P. 150-161

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Spotlight on a team:

Te Matau a Maui Hawke’s Bay Gastroenterology Team

How many nurses and doctors work in your department?

The medical staff in the endoscopy unit includes three gastroenterologists and six surgeons who perform procedures regularly. Additionally, the unit receives support from locum endoscopists that assist with the patient lists and clinics when needed. The combination of permanent staff and locum support helps ensure a consistent level of service and care for patients.

The nursing team in the endoscopy unit comprises a Clinical Nurse Manager (CNM) responsible for overseeing operations, 18 staff nurses, one nurse specialising in Inflammatory Bowel Disease (IBD), one nurse focused on Percutaneous Endoscopic Gastrostomy (PEG) clinics, one infusion nurse, and one nurse dedicated to NBSP. Additionally, there are two nurses who work exclusively in the pre-admission clinic, ensuring that patients are well-prepared for their procedures, and one nurse working on quality improvement initiatives to enhance the unit’s overall performance and service delivery.

numerous changes within both the nursing and medical teams, reflecting the increasing demand for their services and the need for additional staff to accommodate the growing patient load.

The team members have demonstrated their ability to adapt and be flexible during the changes the unit has undergone. They have also established a social club, fostering camaraderie among staff.

Most team members actively participate in this club and attend semi-regular dinners, providing an opportunity for colleagues to interact in a more informal setting, promoting stronger relationships and camaraderie among team members.

In recent years, the endoscopy unit has experienced a positive and flourishing environment, as evident from the positive feedback received from locum endoscopists who have worked in the unit. They have observed a positive and pleasant atmosphere, often referred to as the “good vibe” of the unit. The team itself is diverse, comprising staff from various cultural backgrounds and countries, contributing to a rich and inclusive work environment.

How many procedure rooms do you have and what kinds of procedures do you do?

Do you have any work or quality improvement projects on the go at the moment?

The endoscopy unit is currently equipped with two procedure rooms, with plans to open a third room likely early next year.

The unit is active in various procedures, including conducting the Bowel Screening Program weekly. Other procedures performed in the unit include Endoscopic Retrograde Cholangiopancreatography (ERCP), oesophageal and colonic stentings, Percutaneous Endoscopic Gastrostomy (PEG) and Nasojejunal (NJ) tube insertions, administration of biologic infusions, and capsule endoscopy, liver clinic, among others.

The endoscopy unit underwent a recent audit as part of the National Bowel Screening Program (NBSP). The results of the audit were generally positive, indicating that the unit is performing well in certain areas. However, the audit also identified specific areas where improvements can be made, particularly related to documentation practices. These findings are essential for the unit to enhance its services and ensure compliance with best practices.

What’s special about your work team? Do you do any fun social events? Do you have any sports teams you do together? Do you have a multicultural team- where is everyone from?

The endoscopy unit conducts regular team meetings, during which all team members come together to discuss various issues and collaboratively work on solving problems. The primary goal of these meetings is to streamline the unit’s processes, making them more efficient and effective. The team’s dedication to improving their practices aims to ensure that patients receive the best possible experience during their procedures and throughout their care.

Do you have any challenges at the moment?

Over the past five years, the endoscopy unit has experienced significant growth, transitioning from a small procedure room to its own independent, stand-alone unit. This expansion has led to

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What are you proud of in your department? What do you love about working in gastroenterology?

One of the primary challenges faced by the endoscopy unit is the rotation of staff through all areas, particularly for procedures like Endoscopic Retrograde Cholangiopancreatography (ERCPs), which are less frequent, possibly occurring around once every two weeks (fortnightly). This infrequency of procedures can hinder staff members’ ability to gain repeated experience and maintain continuity in their skills. Additionally, the availability of staff to upskill in this area can be challenging. The unit also faces challenges related to waitlists and patient accessibility, which is a widespread issue experienced across the country.

Despite facing a few challenges, the endoscopy unit has demonstrated resilience and adaptability during difficult times.

For instance, during the COVID-19 pandemic, the unit had to vacate twice to make room for COVID patients and repurpose the endoscopy unit into a COVID Intensive Care Unit (ICU). Despite this, the team continued to conduct procedures in the theatre.

More recently, the unit also faced the impact of a cyclone, leading to the conversion of the endoscopy unit into a discharge lounge to ease the burden on the ward.

I love the difference that we make. In the grand scheme of things, endoscopy is a fast, non-invasive procedure that can provide life changing outcomes for our patients. I have a particular passion around screening and the removal of polyps at the pre-cancerous stage; when you look at the benefits of colonoscopy and early detection/prevention vs. late diagnosis and cancer treatment/ surgery it is incredible the difference that colonoscopy can make.

I believe it is a vitally important procedure for our community.

We receive a lot of positive feedback from patients for our team, often quoting pre procedure anxieties and how these were eased through the teams support, care, skill and knowledge. This makes me feel so proud of the service we provide.

Te Matau a Maui Hawke’s Bay - Gastroenterology team.

By David Prieto & Nerissa Kirkby Proof read by Maxine Hooker

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Fundamentals of Endoscope Reprocessing and Practical Skills Assessments – New Zealand Karen Kempin and Holly Weale GastroEnterology Nurses College Australia (GENCA) Fundamentals of Endoscope Reprocessing workshops with Practical Skills Assessments have been running around New Zealand for almost 10 years, with a break for COVID-19 restrictions in 2020-2021. The two Karen’s (Kempin and Clarke/Gower) have facilitated workshops in Auckland, Christchurch, Dunedin, Hamilton, Nelson Marlborough, Palmerston North, Rotorua and Wellington, with excellent support and participation of nurses, technicians, aides and managers from endoscopy units across the country.

The workshop program is a full day with eight sections dedicated to endoscopy, covering infection prevention and control, workplace health and safety, staff training, quality management, water quality, endoscope components, reprocessing activities and microbiological testing. Practical skills assessment can be added to registration for individuals who want a one on one assessment of their knowledge and understanding of reprocessing using the GENCA principles.

Holly and Karen have recently had the added complexity of a major update to the Fundamentals workshop content in line with the Infection Prevention and Control in Endoscopy update released in 2021. The Wellington workshop, held on 18 August, was the very first outing of the new content and slides and feedback from participants was positive. We have offered some suggestions for minor changes and look forward to presenting the final updated version in 2024.

For next year we are planning to run the usual workshops in Christchurch, Auckland and Wellington. However, there is always an opportunity to deliver in other areas if sufficient numbers of participants are registered. GENCA will take requests for Fundamentals workshops in any area as long as 10-12 registrations are received. If you would like to have a workshop closer to home and think you have the numbers in your region, send an email request to admin@genca.com and we will see what we can organise.

Karen and Holly can be reached for specific inquires about workshops via GENCA through the above email. We look forward to seeing some of you in 2024.

2023 has heralded some changes in the program with the retirement of Karen Gower and Holly stepping in to the facilitator role. We would like to take this opportunity to thank Karen for contributing her amazing knowledge and experience into the Fundamentals program and let her know that we are still using some of her stories to make a point about potential problems when reprocessing our complex equipment. Holly has picked up the program in the last year by observing and then presenting with back up and feedback by both Karen’s. In 2024 she will undertake a “Train the Trainer” workshop provided by GENCA to formalise her role as an education provider.

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AutoCap™ RX Integrated Biopsy Cap and Guidewire Locking Device

The AutoCap RX system builds on the strong track record of Boston Scientific’s RX Biliary System. The RX system is intended to allow for physician access and control during biliary interventions.

The AutoCap RX is intended to facilitate physician controlled placement of a guidewire and device exchanges during ERCP procedures. It is designed to provide an attachment to the scope, minimize leakage of biomaterial, and maintain insufflation.

The AutoCap RX is designed to offer the following benefits:

1

2

3

4

One-Snap scope

Integrated guidewire lock

Maximize Sealing

Supplied in a sterile

Attachment with tactile

designed for 0.025 in. an

& Passability capabilities

sealed pouch with No

feedback verification

0.035 in. Guidewires

Preparation Required

ENDO- 1022901-AC

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Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) The new nomenclature for liver disease Jessica Southall, Hepatology Nurse Gastroenterology Day Unit, Waitaha, Canterbury Jessica.southall@cdhb.health.nz

Steatotic liver disease (SLD) has been introduced as a comprehensive nomenclature to encompass the diverse aetiologies underlying hepatic steatosis (American Association for the Study of Liver Disease [AASLD], 2023). Hepatic steatosis is a pathological condition characterized by the accumulation of excessive fat within hepatocytes, the liver’s functional cells.

This condition occurs when there is an imbalance between the deposition and removal of fat in the liver, leading to an increased build-up of fat in the liver tissue (Rinella et al., 2023).

Over many years the field of hepatology has encountered challenges in establishing a suitable nomenclature for this condition. In the absence of more fitting alternatives, the term non-alcoholic fatty liver disease (NAFLD) was embraced, primarily because it aptly denoted the accumulation of fat within the liver while distinguishing it from another prevalent aetiological factor, excessive alcohol consumption (Rinella et al., 2023).

The continued use of the term NAFLD has been primarily driven by the absence of consensus regarding a substantially improved nomenclature and by existing gaps in our understanding of its underlying pathophysiology. However extensive populationbased studies unequivocally establish that, the overwhelming majority of conditions presently categorised as NAFLD are intricately linked to what are commonly referred to as metabolic factors.

These factors encompass excessive body weight, visceral adiposity, hypertension, insulin resistance, and dyslipidaemia (Rinella et al., 2023). While NAFLD effectively describes the accumulation of fat in the liver, it possesses certain limitations.

Firstly, it fails to elucidate the underlying cause of this condition; instead, it predominantly defines what does not contribute to the condition, thus inadequately representing the aforementioned entity (AASLD, 2023).

In response to these concerns, an alternative proposal was introduced in 2019, transitioning for a brief time to metabolic associated fatty liver disease (MAFLD). The nomenclature necessitated the presence of hepatic steatosis alongside specified metabolic criteria, however many patients perceived the term “fatty” as stigmatizing, which consequently obstructs disease awareness and discourages patients from actively seeking health care services (AASLD, 2023). MAFLD also failed to consider the clinical scenario in which patients frequently present with both metabolic and alcohol-related factors contributing to hepatic fat accumulation.

A collaborative effort was initiated in 2020, involving prominent multinational liver societies such as the American Association for the Study of Liver Diseases (AASLD), European Association for the Study of the Liver (EASL), Asian Pacific Association for the Study of the Liver (APASL) to name a few, endocrinologists, paediatricians and patient advocacy groups to review definitions and terminology options. To initiate a systematic effort aimed at achieving consensus on an enhanced nomenclature, the widely recognised Delphi methodology was employed. The journey now resides with Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) signifying an evolution towards a more inclusive and precise terminology (AASLD, 2023).

Steatotic liver disease is diagnosed histologically or by imaging and has many potential aetiologies (AASLD, 2023). Subclassification is determined by the steatotic aetiology and includes Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD), MASLD and increased alcohol intake (MetALD), alcohol associated, specific or cryptogenic. MASLD is defined by the presence of hepatic steatosis in conjunction with a minimum of one among five established cardiometabolic risk factors (CMRF) and no other potentiating cause (AASLD, 2023).

This refined categorization acknowledges the intricate interplay between metabolic dysfunction and hepatic steatosis, elucidating the underlying mechanisms of the disease’s manifestation. In instances where additional precipitating factors for steatosis are identified, then this is consistent with a combination aetiology.

In the case of high alcohol consumption, a distinct classification termed MetALD (pronounced Met A-L-D) has been introduced.

MetALD encapsulates individuals with MASLD who exhibit elevated weekly alcohol intake levels, set at 140g/week for females and 210g/week for males. Whereas in the absence of cardiometabolic criteria, other aetiologies must be excluded (AASLD, 2023).

If no aetiology can be identified this is termed cryptogenic SLD, although periodic reassessment of CMRF would be appropriate.

The previous term: non-alcoholic steatohepatitis (NASH) has been replaced with Metabolic Dysfunction Associated Steatohepatitis (MASH) (AASLD, 2023). This change underscores the pivotal role of metabolic dysfunction in precipitating the inflammatory component within hepatic steatosis. By emphasizing the metabolic underpinnings, the MASH terminology aligns with the contemporary understanding of the condition’s pathogenesis (Rinella et al., 2023).

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(AASLD, 2023)

The introduction of distinct categories such as MetALD and MASH further refines the classification landscape, offering a more nuanced understanding of the disease spectrum and the inclusion of cryptogenic SLD acknowledges the presence of cases that may necessitate further investigation to elucidate underlying causative factors.

• Rinella, M. E., Lazarus, J. V., Francque, S. M., Sanyal, A. J., Kanwal, F.,… Younossi, Z. (2023). A multi-society Delphi consensus statement on new fatty liver disease nomenclature.

Hepatology. Advance online publication. https://doi. org/10.1097/HEP.0000000000000520 If you’re working with patients with liver disease we would love to have you join our hepatology nurses’ group: Contact us via email: nzhepng.chair@gmail.com

References • American Association for the Study of Liver Diseases, Latin American Association for the Study of the Liver, European Association for the Study of the Liver (2023). A call for unity: The path towards a more precise and patient-centric nomenclature for NAFLD. Hepatology (Baltimore, Md.), 78(1), 3–5. https://doi.org/10.1097/HEP.0000000000000412

Continued on next page.

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Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) Cont.

(AASLD, 2023) 22

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Auckland Regional Endoscopy Nurses Study Day 2023: A Day of Learning, Networking, and Fun Kate Grigg, Gino Borromeo & Jonathan Realista

The Auckland Regional Endoscopy Nurses Study Day unfolded the 26th of August 2023. It rekindled a sense of camaraderie and professional growth that had been absent for over four years.

The event, marked by a diverse lineup of speakers, interactive sessions, and engaging activities, left attendees invigorated and informed, and for some, a gentle reminder of the current practice of endoscopy.

Then, Jonathan Realista, the associate clinical charge nurse of NSH Endoscopy, took the stage next to delve into Endoscopic Mucosal Resection Methods. His presentation provided a comprehensive insight into these crucial techniques, fostering a deeper understanding among the attendees.

The integration of Artificial Intelligence (AI) in endoscopy was explored by Dr Ali Jafer, who is very passionate about the topic, revealing how advancements in AI are revolutionizing diagnostic practices. This area of endoscopy is something not to be missed considering that we are in the digital age.

Subsequently, Gino Borromeo’s capsule endoscopy case studies shed light on the practical applications of this innovative approach, showcasing real-world scenarios and outcomes.

Dr Reena Ramsaroop’s discourse on Histology and Cytology in Endoscopy underscored the pivotal role of these aspects in accurate diagnosis and patient care. Simple things like writing the indication and patient’s symptoms are vital aspects that are often overlooked. Moreover, the take home message being the importance of completing specimen forms with the proper details in a legible manner.

Beyond the talks, the event featured a dynamic skills station where leading medical companies, including Boston Scientific, Obex Medical, Olympus, and Bioserve, showcased their endoscopy

There were attendees from the 3 regional Te Whatu Ora hospitals, namely Waitemata, Counties Manukau, and Auckland. In addition, there were also attendees from the private institutions like Endoscopy Auckland, Mercy Ascot, Waitemata Endoscopy, Shore Surgery, MacMurray Centre, and Rodney Surgical Centre.

The meeting commenced with an expert talk by Dr Marius Van Rijnsoever, who offered an Introduction to Endoscopic Ultrasound (EUS) and Luminal Apposing Metal Stents (LAMS). Attendees were introduced to cutting-edge techniques and technologies that are shaping the future of endoscopy, thereby, reducing the need for surgeries.

equipment and innovative technologies. Attendees had the opportunity for hands-on interactions with these equipments.

The affair was further enhanced by the generous sponsorship from these companies, highlighting the vital collaboration between healthcare professionals and industry leaders.

The day reached its climax with a spirited Kahoot session, which saw participants engaging in a friendly competition. With only one victor emerging from the intense battle, the coveted novelty trophy was awarded, serving as a reminder of the event’s lively showdown.

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Fun and education intertwined through the event, leaving attendees with a sense of fulfillment and enrichment. “The mixture of different things throughout the day easily kept us all interested and so much to learn for all,” remarked one participant.

The success of the event was evident in the record-breaking attendance of 90 registered nurses. The overwhelming response highlighted the strong desire of endoscopy nurses for continued learning and professional development in the field.

This day needed to be affordable, easy to attend, and unlike conference, open to all the endoscopy nurses. The decision was made to run the study day on a weekend when the Endoscopy units are closed thus freeing up nurses to attend, offering greater convenience to the participants. Also, a full day was needed to allow in-depth discussions, networking, and a more immersive experience.

On the other hand and behind the event’s accomplishment, the inspiration to organise a full day study day came about because Kate Grigg, Charge Nurse Manager of the two Te Whatu Ora Waitemata endoscopy units, recognised that there is very little endoscopy specific education available. With no educator exclusively for endoscopy in Waitemata Kate brainstormed the subject ideas with the 2 ACCN’s for Waitemata Endoscopy units – Jonathan Realista and Kim Parsons.

However, recognising that this would be better to be planned with support Kate drew on the enthusiasm of Gino Borromeo who ultimately was the fantastic MC of the day too.

In conclusion, the Auckland Regional Endoscopy Nurses study day was a fun sharing of knowledge, camaraderie, and innovation.

From the captivating presentations to the interactive skills station and the spirited Kahoot session. We are hoping to build from this event and look forward to more possible regional study days in the future.

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Gastroenterology Nurse Leaders Day Friday, 8 September 2023, Wellington, NZ What another awesome day with the gastroenterology leaders!

In September the NZgNC gastroenterology nurse leaders day took place at a splendid venue right on the water front. Lots of opportunity for catching up while stretching our legs on a beautiful sunny Wellington day. The group of leaders were, as always, engaged and generous with their sharing of knowledge and information. It is always a great networking day and one the committee look forward to every year.

We thought last year would be hard to beat after the motivational Sarah Linton spoke, but pulled it out of the bag with some more outstanding speakers this year talking on a range of topics. Nikki Baird spoke about her Masters study on barriers and enablers to leadership and talked about the importance of a supportive, positive, and trusting leadership to promote good clinical decision making in our staff. Dr Rhys John spoke about sustainability and green endoscopy – what can we do? Dr Johns talk inspired some conversation, and we are hoping birthday girl Daryl McGann will lead us going forward to fight climate change as a sustainability working group.

We were grateful to hear from Kerri Nuku and she spent some time hearing our stories which we hope she will take back to the NZNO. But, the most positive feedback we received was about Sir Ashley Bloomfield. He talked about leadership being about action - not telling people what to do, and that he always tried to lead with four values; kindness, courage, integrity and humility. What a very humble gentleman, especially letting everyone have a selfie!

One of his take home messages was that ‘people won’t remember what you said or what you did, but how you made them feel’. All of the speakers bought knowledge to share from their own areas of expertise and we appreciated their time and commitment to the leaders.

The table top discussions provided opportunities for all the attendees to share their experiences, goals and fears related

to the field of gastroenterology nursing. This day once again allowed the gastroenterology leaders from around New Zealand to come together and connect to each other so that we all feel supported and motivated in facing the everyday challenges in our own districts. The NZgNC committee would like to thank all who came and are already looking forward to seeing you next year.

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Distributed in New Zealand by: Obex Medical Ltd 109 Carlton Gore Rd, Newmarket, Auckland 1023 T: 09 630 3456 │ Free Phone: 0800 656 239 │E: info@obex.co.nz │ www.obex.co.nz

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Percutaneous Endoscopic Gastrostomy (PEG) Ways to Insert Them and Why Hannah Dunstan (BN, PGDipHealSc) Clinical Nurse Specialist: Enteral Nutrition Te Whatu Ora, Waitaha Canterbury Hannah.dunstan@cdhb.health.nz 0278760796

Contraindications

PEGs provide direct access to the stomach for nutrition for patients who cannot consume enough food and fluid orally (Dietrich & Schoppmeyer, 2020). These types of tubes are inserted endoscopically and are the most common insertion methods (Dietrich & Schoppmeyer, 2020). Percutaneous gastrostomy tubes can also be inserted radiologically or surgically when endoscopic method is not feasible (Dietrich & Schoppmeyer, 2020).

Appropriate patient selection is paramount to good patient outcomes. There is consensus in the research that PEGs are not appropriate for providing nutrition for those with advanced dementia (Bischoff et al., 2022). PEG should not be inserted in anyone who is in the end stages of their terminal illness, and this is defined in the literature as life expectancy of less than one month (Bischoff et al., 2022). Clinicians should consider the individual’s risk factors for sedation related complications. In some cases, anaesthetic support may be required.

Absolute contraindications include: • Coagulation disorders (INR >1.5, PTT> 50s, Platelet count <50000 mm3 ) • Peritonitis • Peritoneal carcinomatosis • Previous total gastrectomy • Lack of safe tract to stomach (interposed organs or overlying surgical mesh) • Gastric varices • Sepsis • Gastric outlet obstruction • Inability for patient or caregiver to comply with required care • Obstructive head and neck tumours Relative contraindications include: • Moderate to large volume ascites • Morbid obesity • Poor respiratory function (FVC <50% predicted) • Hemodynamic instability • Gastric outlet obstruction • Abdominal scarring • Large intrathoracic hiatus hernia • Recent gastric ulcer with high chance of re-bleed (ACI, 2014)

Indications PEGs are considered for people who will need long term enteral nutrition and international guidelines recommend this for people whose oral intake is likely to be impaired for longer than 30 days (Bischoff et al., 2022). Patients need to be assessed on a case-by-case basis and with multidisciplinary team discussion (Agnew & Tham, 2022). PEGs should only be recommended if long term enteral feeding will improve the patient’s quality of life or improve their clinical outcome (Agnew & Tham, 2022).

Patients with progressive, incurable disease should be counselled about advanced care planning and should be given the choice to withdraw enteral nutrition at any time (Agnew & Tham, 2022).

Common indications for PEGs are: Obstruction of the upper GI tract

• Strictures • Malignancy • Trauma • Surgical anastomosis

Neurological dysphagia

• Stroke • Motor neuron disease • Parkinson’s disease • Huntington’s disease • Multiple sclerosis • Guillain-Barre syndrome

Malignancy

• Head and neck cancer (placed prophylactically prior to chemo-radiation) • Ovarian cancer (placed for decompression only to relieve symptoms of malignant small bowel obstruction)

Growth faltering

• Birth defects • Genetic disorders • Cerebral palsy

Increased metabolic requirements

• Chronic obstructive pulmonary disease • Cystic fibrosis • Inflammatory bowel disease • HIV/AIDS • Ventilated patients in ICU >30 days

Disorders of the gastrointestinal tract

• Oesophageal atresia • Achalasia • Oesophageal dysmotility • Eosinophilic oesophagitis • Short bowel syndrome

Patient preparation Informed consent must be obtained prior to the procedure. The patient should be counselled about what the tube will look like, how it will function and what care is needed to maintain and use the tube at home (ACI, 2014). The risks of the procedure also need to be discussed such as peritonitis (2%), perforation (2%), bleeding (2%) and aspiration (1%) (Shangab & Shaikh, 2019).

For some people their conditions may have affect their cognition and they may not have capacity to give consent for the procedure.

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In these circumstances the person’s enduring power of attorney or medical team may consent on their behalf if a PEG is in the person’s best interests (ACI, 2014). This needs careful ethical consideration and the person’s quality of life must be the focus when making decisions (ACI, 2014).

Blood tests to assess coagulation and platelet count is important to assess the risk of bleeding (Shangab & Shaikh, 2019). Patients who are taking anti-coagulant or antiplatelet medication will need to be given advice about when to stop taking this prior to PEG insertion and this advice should be based on local haemostasis guidelines (Shangab & Shaikh, 2019).

Patients will need to be nil by mouth or cease nasogastric feeding six hours prior to the procedure so that no stomach contents remain at the time of the procedure This is imperative to reduce aspiration and peritonitis (Shangab & Shaikh, 2019).

It is important to assess the patient’s allergies to ensure they can have prophylactic IV antibiotics. These are usually administered 30 minutes prior to the procedure. Different centres use different drugs but cephalosporins or penicillin have been shown to the most effective in reducing peristomal infections (Mandal et al., 2019).

This method was established in 1983 and is similar to the process followed when inserting a radiologically inserted gastrostomy (RIG). A balloon gastrostomy tube is used for this method of insertion which has been shown to have a higher rate of accidental dislodgment long term. These tubes also have reduced longevity and need to be replaced every three to six months (Bischoff et al., 2022). (Brayford, 2023)

PEG PLACEMENT – “PULL TECHNIQUE”

Tube types

A. L ocation of the puncture site via transillumination; B. A voidance of bowel interposition confirmed by the absence of bubbles at aspiration: C. Introduction of the trocar; D. Introduction of the guidewire; E. G rasping the guidewire with an endoscopic snare; F. Final result

The “pull” method is utilised for majority of cases and this technique was first utilised in 1980 (Li et al., 2022). These tubes are anchored in the stomach with a solid bolster so are very robust, making them less likely to accidentally dislodge (Li et al., 2022).

They have long dwell times of up to 18 months before replacement is needed with some guidelines suggesting they do not need to be routinely replaced unless defective (Bischoff et al., 2022).

This method can result in tumour seeding if inserted in people with head or neck cancers due to the tube being dragged over the malignant cells during insertion (Bilal et al., 2023). The prevalence of this is unknown but estimated to be between 1-9% (Bilal et al., 2023). Some centres will accept this risk and consent the patient accordingly, others have opted to utilise over tubes or use alternative methods of tube insertion (Bilal et al., 2023).

(Brayford, 2023) The “push” method of insertion is not well established in endoscopy in New Zealand but has been shown to reduce the rate of tumour seeding in people with head and neck cancers (Bilal et al., 2023). Because gastropexy sutures are deployed to approximate the stomach to the abdominal wall it is also thought to be a safer method for people with ascites or poor wound healing as it improves the likelihood of tract formation (Bischoff et al., 2022).

Pictures and text from Fugazza et al., 2022 The “push” method of insertion is not well established in endoscopy in New Zealand but has been shown to reduce the rate of tumour seeding in people with head and neck cancers (Bilal et al., 2023). Because gastropexy sutures are deployed to approximate the stomach to the abdominal wall it is also thought to be a safer method for people with ascites or poor wound healing as it improves the likelihood of tract formation (Bischoff et al., 2022).

This method was established in 1983 and is similar to the process followed when inserting a radiologically inserted gastrostomy (RIG). A balloon gastrostomy tube is used for this method of insertion which has been shown to have a higher rate of accidental dislodgment long term. These tubes also have reduced longevity and need to be replaced every three to six months (Bischoff et al., 2022).

29

“PUSH” GASTROPEXY TECHNIQUE (CONTINUED)

TRACT DILATION

• D ilutors are introduced over the guidewire • Dilate to allow a 14f balloon gastrostomy tube to be introduced • Peel away sheath is removed after balloon inflation (Brayford, 2023)

Post procedure cares and monitoring There is a differing opinion among centres about whether PEGs should take place as a day stay procedure or as an overnight admission. A short inpatient stay should be planned for those who are likely to experience refeeding syndrome or are high risk of complications due to co-morbidities and frailty (Bischoff et al., 2022). An overnight stay is also recommended for those who are likely to need higher levels analgesia due to pre-existing chronic pain syndromes (Bischoff et al., 2022). Having the patient stay overnight also allows them to rest and recover while procedural sedation effects wear off without having the added stress and anxiety of managing their tube home without appropriate education (Bischoff et al., 2022). Registered nurses should provide education about tube care and troubleshooting prior to discharge and ensure the patient feels confident managing their tube (Bischoff et al., 2022).

• T he stomach is fastened to the abdominal wall with 3 T fastener sutures under endoscopic guidance (gastropexy procedure) • The gastrostomy site is within the T fastener triangle • A small horizontal incisio is made so a trocar and guidewire can be inserted.

(Brayford, 2023)

(Brayford, 2023) 30

Long term complications

• Dietrich, C. G., & Schoppmeyer, K. (2020). Percutaneous endoscopic gastrostomy – Too often? Too late? Who are the right patients for gastrostomy? World Journal of Gastroenterology, 26(20), 2464–2471. https://doi. org/10.3748/wjg.v26.i20.2464

Buried bumper syndrome occurs when the internal bumper erodes through the gastric wall and becomes imbedded (CarterStevens, 2021). This is due to excess tension on the tube from the external flange being too tight or excessive use of dressings under the flange (Carter-Stevens, 2021). To prevent this the happening, the patient should be given education about rotating the tube 360 degrees and slight in and out movement daily (Carter-Stevens, 2021). Some guidelines suggest this can be done from day one post procedure (ACI, 2014); others suggest waiting seven to ten days until the incision has healed (Bischoff et al., 2022).

Accidental tube dislodgement can occur at anytime after insertion. This occurs more so with balloon gastrostomy tubes due to the internal balloon rupturing or loosing volume (Bischoff et al., 2022). It is imperative to educate the patient about early signs of migration such as pain, change in skin depth measurement, leakage of gastric contents or inability to mobilise tube in the tract (Bischoff et al., 2022).

If the tube dislodges in the first four weeks, the person is at risk of peritonitis due to leakage of gastric contents into the abdominal cavity (ACI, 2014). This happens because the tract has not had sufficient time to form and mature (ACI, 2014). After four weeks the risk of peritonitis is reduced greatly however, timely reinsertion is imperative as the stoma tract will start to close after one to two hours (Bischoff et al., 2022).

• Li, X., Wang, J. X., Wang, Y. P., Shen, J. X., Zheng, Y. X., Zhang, P. H., Wei, J. J., & Zhuang, Z. H. (2022). Comparison of pull and introducer techniques for percutaneous endoscopic gastrostomy. Journal of Multidisciplinary Healthcare, 15, 733741. doi: 10.2147/JMDH.S356865 • Mandal, A., Kesar, V., Gonzalez, Z., Roy, N. P., Kanth, R., & Roy, P. K. (2019). Prophylactic antibiotics for PEG tube placement: An updated meta-analysis of randomized controlled trials.

The American Journal of Gastroenterology, 114(Supplement), S326. doi: 10.14309/01.ajg.0000591792.48999.48 • Ponsky, J. L. (2021). Percutaneous endoscopic gastrostomy: after 40 years. Clinical Endoscopy, 93(5), 1086-1087. https:// doi.org/10.1016/j.gie.2020.09.036 • Shangab, M. O. M., & Shaikh, N. A. (2019). Prediction of risk of adverse events related to percutaneous endoscopic gastrostomy: a retrospective study. Annals of Gastroenterology, 32(5), 469-475. doi: 10.20524/aog.2019.0409

References • Agency for Clinical Innovation [ACI] (2014). A Clinician’s Guide: Caring for People with Gastrostomy Tubes and Devices. https://www.genca.org/public/5/files/ACI_Gastrostomy_ Guide.pdf • Agnew, P., & Tham, T. C. K. (2022). Reduction in mortality after percutaneous endoscopic gastrostomy tube insertion is likely due to careful patient selection. Gastrointestinal Endoscopy, 96(6), 955. https://doi.org/10.1016/j.gie.2022.08.028 • Bilal, S., Saeed, S., Amjad, S., Javed, N., Jahangir, Z., Salman, U., Siddique, M. Z., Mehmood, S., & Yusuf, M. A. (2023). Risk of tumor seeding in percutaneous endoscopic gastrostomy (PEG) in aerodigestive tumors: A single centre experience [Abstract]. Endoscopy, 55(S 02), S137-S138. doi: 10.1055/s-00431765336 • Bischoff, S. C., Austin, P., Boeykens, K., Chourdakis, M., Cuerda, C., Jonkers-Schuitema, C., Lichota, M., Nyulasi, I., Schneider, S. M., Stanga, Z., & Pironi, L. (2022). ESPEN practical guideline: Home enteral nutrition. Clinical Nutrition. (41) ,468-488. https://doi.org/10.1016/j.clnu.2021.10.018 • Brayford, P. (2023, May). Percutaneous Endoscopic Gastrostomy (PEG) tube insertion: Push or Pull and Why? [conference presentation]. GENCA National Conference, Perth, Western Australia.

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Inflammatory Bowel Disease Sub Specialty Group Report of the NZ IBD Nurses Committee as Sub-Committee to NZgNC Committee: Marian O’Connor (Chair), Kirsten Arnold (Co-chair), Nideen Visesio (Education lead), Donna Howe (Secretary) Report Date: September 2023 Prepared By: Marian O’Connor Reporting Period: Apr 2023 – Sept 2023

EDUCATION: IBD Nurses Meeting

• IBDNA has just ran their Advanced IBD Nurse School in Brisbane (Sept 2023) – report likely to follow as part of the next GENCA journal • Marian continues as a board director of GENCA and encourage you to avail of the reduced membership for kiwi’s which provides access to online education and the national conference (planned for Brisbane in May 2024).

• The NZ IBD Nurses meeting took place on Thursday the 24th of August 2023 at the Novotel Taunia Hamilton with 25 nurses attending • The agenda for the meeting was developed on the feedback from the 2022 meeting and provided presentations on the new biologic’s medications (Ustekinumab & Vedolizumab), transition, psychological services, nutrition, and the acute clinic at Christchurch hospital. There were also case studies on pregnancy and transition and a presentation on the lived experience from David Snell whom talking candidly about his experience of Crohn’s disease and mental health • The feedback from the study day is currently being analyses and this will be shared directly with the committee and NZgNC for future education day planning • The committee are very grateful to NZgNC and Pharmaco for educations grants which allows us to financially support this event • A presentation was made at the end of the meeting to our committee members who has recently stepped down. Jacqui Stone (outgoing chair) & Carly Bramley (outgoing education lead) were both presented with a letter of appreciation from Merrilee Williams (Chair of NZgNC) and a small gift to acknowledge their work for NZIBDNG. Karen Murdoch (outgoing secretary) was not present at this meeting and therefore her gift and letter was posted directly to her • The committee are working on our 2024 NZIBD Nurses Education Day and will email the membership (and publish it in the here in the TUBE) soon with a save the date.

CALL TO ACTION • To re-cap the call to action was published (May 2022 - TUBE) and then resulted in a joint letter between NZSG, NZgNC and NZIBDNG which was sent to Te Whatu Ora (Nov 2022) highlighting the issues with low numbers of IBD Nurse nationally • Since my last update here (April 2023), we have not achieved much further progress with this issue • As a committee we discussed this openly with nurses present our Education Day in August and have now set-up a Focus Group so that we can lead on this issue as a group nationally • We have had previous support from NZSG and more recently also from CCNZ and we are keen to collaborate with them both and other interested stakeholders to attempt to address this issue.

NZSG IBD MEDICATION WORKING GROUP We have approached NZSG and asked to have nursing representation on their medication working group which they have agreed to. Kirsten Arnold has agreed to be our representative and will feedback on this report in due course.

COMMITTEE

GENCA & IBDNA

The NZIBDNG committee continues to meet every 4-6 weeks virtually (via zoom), on your behalf and welcome contact from any new IBD nurse with any issues that you think need addressing.

• Carly Bramley is departing the shores soon for Australia and has recently been elected as the chair of IBDNA, so the connection with IBDNA will remain albeit Carly is no longer part of our committee

32

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33

CHEMISTRY

Helpline Activity in a High-Volume Inflammatory Bowel Disease Centre Michelle Harkess RN, MCN Clinical Nurse Specialist, Inflammatory Bowel Disease P: 0277 181810 Michelle.Harkess@cdhb.health.nz No conflicts of interest to disclose

Background

(5.4%), blood forms or results 81 (10%), special authority 35 (4.2%) and other 204 (24.4%), with medical input required in 142 (17%) cases. Details are shown in graph 3. In addition to the helpline, the IBD nursing team also provided service to 160 patients in nurse led clinics and the inpatient setting during the study period.

Inflammatory bowel disease (IBD) refers to Crohn’s disease (CD) and ulcerative colitis (UC) that are chronic complex lifelong conditions (Fiorino, 2019). IBD programs provide helpline services to support patients manage their disease. Helplines are maintained by IBD nursing teams and provide patients with timely access to specialist medical and surgical care and prevent hospital admissions (Fiorino, 2019). IBD Helplines run by nurses are safe and cost effective and can reduce outpatient visits (Kemp et al., 2018). While it is considered standard of care to provide this service, it is important to monitor the volume of activity for continued service delivery. The purpose of this study was to identify the helpline activity at a high-volume adult IBD centre.

The IBD centre at Waitaha Canterbury has a population of around 3500 IBD patients, based on numbers already enrolled in Crohn’s Colitis Care (CCCare). This is a cloud-based management system used at Waitaha Canterbury to document all IBD management and helpline activity including patient discussion, advice provided with test/investigations and acute clinic bookings. We also use a helpline patient contact sheet for follow up and audit purposes.

This captures patient details, type of contact, reason for contact, diagnosis and allocated gastroenterologist.

Patients have access to the helpline from Monday to Friday between 8am – 4pm with a response time within 12-24hrs.

Patients can contact the helpline via email and phone for a variety of reasons. However, the primary purpose of the helpline is to capture unwell patients that require prompt review in the acute clinic. And secondly, to provide access for general IBD advice and access to the allied health team.

Discussion International guidelines recommend that IBD patients should have access to a helpline as standard of care (Australian Standards, 2016; Fiorino, 2019). However, it can be challenging to provide this service with IBD nurse shortages across New Zealand (NZ).

A national audit by Hackett and colleagues (2020) described NZ IBD nurse roles and the challenges for outpatient service delivery.

While the audit found that NZ IBD nurses provide high quality care, the rostered hours (0.6-0.8FTE) were insufficient to complete IBD specific tasks i.e. nurse led clinics and telephone/email advice lines.

This was further supported by the Inflammatory bowel disease nurses; New Zealand and Australian Survey led by O’Connor et al.

(2021) that found most IBD nurses worked in part time positions (0.4-0.8 FTE) and were also covering other specialities including hepatology, endoscopy and general gastroenterology.

The survey by O’Connor et al. (2021) also revealed severe IBD nurse shortages and this led to a “Call to Action” by the New Zealand IBD Nursing Group (NZIBDNG). The Call to Action quotes the UK model as 1.0 FTE IBD nursing positions per 600 patients.

Therefore, if the IBD service applied this model it would require a minimum of 3.0 FTE nursing positions to manage the local patient population. Waitaha Canterbury has a funded position 0.8 CNS FTE, that is well below the international standards. The IBD centre received funding for a specialty clinical nurse (SCN) for a trial period in 2022 that significantly improved patient care by optimising helpline response times and nurse led clinics.

Unfortunately, the trial period has now finished.

Interestingly, the IBD centre had increasing helpline activity throughout 2022 with a total number of helpline contacts of 1816 which was 983 helpline contacts for the second half of the year from August 2022 to December 2022. Additionally, the number of patients seen in nurse led clinics in this time frame was 230 for a total of 390 patients in 2022. The nursing service continue to provide monthly prospective helpline and nurse led clinic audit and reporting for service planning, with a Te Whatu Ora business case under review at the time of writing.

Methods

Monthly data was captured prospectively for all patient contact between January to July 2022. The number of calls, text messages and emails were collated in a spreadsheet from contacts sheets to provide a monthly report for IBD nursing occasions of service.

In addition, a retrospective review was completed to identify reasons why patients accessed the helpline for advice.

Results From January 2022 to July 2022, the IBD helpline received 833 patient contacts. Details are shown in graph 1. Methods of contact were 562 telephone calls or text message and 261 emails including 10 contacts regarding adolescent patients under 17 years of age. Details are shown in graph 2. Reasons for contact were flare and illness advice 224 (26.8%), medication advice 106 (12.7%), prescriptions 68 (8%), covid advice 70 (8.4%), infusions 45

Conclusion IBD helplines are an integral and essential part of an IBD service.

This is the first study to identify helpline activity from this high-

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GRAPH 3.

GRAPH 1.

GRAPH 2.

volume centre and reinforces the importance of providing helpline access as standard of care. The helpline accounts for approximately 60% of the nursing role. Therefore, it’s critical that regular audit and review is undertaken for service planning to optimise IBD nursing FTE. Thereby, ensuring patients continue to have rapid and direct access to the IBD centre.

National Audit of Outpatient Inflammatory Bowel Disease Standards of Care. Clinical and Experimental Gastroenterology.

13, 285-292.

• IBD Australian Standards 2016 Crohn’s and Colitis Australia Australian Government Department of Health • Karen Kemp, Lesley Dibley, Usha Chauhan, Kay Greveson, Susanna Jaghult, Katherine Ashton, Stephanie Buckton, Julie Dubncan, Petre Hartmann, Nienke Ipenburg, Liesbeth Moortgat, Rosaline Theeuwen, Marthe Verwey, Lisa Younge, Andreas Stum, Palle Bager. Second N-ECCO Consensus Statement on the European Nursing Roles in Caring for Patients with Crohn’s Disease or Ulcerative Colitis. (2018).

Journal of Crohn’s and Colitis, 760–776

References • Call to Action published on NZIBDNG subgroup of NZNO Gastroenterology Nurses’ College website • Gionata Fiorino., Mariangela Allocca., Maria Chaparro., Sofie Coenen., Catarina Fidalgo., Lisa Younge., Javier P. Gisbert.

(2019). ‘Quality of Care’ Standards in Inflammatory Bowel Disease: A Systematic Review. Journal of Crohn’s and Colitis: 127–137.

• O’Connor, M., White, L., Stone, J., and Murdoch, K. Inflammatory Bowel Disease Nurses; New Zealand and Australian Survey 2020. Journal GENCA 2021: 30(7), 30-14.

• Robert Hackett., Richard Gearry., Christine Ho., Andrew McCrombie., Megan Mackay., Karen Murchoch., Kirsten Rosser., Nideen Visesio., Stephen Inns. (2020). New Zealand

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NZNOCSTN CONFERENCE 2023

“INNOVATION” Please join us at our 2024 conference:

WHERE:

Ellerslie Racecourse, Auckland

WHEN:

February 29 and March 1 , 2024

th

st

KEY NOTE SPEAKER: Dave Letele - AKA Butter Bean COST:

– remarkable motivational inspiring speaker th

Early bird - $200 prior to 18 Dec 2023 th

Full price - $220 after 19 Dec 2023 Keep an eye out for email updates over the coming weeks.

Up to date information can be found on the NZNO College of Stomal Therapy Nurses website 36

NZNOCSTN CONFERENCE 2023

“INNOVATION” CALLING FOR ABSTRACTS FOR PEER PRESENTIONS NZNO College of Stomal Therapist Nurses conference will be held in Auckland on Feb 28-March 1 2024 The NZNOCSTN committee would like to invite ALL members to submit an abstract for consideration to present at our “Peer Presentation” section of our 2024 conference. We cannot stress how important this part of YOUR conference this call is. With delegate participation, we are sure to have successful conference; PLEASE support it with your submission. Share your knowledge; tell your story to show off the innovative work you are doing.

All presentations will automatically go in to a sponsored competition for “BEST PRESENTATION” (sponsorships and prizes TBA) and ALWAYS excellent to include in the PDRP. TOPIC: Anything stoma, fistula management, experiential, task, knowledge and/or skills related, where you have used your innovation and/or your expertise.

TIME: 15-minute presentation, 5 minute question time.

PROCESS: Submit abstract 100-200 words via email to the editors of “The Outlet”, outlining your Topic, content and a snap shot about your role by 30th September 2023.

Preeti.charan@waitematadhb.govt.nz

or Marie.buchanan@waitematadhb.govt.nz

NZNOCSTN committee members will review ALL abstracts. Outcome of submissions will be advised end of October 2023.

37

SCOPE OUT OUR NATURAL ORANGE FLAVOUR AND IMPROVED FORMULATIONS1-5

Before prescribing, please review full Data Sheet available via https://www.fresenius-kabi.com/nz/ products/gastroenterology or contact Medical Information on 0800 144 892.

Restricted Medicine: New Zealand PHARMAC Information: These products are not funded medicines.

GLYCOPREP ORANGE Minimum Data Sheet GLYCOPREP ORANGE contains macrogol 3350, sodium chloride, potassium chloride, sodium sulfate. INDICATIONS: Bowel emptying and cleansing by means of total gastrointestinal tract perfusion in preparation for gastrointestinal procedure (such as colonoscopy, barium enema x ray examination), prior to intravenous pyelograms (IVP) or colorectal surgery. CONTRAINDICATIONS: Hypersensitivity to any ingredients, gastrointestinal obstruction, gastric retention, bowel perforation (frank or suspected), toxic colitis, toxic megacolon, ileus, severe dehydration, body weight <20 kg. PRECAUTIONS: Severe ulcerative colitis, patients with a stoma, impaired renal function, pre-existing electrolyte disturbances, dehydration, undiagnosed abdominal pain, congestive heart failure, diabetes, elderly, children, pregnancy, lactation; Impaired gag reflex, semi-conscious, prone to regurgitation or aspiration, nasogastric intubation.

INTERACTIONS: GLYCOPREP ORANGE increases the GI transit rate and therefore may reduce the efficacy of concomitant medications (e.g. oral contraceptive pill, antibiotics, other oral medications). Concomitant calcium channel blockers, diuretics or other medications may affect electrolyte levels. ADVERSE EFFECTS: Nausea, abdominal fullness and bloating, cramps, vomiting, anal irritation. DOSAGE AND ADMINISTRATION: Day before procedure: drink recommended clear fluids only. Dissolve contents of one 70g sachet in one litre of water. Drink one/two 250 mL glasses of prepared solution every 15–20 minutes until completed and then repeat preparation until 3 litres consumed. Continue to drink recommended clear fluids between commencing the GLYCOPREP ORANGE preparation and 2 hours prior to the procedure. Based on Medsafe approved Data Sheet. Date of revision 7 September 2021.

GLYCOPREP-O KIT Minimum Data Sheet GLYCOPREP-O KIT contains 3 GLYCOPREP ORANGE sachets (macrogol 3350, potassium chloride sodium chloride, sodium sulfate), 1 Magnesium Citrate sachet (magnesium carbonate hydrate, citric acid) and 3 Bisacodyl 5 mg Tablets (bisacodyl). INDICATIONS: Bowel emptying and cleansing by means of total Gl tract perfusion in preparation for GI examination (such as colonoscopy, barium enema x-ray examinations), prior to intravenous pyelograms (IVP) or colorectal surgery. CONTRAINDICATIONS: Clinically significant renal impairment, acute abdominal conditions such as appendicitis, GI obstruction, gastric retention, bowel perforation, toxic megacolon, toxic colitis, ileus, body weight < 20 kg, severe dehydration or hypersensitivity to any of the ingredients. PRECAUTIONS: Debilitated patients or patients with IBD, those with a stoma, severe ulcerative colitis, heart conditions, pre-existing electrolyte disturbances, congestive heart failure or diabetes. INTERACTIONS: GLYCOPREP-O KIT increases the GI transit rate and therefore may reduce the efficacy of concomitant medications (e.g. oral contraceptive pill, other oral medications) Concomitant use of bacitracin, benzylpenicillin, medicines for diabetes as well as calcium channel blockers, diuretics or other medications that may affect electrolyte levels and other bowel cleansing preparations or laxatives. ADVERSE EFFECTS: Nausea, abdominal fullness and bloating, cramps, vomiting, anal irritation. DOSAGE AND ADMINISTRATION: Day before procedure: drink recommended clear fluids only. Take 3 bisacodyl tablets with 250mL of warm water at 11am.

Dissolve contents of magnesium citrate sachet in 250mL of warm water and drink solution at 5pm. Dissolve contents of 1 GLYCOPREP ORANGE sachet in 1 litre of water and repeat three times. From 8pm onwards, drink one to two 250mL glasses of GLYCOPREP ORANGE solution every 15-20 minutes until completed. Continue drinking adequate recommended clear liquids until bedtime. Based on Medsafe approved Data Sheet. Date of revision 21 January 2022.

PICOPREP ORANGE Minimum Data Sheet WARNING: Life-threatening dehydration and/or electrolyte disturbances may occur in “at risk” groups. See Contraindications and Precautions.

PICOPREP ORANGE contains sodium picosulfate, magnesium carbonate hydrate and citric acid. INDICATION: Bowel emptying and cleansing by means of total gastrointestinal tract perfusion in preparation for GI examination (such as colonoscopy, barium enema x-ray examination), prior to intravenous pyelograms (IVP) or colorectal surgery, in adults and children 9 years of age and over. CONTRAINDICATIONS: Renal impairment, GI obstruction, gastric retention, bowel perforation, toxic megacolon, toxic colitis, ileus, those with a stoma or hypersensitivity to any of the ingredients. Children < 9 years. PRECAUTIONS: Debilitated patients or patients with severe ulcerative colitis, pre-existing electrolyte disturbances, heart conditions, dehydration, congestive heart failure, diabetes, impaired gag reflex, who are unconscious or semi-unconscious, who are prone to regurgitation or aspiration and particularly those with nasogastric intubation. INTERACTIONS: Oral medication taken within one hour of commencing PICOPREP ORANGE may be flushed from the GI tract and not absorbed. Antibiotics, low-dose contraceptive pill, calcium channel blockers, diuretics or other medications that may affect electrolyte levels and other bowel cleansing preparations or laxatives. Diabetic patients may require adjustment of their diabetic medication.

ADVERSE EVENTS: Nausea, abdominal fullness and bloating, abdominal cramps, vomiting and anal irritation. DOSAGE & ADMINISTRATION: Day before procedure: drink recommended clear fluids only. Dissolve contents of one sachet in a 250 mL glass of warm water. Drink the contents of the glass followed by a glass of water. If two sachets are required, drink one sachet at approximately 3pm and 9 pm. If three sachets are required, drink one sachet at 1pm, 5pm and 9pm. Continue drinking approved clear fluids, at least one glass (250 mL) per hour, until 2 hours prior to examination. Based on Medsafe approved Data Sheet. Date of revision 21 January 2022.

PREPKIT ORANGE Minimum Data Sheet WARNING: Life-threatening dehydration and/or electrolyte disturbances may occur in “at risk” groups. See Contraindications and Precautions.

PREPKIT ORANGE contains 1 GLYCOPREP ORANGE sachet (macrogol 3350, potassium chloride, sodium chloride, sodium sulfate) and 2 PICOPREP ORANGE sachets (citric acid, magnesium carbonate hydrate, sodium picosulfate). INDICATIONS: PREPKIT ORANGE™ is indicated for bowel emptying and cleansing by means of total gastrointestinal tract perfusion in preparation for gastrointestinal examination (such as colonoscopy, barium enema x-ray examination), prior to intravenous pyelograms (IVP), or colorectal surgery, in adults 18 years and over. CONTRAINDICATIONS: PREPKIT ORANGE™ should not be used by patients with clinically significant renal impairment, gastrointestinal obstruction, gastric retention, bowel perforation (frank or suspected), toxic megacolon, toxic colitis, ileus, severe dehydration, those with a stoma and whose body weight is less than 20 kg or are hypersensitive to any of the ingredients. PRECAUTIONS: Debilitated patients or patients with severe ulcerative colitis, heart conditions or diabetes. INTERACTIONS: PREPKIT ORANGE increases the GI transit rate and therefore may reduce the efficacy of concomitant medications (e.g. oral contraceptive pill, antibiotics, other oral medications). Concomitant use of bacitracin, benzylpenicillin, medicines for diabetes as well as calcium channel blockers, diuretics or other medications that may affect electrolyte levels and other bowel cleansing preparations or laxatives. ADVERSE EFFECTS: Nausea, abdominal fullness and bloating, cramps, vomiting, anal irritation. DOSAGE AND ADMINISTRATION: Day before procedure: drink one glass of recommended clear fluids each hour. Dissolve contents of one sachet of PICOPREP ORANGE in 250mL of warm water and drink at 1pm. Dissolve contents of one sachet of GLYCOPREP ORANGE in 1 litre of water. From 5pm, drink one to two 250mL glasses of GLYCOPREP ORANGE every 15-20 minutes until completed. Dissolve contents of one sachet of PICOPREP ORANGE in 250mL of warm water and drink at 9pm. Continue to drink recommended clear fluids. Nothing (nil) by mouth 2 hours prior to the procedure. Based on Medsafe approved Data Sheet 14 July, 2022.

REFERENCES: 1. Picoprep Orange Approved Data Sheet. Date of revision 21 Jan, 2022. 2. Glycoprep Orange Approved Data Sheet. Date of revision 07 Sep, 2021. 3. Prepkit Orange Approved Data Sheet, 14 July, 2022.

4. Glycoprep-O Kit Approved Data Sheet. Date of revision 21 Jan, 2022. 5. Data on File. Available on request (accessed July 7, 2021).

Fresenius Kabi New Zealand Limited. NZBN 9429033897769. The HSBC Tower Level 14, 188 Quay Street AUCKLAND 1010, NEW ZEALAND. T 0800 144 892 W www.fresenius-kabi.com/nz Date of approval: September 2023 | PM2023.1840 | TAPS MR9621 | FKA115 38

39

NEW ZEALAND NURSES ORGANISATION GASTROENTEROLOGY NURSES COLLEGE Minutes of the Annual General Meeting of the NZNO Gastroenterology Nurses College held at the ASM, Auckland on Thursday 24th November 2022: 1245 - 1345 Present: Committee: Merrilee Williams (Chair), Rachel Cashmore (outgoing treasurer), Kiran Joseph, Karen Kempin, Marian O’Connor, Kirsten Arnold (incoming treasurer), Jessica Southall

Gale, Kate Grigg, Natalie Haydock, Christine Ho, Maxine Hooker, Donna Howe, Jessie Huang, Judith Mclaughlin, Louise O’Connor, Nina Silcock, Jacqui Stone, Angela Taylor, Myra Vital, Sharon Viney, Sherilyn Walker, Karen Gower, Sarah Cook, Leah Crooks, Toakase Misa, Karen Murdoch, Chrissy Rees, Marina Richards, Michelle Harkess, Michelle Harman.

Present via Zoom: Julia Anderson (PNA), Genevieve Cowley, Kerrin Bennett, Carly Bramley, Jessica Browne, Ginette Campbell, Nancy Carey, Gillian Clarke, Kaitlyn Doak, Susan

Apologies: Nicola Caine

1. Welcome and Introduction of Committee Merrilee Williams opened the meeting.

1.1 Roll Call 1.2 Apologies 1.3 Confirmation of Quorum – Confirmed at over 5% 1.4 Confirmation of last Gastroenterology Section meeting Minutes Moved: The minutes of the Gastroenterology meeting held on November 2021 to be confirmed.

Moved: Seconded: CARRIED

Merrilee Williams Karen Gower

1.5 Matters Arising from 2021 AGM minutes – Financials from 2021 AGM to be moved – in financial section No other matters arising.

2. Correspondence No correspondence relating to AGM.

3. Financial for previous financial year Read by Rachel Cashmore (treasurer) Move for 2020 / 2021 financials to accepted as error noted at last AGM Moved: Seconded: CARRIED

Rachel Cashmore Karen Kempin

3.1 Move any accounts for payment Moved: Seconded: CARRIED

Rachel Cashmore Karen Gower

3.2 Present prospective budget for financial year Moved: Seconded: CARRIED

Kirsten Arnold Rachel Cashmore

4. Report 4.1 Chairperson’s Report: Summarised by Merrilee Williams – full report available on website.

Moved: Seconded: CARRIED

Merrilee Williams Karen Murdoch

40

4.2 PNA Report Summarised by Julia Anderson over zoom – full report available on website.

Moved: Seconded: CARRIED

Julia Anderson Christine Ho

4.3 Other committee reports IBD sub group Summarised by Marian O’Connor – full report available on website.

Moved: Seconded:

Marian O’Connor Donna Howe

Hepatology sub group Summarised by Jessica Southall – full report available on website.

Moved: Seconded:

Jessica Southall Kirsten Arnold

5. Remits 5.1 Rule remits: Summarised by Karen Kempin on behalf of the committee – full remit available on website.

CARRIED

6. NZNO Reports NIL

7. General Business Question from the floor about The Tube – brief overview given by Chair Merrilee Williams about the plans for a Pānui and two Tube editions for 2023. Information about Camp Purple given by Kirsten Arnold and a shout out for nurse volunteers for the next camp.

8. National Committee Election Results A farewell to Rachel Cashmore as outgoing treasurer – her contribution has been absolutely invaluable, and her accountancy background made the finances look easy.

Official handover to Kirsten Arnold as incoming treasurer.

One application to join the committee: Justine Augustine joins the NZgNC from the gastroenterology department in Greymouth Hospital.

9. Other Business No other business raised.

The meeting concluded at 13:25 when Merrilee Williams closed. The next meeting will be held on 7th December 2023 in Rotorua.

Chairperson: Date:

30 / 11 / 2022

41

TUBE Writing Guidelines for Authors The Tube is the official journal of the NZgNC (New Zealand Gastroenterology Nurses’ College), and is published quarterly.

We welcome articles that will be of interest to nurses working in Gastroenterology and related. Our aim is to publish a high quality, professional and educational journal for nurses working within the specialty of Gastroenterology.

Structure of Article for submission

All manuscripts received by the editor will be acknowledged, however, reports, area news or letters to the Editor will not. If you have not received confirmation of receipt within six weeks, please contact the Editor.

• Author(s) name(s) in full

The submission should include the following information: Title Page • Title of the Paper (20 word max)

• Qualifications, current position, details of other relevant achievements, and affiliations of author(s) • Address, contact telephone numbers, email address of the author(s)

Suggestions for articles include: • Recommendations for nursing practice based on current global trends/literature

• Conflict of interest and / or financial disclosure related to the article or related matter

• Overview of learning achieved through post graduate paper, or conference attendance

Body of article • Title at top of first page

• Review of literary article relevant to best practice

• The body of work should be clearly written in an academic style of writing, and organised with headings/sub-headings (where appropriate)

• Case study relevant to specialty • Education for nurses based on sub specialty topic

Editorial review/acceptance

• Pages numbered consecutively

Articles submitted to The Tube are currently reviewed at a minimum by the editor and co-editor. The review will assess the accuracy of fact, clarity of presentation, use of references and relevance to practice of gastroenterology nursing. The editor/coeditor may also request a committee member review any article, particularly if the article is a sub-specialty of gastroenterology nursing and the committee member area of special interest/ work.

• Tables, figures (if applicable) should be referred to in the body of the manuscript • References (APA 6th Edition) • Written authorisation(s) to publish identifiable person(s)/ institutions and copyright materials • Word limit is approximately 1000 words. For the purposes of publication all articles should be formatted in Calibri, font size 10.

All articles which are being considered for publication may be reviewed and returned to the author with suggestions for revisions and improvement. The author will be provided with a deadline in which to provide the revised article in order to comply with publication schedule.

• All work should be saved as MS-Word (.docx) or text only (.txt) files.

All articles must be fully referenced where appropriate (APA 6th Ed)

The Editor’s decision to publish or reject an article is final. You are welcome to email or phone the Editor to discuss your article should it not be accepted for publication.

Authors should keep an original copy of their article.

42

Submission

Case study/clinical practice article:

Articles should be submitted to the editor at editorofthetube@ gmail.com

• Outline the nature of the treatment/procedure/product that forms the basis of the case study

If submission of your article is as a requirement of a NZgNC Education/Travel Grant, please ensure you submit within the required timeframe of your funding application.

• Provide information on the patient: age, sex, history, any other pertinent clinical/social/cultural aspects. Avoid using information which would clearly identify the patient.

Request Further Information

• Tell readers what is new, interesting, different, pioneering, about this treatment/procedure/product

For advice or clarification on any of the above matters please contact the editorofthetube@gmail.com

• Outline the actual treatment/procedure or how product works

College committee members’ reports:

• Report on the patient’s/client’s response/recovery/

The aim of such reports is to inform the national College membership of the business and activities of the College during the last quarter.

• Tell readers what you have learnt through your involvement with this

Treatment /procedure/product

These reports should include such activities as: • College meetings/teleconferences (date and venue)

• Outline any implications/meaning gastroenterology nurses’ practice

it

• Decisions arising from these meetings/teleconferences (can be focused on the minutes of these meetings)

• Provide references to support the article.

may

have

• Plans/development the College is involved in/hopes to develop • Any external meetings committee members have attended relating to the business of the College, e.g. meetings with NZNO professional nursing adviser/professional services manager • Any contributions to national NZNO business, e.g. contribution to any submissions/ national guideline development • These should be a maximum of 600 words and contain people’s correct names and titles.

TO COMPLY WITH THE PRIVACY CODE: ALL INFORMATION REGARDING YOUR APPLICATION WILL BE CONFIDENTIAL TO THE NZNO GASTROENTEROLOGY NURSES’ COLLEGE NATIONAL COMMITTEE AND THE JUDGES.

43

for

GASTROENTEROLOGY UNITS IN NEW ZEALAND ASHBURTON HOSPITAL Operating Theatre Endoscopy Unit Private Bag 801, Ashburton Ph: 03 308 4149 CNC: Rachel.McEwan@cdhb.health.nz

AUCKLAND HOSPITAL Gastroenterology Department Level 6 Private Bag 92024, Grafton, Auckland Ph: 09 307 4949 ext: 125570 CNM: cristinag@adhb.govt.nz

AUCKLAND SURGICAL CENTRE 9 St Marks Road, Remuera Auckland 1050 Theatre Mgr: Tracy McConnochie

BELVERDALE HOSPITAL Endoscopy 5 Campbell Street, Wanganui Ph: 06 348 1182 Donna Plumridge manager@belverdale.co.nz

BIDWELL HOSPITAL Endoscopy Unit 53 Elizabeth Street, Timaru 7910 Ph: 03 687 1230 Operating Theatre Bidwill Trust Hospital Ph: 03 687 1230 ext 225 DD 03 687 1245 Rachel Pilgrim: theatre@bidwilltrusthospital.co.nz Carol Campbell: clinicalleader@bidwillhospital.co.nz

BOULCOTT HOSPITAL Boulcott Endoscopy PO Box 31459, Lower Hutt, Wellington Ph: 04 569 7555 ext: 612 khall@boulcotthospital.co.nz

BOWEN HOSPITAL Gastroenterology Department 98 Churchill Downs, Wellington Ph: 04 479 8261 endo@bowen.co.nz

BRAEMAR HOSPITAL Endoscopy Unit PO Box 972, Hamilton Ph: 07 839 1899 nicolaw@braemarhospital.co.nz stuartm@braemarhospital.co.nz

BRIGHTSIDE 3 Brightside Road Epsom, Auckland 1023 Ph: 09 925 4200 Theatre Mgr: John Drinkwater

CAMBRIDGE SPECIALIST CENTRE 21 Hamilton Road, Cambridge 3434 edeere@cambridgespecialists.co.nz afyers@cambridgespecilaists.co.nz

CHARITY HOSPITAL Endoscopy, 349 Harewood Road, Christchurch Ph: 03 360 2266 Anita Tuck: anita@ccht.org.nz

CHELSEA HOSPITAL Endoscopy Unit 189 Cobden Street, Gisborne Ph: 06 867 2237

CHRISTCHURCH HOSPITAL Gastroenterology Department PO Box 4710, Christchurch Ph: 03 364 0925 Gendy.bradford@cdhb.health.nz

CLUTHA HOSPITAL Endoscopy Unit PO Box 46, Balclutha Ph: 03 418 0500

CREST HOSPITALS Endoscopy Unit 21 Carroll Street, Palmerston North 4410 PO Box 1622, Palmerston North 4440 Ph: 06 356 5180 OT Mgr: Susie Wright Ward Day Stay Mgr: Pete Baur

DUNEDIN HOSPITAL Gastroenterology Department Dunedin Hospital Internal Extn: 59326, DDI: 03 470 9326 CNM: Merrilee.Williams@southerndhb.govt.nz ACNM: Genevieve.Cowley@southerndhb.govt.nz

DUNSTAN HOSPITAL Endoscopy Unit Clyde Otago Ph: 03 449 2878 merrilee.williams@southerndhb.govt.nz

ENDOSCOPY AUCKLAND Endoscopy Unit 148 Gillies Ave, Epsom, Auckland Ph: 09 623 2020 Sue Valentine: sue@endoscopyak.co.nz

FORTÉ HEALTH Christchurch coisey.voldoire@fortehealth.co.nz

GILLIES HOSPITAL 160 Gillies Ave, Epsom Auckland 1023 Ph: 09 925 4000 OR Mgr: Carol Burnside

GISBORNE/ TAIRAWHITI 421 Ormond Road, Gisborne 4010 Endoscopy Clinical Nurse Co-ordinator: Sue Egan-Cunningham Ph: 06 869 0500 ext. 8320 or 021 346 024 Susanne.egan-cunningham@tdh.org.nz

GRACE HOSPITAL Endoscopy Room 281 Cheyne Road, Tauranga 3112 PO Box 2320, Tauranga 3140 sarahha@gracehospital.co.nz endoscopy@gracehospital.co.nz

GREENLANE MEDICAL SPECIALISTS Ph: (09) 9306108, F: (09) 9306109 Building A, Ground Floor, 93 Ascot Ave, Greenlane, Auckland 1051 Ph: (09) 9306108, F: (09) 9306109 micah@glms.co.nz

GREY HOSPITAL (Te Nikau) Theatre & Endoscopy PO Box 387, Greymouth 7840 Ph: 03 768 0499 w.stuart@westcoastdhb.health.nz

HAWKE’S BAY REG. HOSPITAL Operating Theatre Endoscopy Unit, Private Bag, Hastings Ph: 06 878 8109 Kerrin.bennett@hbdhb.govt.nz

HUTT HOSPITAL Endoscopy Unit Private Bag 31 907 Lower Hutt, Wellington Ph: 04 566 6999 Marie.press@huttvalleydhb.org.nz

INTUS DIGESTIVE AND COLORECTAL CARE Milford Chambers, St Georges Medical Centre 249 Papanui Road, Christchurch Ph: 03 977 5977 nurses@intus.co.nz INTUS WANAKA & QUEENSTOWN Kate.lawrence@intus.co.nz

44

GASTROENTEROLOGY UNITS IN NEW ZEALAND KAITAIA HOSPITAL Day Stay Unit Redan Road, Kaitaia Ph: 09 408 0010 suzie.walker@northlanddhb.org.nz

KENEPURU HOSPITAL Outpatients Department Endoscopy Unit PO Box 50215, Porirua, Wellington Ph: 04 237 0179 CNM: jane.bilik@ccdhb.org.nz ACNM: cel.aligno@ccdhb.org.nz

KENSINGTON HOSPITAL Endoscopy Unit 12 Kensington Ave, Whangarei Ph: 09 437 9080 tshumaemelda@yahoo.com emaldat@kensingtonhospital.co.nz

KEW HOSPITAL Endoscopy Unit Invercargill Ph: 03 218 1949 Mel.kurman@southerndhb.govt.nz

LAKES DISTRICT HOSPITAL Endoscopy Unit 20 Douglas Street Frankton, Queenstown Ph: 03 441 0015 Lindsay.jackson@sdhb.govt.nz

MANAKAU HEALTH PARK SUPERCLINIC Joanne.pawley@middlemore.co.nz

MERCY HOSPITAL Manaaki by Mercy 72 Newington Ave Maori Hill, Dunedin Ph: 03 464 0107 Paula.sharp@mercyhospital.org.nz CNS: rowena.simons@mercyhospital.org.nz

MERCY ASCOT HOSPITAL Mercy Endoscopy North Shore 46 Taharoto Road, Takapuna, Auckland Ph: 09 486 4346 Raewyn.paviour@mercyascot.co.nz

MERCY ASCOT HOSPITAL ENDOSCOPY 100 Mountain Road, Epsom PO Box 9911 Newmarket, Auckland Ph: 09 623 5725 Jennifer Hussong Jennifer.hussong@mercyascot.co.nz

MIDDLEMORE HOSPITAL Gastroenterology Department Private Bag 93311 Otahuhu, Auckland Ph: 09 276 0039 harun.riza@middlemore.co.nz linda.jamieson@middlemore.co.nz

ROTORUA HOSPITAL Operating Theatre Endoscopy Unit Private Bag 3023, Rotorua Ph: 07 349 9860 Chrissy.rees@lakesdhb.govt.nz

ROYSTON HOSPITAL Endoscopy Unit 325 Prospect Road, Hastings Ph: 06 873 1111 Anna.Harland@royston.co.nz

SHORE SURGERY 181 Shakespeare Road Milford, Auckland 0602 Ph: 09 486 0113 office@shoresurgery.co.nz Ingrid.goodenough@shoresurgery.co.nz

NELSON HOSPITAL Endoscopy Unit Medical Outpatient Department PO Box 18, Nelson Ph: 03 546 1833 endoscopytriagenurse@nmdhb.govt.nz

NORTH HARBOUR CAMPUS 232 Wairau Road Glenfield, North Shore 0745 Ph: 09 925 4400 Theatre Mgr: Avril Astrop

NORTH SHORE HOSPITAL Endoscopy Department Private Bag 93503 Takapuna, Auckland Ph: 021 192 9825 Kate.Grigg@waitematadhb.govt.nz

ORMISTON HOSPITAL 125 Ormiston Road, Flat Bush, Howick Manakau City 2016 PO Box 38921, Manakau City, Auckland 2145 Ph: 09 250 1157 ext: 5818 suzannec@ormistonhospital.co.nz

ORMISTON HOSPITAL Level 3, 125 Ormiston Road, Botany Junction, Auckland Andrea.Dixon@ormistonhospital.co.nz

PALMERSTON NORTH HOSPITAL (Mid Central Health) Gastroenterology Department PO Box 2056, Palmerston North Ph: 06 350 8665 Ben Duff – Charge Nurse gastro@midcentral.co.nz CNS: michelle.harman@midcentraldhb.govt.nz

RODNEY SURGICAL CENTRE Ph: 09 425 1190 Shelley Scott – Gen. Mgr gm@rodneysurgicalcentre.co.nz

THE RUTHERFORD CLINIC Level 1, 2 Connolly Street Lower Hutt Ph: 04 903 2900 Kate.broome@rutherfordclinic.co.nz Sarah.denton@rutherfordclinic.co.nz

RUTHERFORD HEALTHCARE 132 Collingwood Street, Nelson 7010 Ph: 03 548 8156 Andrew@rutherfordhealthcare.co.nz Lynda@rutherfordhealthcare.co.nz

SOUTHERN CROSS HOSPITALS Operating Theatre 108 Deveron Street Invercargill Ph: 03 214 4269 Hilda.Toole@southerncrosshospitals.co.nz

SOUTHERN CROSS HOSPITALS Operating Theatre 21 Von Tempsky Street, Hamilton 3216 Ph: 07 838 1059 Evelyn.McMorran@southerncrosshospitals.co.nz

SOUTHERN CROSS HOSPITALS Operating Theatre 131 Bealey Ave, Christchurch Ph: 03 379 4433 Wasana.burgess@southerncrosshospitals.co.nz

SOUTHERN CROSS HOSPITALS Operating Theatre 58 Otonga Road, Rotorua 3015 Ph: 07 348 8156 Chris.Mott@southerncrossqe.co.nz

SOUTHERN CROSS HOSPITALS Specialist Centre 90 Hanson Street, Newtown, Wellington 6021 Ph: 04 910 2160 Ropeti.Taito@schl.co.nz

45

MANAKAU STREET HOSPITAL Operating Theatre Endoscopy Unit 36 Manuka Street, Nelson, 7010 Karen.tijsen@manukastreet.org.nz

GASTROENTEROLOGY UNITS IN NEW ZEALAND SOUTHERN ENDOSCOPY CENTRE Level 1, 21 Caledonian Road, St Albans, Christchurch 8014 Ph: 03 968 9800 Tamsin.dunn@southernendoscopy.co.nz

STARSHIP HOSPITAL Operating Theatre Endoscopy Unit Private Bag 92 024 Grafton, Auckland Ph: 09 839 0000

St GEORGES HOSPITAL St Georges Day Surgery, Endoscopy 249 Papanui Road, Christchurch Ph: 03 355 6563 Sheryll.Williamson@stgeorges.org.nz

TARANAKI BASE HOSPITAL Endoscopy Unit Private Bag 2016, New Plymouth 7861 Ph: 06 753 7777 Liana.herbert@tdhb.org.nz

TAUPO HOSPITAL Endoscopy Unit, Lakes DHB PO Box 841, Taupo Ph: 07 376 1000 Chrissy.rees@lakesdhb.govt.nz

TAURANGA HOSPITAL Endoscopy Private Bag 12024, Tauranga Ph: 07 579 8603 david.oconnor@bopdhb.govt.nz

TE KUITI HOSPITAL Day Surgery Endoscopy Unit Alisa Street, Te Kuiti Ph: 07 878 7333

THAMES HOSPITAL ENDOSCOPY UNIT Day Stay Unit L3, PO Box 707, Thames 3540 Ph: 07 868 6550

THE MACMURRAY CENTRE 3 MacMurray Road Remuera, Auckland 1050 Ph: 09 550 1080 iritb@macmurray.co.nz

TIMARU HOSPITAL Endoscopy Private Bag 911, Timaru Ph: 03 684 4000 endoscopy@scdhb.health.nz jwellford@scdhb.health.nz

TOKOROA HOSPITAL Endoscopy Unit Maraetai Road, Tokoroa Ph: 07 886 7239

WAIKATO HOSPITAL Gastroenterology Unit PO Box 934, Hamilton Ph: 021 549 675 sarah.cook@waikatodhb.health.nz amanda.desouza@waikatodhb.health.nz

WAIRARAPA HOSPITAL Operating Theatre Endoscopy Unit PO Box 96, Masterton Ph. 06 9469800 Janette.sigvertsen@wairarapa.dhb.org

WAIRAU HOSPITAL Endoscopy Suite PO Box 46, Blenheim Ph: 03 578 4099 ext: 8836/8724 Pravidha.david@nmdhb.govt.nz Bronwyn Lane: Bronwyn.Lane@nmdhb.govt.nz

WAITAKERE HOSPITAL Day Surgery Unit Endoscopy Unit Lincoln Road, Henderson, Auckland Ph: 021 192 9825 Kate.Grigg@waitematadhb.govt.nz endoscopyWTK@waitematadhb.govt.nz

WAITEMATA ENDOSCOPY 232 Wairau Road Glenfield, Auckland 0627 Ph: 09 925 4449 Sihaam@waitemataendoscopy.co.nz

WAKEFIELD HOSPITAL Gastroenterology Department Private Bag 7909 Newtown, Wellington Ph: 04 381 8110 ext: 5914 Marie.verschoor@wakefield.co.nz

WANGANUI HOSPITAL Theatre Services Endoscopy Unit Private Bag 3003, Wanganui Ph: 06 348 1235 endoscopynurse@wdhb.org.nz

WELLINGTON HOSPITAL Endoscopy Unit Private Bag 7902, Newtown, Wellington Ph: 04 385 5999 Nurse Manager: Jane.Bilik@ccdhb.org.nz ACNM: cel.aligno@ccdhb.org.nz

WHAKATANE HOSPITAL Operating Theatre Endoscopy PO Box 241, Whakatane Ph: 07 307 8999 Irene Whitehead: Irene.whitehead@bopdhb.govt.nz Mary Honan: Mary.Honan@bopdhb.govt.nz

WHANGAREI HOSPITAL Endoscopy Unit Maunu Road, Whangarei Ph: 09 430 4101 ext: 8772 Diandra.Brass@northlanddhb.org.nz

46

Advertising Rate Card

The NZgNC is the national voice for gastroenterology nursing practice in NZ, and works collaboratively with the NZSG, and international societies such as GENCA and BSG. We represent nurses working in endoscopy, Hepatology, Inflammatory Bowel Diseases, Enteral Feeding, and Nurse Endoscopists.

We have 2 e-publications that are sent to our membership of nearly 500 nurses The TUBE e-magazine is the official journal of the NZNO Gastroenterology Nurses College and is published twice yearly.

It features scholarly articles on all aspects of gastroenterological nursing including current research, education opportunities, reports from conferences, case studies, new medications and products, infection control and updates in clinical practice.

The PANUI newsletter is new for 2023 and is published 6 x per year.

It is designed to be a snapshot update for our membership to print and place in their workplaces to keep teams up to date with education and learning opportunities coming up, clinical practice news, and general gastroenterology focussed news.

We welcome sponsor contributions to nursing education for Gastroenterology Nurses through advertising in our publications

Advertising Rates 2023 THE TUBE

PANUI

A4 Full Page 210mm wide x 297mm high

$550 inc GST

Live link logo To sponsor education content

$150 inc GST

A4 Half Page 180mm wide x 120mm high

$275 inc GST

Sponsor Corner 80 x 80mm with live link to sponsor

$200 inc GST

Content deadlines for publication inclusions

Content deadlines for publication inclusions

February Edition

Due: 3rd Jan

October Edition

Due: 3rd Sept

January, March, May, July, September, December

Due on the 1st of each month prior ie. Due 1st Dec for Jan edition

Artwork

Please include 3mm bleed • Resolution at least 300dpi at full size • Submit PDF or JPG

Acceptance of advertising requests is subject to approval by the NZgNC committee, and required by the deadline for publishing.

Please complete the booking request form, and email to NZGNC Secretary secretaryofnzgnc@gmail.com Spaces are limited for each publication.

Complete the advertising request form and send to: secretaryofnzgnc@gmail.com 47

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