References

Safe sedation practice for healthcare procedures.: Standards and guidance; 2013

Advisory Committee on the Safety of Blood, Tissues and Organs. Patient consent for blood transfusion. 2011. https://tinyurl.com/y88ap6nb (accessed 10 December 2018)

Thomas D, Wee M Blood transfusion and the anaesthetist: management of massive haemorrhage. Anaesthesia. 2010; 65:(11)1153-1161 https://doi.org/10.1111/j.1365-2044.2010.06538.x

Babiuc RD, Purcarea M, Sadagurschi R, Negreanu L. Use of Hemospray in the treatment of patients with acute UGIB—short review. J Med Life. 2013; 6:(2)117-119

Bager P, Dahlerup JF. Randomised clinical trial: oral vs. intravenous iron after upper gastrointestinal haemorrhage—a placebo-controlled study. Aliment Pharmacol Ther.. 2014; 39:(2)176-187 https://doi.org/10.1111/apt.12556

Barkun AN, Bardou M, Kuipers EJ International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med.. 2010; 152:(2)101-113 https://doi.org/10.7326/0003-4819-152-2-201001190-00009

Blatchford O, Murray WR, Blatchford M. A risk score to predict need for treatment for uppergastrointestinal haemorrhage. Lancet. 2000; 356:(9238)1318-1321

Button L, Roberts S, Evans PA Hospitalized incidence and case fatality for upper gastrointestinal bleeding from 1999 to 2007: a record linkage study. Aliment Pharmacol Ther.. 2011; 33:(1)64-76 https://doi.org/10.1111/j.1365-2036.2010.04495.x

Everett SM, Griffiths H, Nandasoma U, Ayres K, Bell G. Guideline for obtaining valid consent for gastrointestinal procedures. Gut. 2016; 65:(10)1585-1601 https://doi.org/10.1136/gutjnl-2016-311904

General Medical Council. Consent: patients and doctors making decisions together. 2008. https://tinyurl.com/y9g398ou (accessed December 11 2018)

Gralnek I, Dumonceau JM, Kuipers E Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47:(10)a1-46 https://doi.org/10.1055/s-0034-1393172

Haynes AB, Weiser TG, Berry WR A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med. 2009; 360:(5)491-9 https://doi.org/10.1056/NEJMsa0810119

Hwang JH, Shergill AK, Acosta RD The role of endoscopy in the management of variceal hemorrhage. Gastrointest Endosc.. 2014; 80:(2)221-227 https://doi.org/10.1016/j.gie.2013.07.023

Institute for Healthcare Improvement. SBAR Tool: situation-background-assessment-recommendation. 2018. http://www.ihi.org/resources/Pages/Tools/SBARToolkit.aspx (accessed 11 December 2018)

Kahi CJ, Jensen DM, Sung JJY Endoscopic therapy versus medical therapy for bleeding peptic ulcer with adherent clot: a meta-analysis. Gastroenterology. 2005; 129:(3)855-862 https://doi.org/10.1053/j.gastro.2005.06.070

Lo EA, Wilby KJ, Ensom MH. Use of proton pump inhibitors in the management of gastroesophageal varices: a systematic review. Ann Pharmacother. 2015; 49:(2)207-19 https://doi.org/10.1177/1060028014559244

Malfertheiner P, Megraud F, O'Morain CA European Helicobacter Study Group. Gut. 2012; 61:(5)646-64 https://doi.org/10.1136/gutjnl-2012-302084

Matharoo M, Thomas-Gibson S, Haycock A, Sevdalis N. Implementation of an endoscopy safety checklist. Frontline Gastroenterology. 2014; 5:(4)260-265 https://doi.org/10.1136/flgastro-2013-100393

McCarty TR, Njei B. Self-expanding metal stents for acute refractory esophageal variceal bleeding: a systematic review and meta-analysis. Dig Endosc.. 2016; 28:(5)539-547 https://doi.org/10.1111/den.12626

National Confidential Enquiry into Patient Outcome and Death. Time to get control? A review of the care received by patients who had a severe gastrointestinal haemorrhage. 2015. https://tinyurl.com/yagqblep (accessed 11 December 2018)

National Institute for Health and Care Excellence. Medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence. CG76. 2009. https://www.nice.org.uk/guidance/cg76 (accessed 11 December 2018)

National Institute for Health and Care Excellence. Acute upper gastrointestinal bleeding in over 16s: management. CG141. 2012. https://tinyurl.com/ybznup97 (accessed 11 December 2018)

National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management. CG184. 2014. https://tinyurl.com/y7dvjpry (accessed 11 December 2018)

National Institute for Health and Care Excellence. 2018. https://tinyurl.com/y76u975r (accessed 11 December 2018)

Ramaswamy R, Choi H, Mouser H Role of interventional radiology in the management of acute gastrointestinal bleeding. World J Radiol.. 2014; 6:(4)82-92 https://doi.org/10.4329/wjr.v6.i4.82

Resuscitation Council (UK). Guidelines and guidance. The ABCDE approach. 2015. https://tinyurl.com/njg37xq (accessed 11 December 2018)

Ríos Castellanos E, Seron P, Gisbert J, Bonfill Cosp X. Endoscopic injection of cyanoacrylate glue versus other endoscopic procedures for acute bleeding gastric varices in people with portal hypertension. Cochrane Database Syst Rev.. 2015; (5) https://doi.org/10.1002/14651858.CD010180.pub2

Rockall TA, Logan RFA, Devlin HB Risk assessment after acute upper gastrointestinal haemorrhage. Gut. 1996; 38:316-21 https://doi.org/10.1136/gut.38.3.316

Royal College of Nursing. Iron deficiency anaemia in adults. RCN Guidance for nursing staff. 2015. https://tinyurl.com/ybs34x94 (accessed 11 December 2018)

Scally B, Emberson JR, Spata E Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: a meta-analysis of randomised trials. Lancet Gastroenterol Hepatol.. 2018; 3:(4)231-241 https://doi.org/10.1016/S2468-1253(18)30037-2

Scottish Intercollegiate Guidelines Network. Management of acute upper and lower gastrointestinal bleeding. 2008. https://tinyurl.com/ybbt67yq (accessed 11 December 2018)

Selinger CP, Cochrane R, Thanaraj S, Sainsbury A, Subramanian V, Everett S. Gastric ulcers: malignancy yield and risk stratification for follow-up endoscopy. Endosc Int Open. 2016; 4:(6)E709-14 https://doi.org/10.1055/s-0042-106959

Shi K, Shen Z, Zhu G, Meng F, Gu M, Ji F. Systematic review with network meta-analysis: dual therapy for high-risk bleeding peptic ulcers. BMC Gastroenterol.. 2017; 17:(1) https://doi.org/10.1186/s12876-017-0610-0

Siau K, Chapman W, Sharma N, Tripathi D, Iqbal T, Bhala N. Management of acute upper gastrointestinal bleeding: an update for the general physician. J R Coll Physicians Edinb.. 2017; 47:(3)218-230 https://doi.org/10.4997/JRCPE.2017.303

Tripathi D, Stanley AJ, Hayes PC Clinical services and standards committee of the British Society of Gastroenterology. UK guidelines on the management of variceal haemorrhage in cirrhotic patients. Gut. 2015; 64:(11)1680-1704 https://doi.org/10.1136/gutjnl-2015-309262

Villanueva C, Colomo A, Bosch A Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med.. 2013; 368:(1)11-21 https://doi.org/10.1056/NEJMoa1211801

Walker IA, Reshamwalla S, Wilson IH. Surgical safety checklists: do they improve outcomes?. Br J Anaesth. 2012; 109:(1)47-54 https://doi.org/10.1093/bja/aes175

World Health Organiazation. Adherence to long term therapies: evidence for action. 2003. https://tinyurl.com/y7pr7tbh (accessed 11 December 2018)

Acute upper gastrointestinal bleeding: a guide for nurses

10 January 2019
Professional
02 January 2019
Volume 28 · Issue 1

Abstract

This article outlines latest evidence-based care for patients with acute upper gastrointestinal (GI) bleeding. It aims to help gastroenterology and general medical ward nurses plan nursing interventions and understand the diagnostic treatment options available. Acute upper GI bleeding can present as variceal or non-variceal bleeding and has a high death rate. Endoscopy is used for diagnosis and to provide therapy, prior to which the patient should be adequately resuscitated and assessed. Various therapies can be initiated at endoscopy, depending on the source of bleeding. If bleeding continues in spite of these therapies, further interventions such as the Sengstaken tube, oesophageal stents, radiological or surgical treatments may be required. After endoscopy, it is important to have a plan for ongoing treatment. Patients may require acid suppression treatment or eradication of Helicobacter pylori as part of their treatment plan. They may in additional require correction of their haemoglobin levels and follow-up endoscopy. It is essential that nurses caring for such patients are aware of the current UK guidance and help patients to adhere to agreed treatment plans.

Acute upper gastrointestinal (GI) bleeding is a common medical emergency with an estimated incidence of 134 per 100 000 population (Button et al, 2011). It occurs above the ligament of Treitz, the boundary between the duodenum and the jejunum. National guidelines have been produced by the National Institute for Health and Care Excellence (NICE) (2012) and by a collaboration between the Scottish Intercollegiate Guidelines Network (SIGN) and the British Society of Gastroenterology (SIGN, 2008) to improve patient outcomes. However, the 2015 National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2015) review on patients with acute upper GI bleeding found variable practice and less than adequate standards of care. Consequently, NCEPOD proposed a set of criteria to standardise practice (NCEPOD, 2015: 97-98). Despite these, it is noteworthy that guidance specific to nursing care is lacking, and yet it is essential that nurses caring for patients with acute GI bleeding are aware of the current standards to ensure optimal care.

Register now to continue reading

Thank you for visiting British Journal of Nursing and reading some of our peer-reviewed resources for nurses. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to clinical or professional articles

  • Unlimited access to the latest news, blogs and video content

Register
Or continue by

Signing in with your registered email address

Upper gastrointestinal bleeding
Endoscopy
Variceal bleeding
Non-variceal bleeding
Evidence-based practice