Application of a Positioning Wedge During Colonoscopy of Obese Patients to Mitigate Nurse Pain

Background: The application of external abdominal pressure by endoscopy nurses has long been recognized to facilitate passage of the endoscope during colonoscopy. Applying sustained abdominal pressure during a colonoscopy for an obese patient is especially challenging and may result in musculoskeletal injury for the endoscopy nurse. Methods: Four experienced endoscopy nurses cared for 100 obese adult patients scheduled for colonoscopy who had a body mass index (BMI) greater than 25 kg/m(2). Duration of applied pressure, as well as nurse pain and fatigue were examined after they cared for 50 patients with and 50 patients without a positioning wedge. Findings: No difference in the mean fatigue score between nurses providing standard care versus those using the positing wedge was observed (mean score: 2.6 vs. 2.0, respectively); however, self-reported pain was higher for those providing standard care relative to those using the positioning wedge (mean score: 2.9 vs. 1.3, p = .0143). In 18 patients who required both the wedge and pressure, these nurses still reported lower pain scores relative to nurses who provided care without a wedge (M = 1.3 vs. 2.9, respectively). Conclusion/Application to practice: A positioning wedge for obese patients undergoing a colonoscopy can reduce the need for external abdominal pressure applied by endoscopy nurses. Occupational health nurses should endorse the use of a gel wedge to promote safe patient handling and reduce the potential for musculoskeletal injury among endoscopy nurses.