This technique may help reduce spillage into the peritoneum which can create broad tissue staining. Some endoscopists use a two-step approach by first injecting saline to create a bleb, and then using the same needle to inject the ink.
Tenting the tissue is helpful to verify submucosa depth.The needle should then be pulled back to thesubmucosa level.The injection needle should be inserted 3cm from the lesion at an angle to the colon wall so that the tip of the needle is beneath the mucosa.Remember to check the labels and inserts of the ink you choose for indications, contraindications, and instructions for use. While several techniques are suggested in the literature for tattooing the GI tract, the four quadrant technique is often recommended, as it optimizes intraoperative visualization. It is packaged sterile in a 5cc syringe, and is ready for use after shaking. It is the first and only non-india ink based FDA cleared tattoo product. The Spot endoscopic marker was introduced in 2000 as a sterile, pre-mixed, pre-loaded, biocompatible suspension of purified, very fine carbon particles. The ink is then drawn up into a syringe for the gastroenterologist or surgeon to use.
Because india ink is inherently unstable, a clinician (often the GI Endoscopy Nurse) must dilute the ink with saline and sterilize it using an autoclave or passing it through a bacteriostatic Millipore filter. 3 Different substances found in india ink have been known to cause inflammatory reactions. It is composed of carbon particles and other substances including ethylene glycol, phenol, shellac, and animal products (i.e., gelatin). India ink was the most common type of ink for many years. 2Įndoscopic tattooing has been used since the 1970s for marking lesions along the GI tract. According to the American Society for Gastrointestinal Endoscopy (ASGE), the other inks are less useful with respect to safety, efficacy, and ease of use. Many nurses and physicians are most familiar with india ink and Spot. There are several types of ink available for use in endoscopy tattooing, including india ink, Spot™ (purified, very fine carbon particles), methylene blue, indigo carmine, and indocyanine green (ICG). The potential for the surgeon to remove the wrong section of bowel. The need for the surgeon to do an interoperative colonoscopy.
The need for the surgeon to change from a laparoscopic to an open procedure.Additional surgeries because the surgeon must go back to find the lesions.Longer surgical times while the surgeon attempts to locate the lesions.When a surgeon cannot locate a lesion during surgery, the potential risks include: By localizing lesions with very clear, permanent tattoo marks, colon resection surgery and follow-up surveillance is much easier. Patients, surgeons and gastroenterologists all benefit from having colorectal lesions tattooed. Even if a lesion looks like it will be easy to find later on, the anatomy of the bowel can contribute to imprecise measurements for the procedure reports, so it is often recommended that all suspicious lesions be tattooed. Therefore the lesion location is tattooed so that it can later be found on subsequent screening or for surgical resection. When a gastroenterologist or surgeon sees a lesion in the GI tract, it is often unknown whether or not it is cancerous until a biopsy result is obtained.
#Higgins india ink tattoo full
Since almost all GI Endoscopy nurses have had to hand their gastroenterologist or surgeon a syringe full of ink for lesion marking, below is a quick guide to help answer some common questions:Įndoscopic tattooing or marking of lesions plays a very important role in patient care. This includes helping to educate staff on the importance of certain procedures, including endoscopic tattooing. Gastroenterology and endoscopy nurses play a large role in the safety and efficiency of GI Endoscopy suites.
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