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Bowel screening: Nitrous for sedation

Bowel screening: Nitrous for sedation

What is the Bowel Screening?

Bowel cancer is the second most commonly diagnosed cancer overall for both men and women in New Zealand, and the second leading cause of death from cancer. Bowel screening can help save lives by detecting bowel cancer at an early stage when it can be more easily treated and often cured. This is important as there may be no warning signs that bowel cancer is developing.

Bowel screening in New Zealand involves people within a certain age range being offered a screening test called an immunochemical faecal occult blood test (iFOBT) to check for tiny traces of blood in their bowel motions that may be an early warning there is something wrong with their bowel.

If blood is found, participants are offered a diagnostic colonoscopy which can detect polyps and cancers if they are present. Polyps are not cancers, but they are growths that may develop into cancers over a number of years. Polyps can usually be removed during a colonoscopy.

What is a colonoscopy?

A colonoscopy is the most common test used to check the bowel and involves a specially trained doctor passing a thin flexible tube with a light and camera on the end around the large bowel (colon). This is not generally a painful procedure but it can be uncomfortable.


Bowel Screening Programme - Waitemata

Bowel Screening Programme - WaitemataIn October 2011, Waitemata DHB was chosen to host the pilot for the bowel screening programme for men and women aged 50-74. Of the participants who completed and returned their at-home test to date:

  • over 7,800 people received a "positive" result and were referred for an investigative colonoscopy
  • over 320 people were diagnosed with bowel cancer, most of whom had no symptoms prior to screening

The success of the programme has led to the extension of our pilot until December 2017, and in May 2016 the Minister of Health announced that bowel screening would begin rolling out nationally in 2017.


Bowel screening patient story

View more about Chrissie and Pio's bowel screening journey:

Patient story: Chrissie and Pio - Bowel screening journey


What are we trying to achieve?

We are continuously trying to improve the service that we provide. One of the issues identified within the service has been sedation options for patients requiring a colonoscopy for further investigation following a positive test result.

Historically we have used intravenous (injected into a vein) sedation for this procedure. When this is used, the participant cannot drive, and must have someone with them for 12 hours following the procedure. This is very difficult for people who live alone, have a partner who cannot or is unable to drive, or who live a long way from the hospital. 

We wanted to find an alternative sedation method to:

  • improve patient experience
  • reduce patient recovery time post-procedure
  • increase patient attendance

What have we done?

We undertook a review of alternative sedation methods by:

  • researching colonoscopy procedures in the UK
  • investigating use of sedation methods in our organisation
  • consulting internally with our pharmacy, anaesthetic department, senior nursing team and gastroenterology department

We identified Nitrous Oxide as being a safe alternative for sedation. Nitrous Oxide is commonly known as ‘laughing gas’ and is used for controlling pain, with additional benefits such as reducing fear and anxiety, and memory of pain.

Nitrous oxide for sedation


Resource development

  • With support from Dr Russell Walmsley we developed the policy 'Nitrous Oxide for Endoscopy Procedures'
  • Developed supporting resources including:
    • Nitrous Oxide information for patients
    • Assessment checklist for the use of Nitrous Oxide in endoscopy
    • Nitrous Oxide administration notes for registered nurses
    • Nitrous Oxide quiz for registered nurses

Did we make a difference?

We started using Nitrous Oxide in June 2016 and patient feedback has been very positive, with everyone commenting that they would be happy to have another colonoscopy using the same method of sedation.

It has enabled some participants to attend a colonoscopy appointment and have their discomfort controlled with Nitrous Oxide where otherwise they either would not have attended, or may have had no sedation and endured the discomfort.


Where to from here?

  • Nitrous Oxide is not intended to replace intravenous sedation but it does offer a viable alternative for some participants
  • We will continue to use and closely monitor the effectiveness of Nitrous Oxide in the endoscopy setting and it will further evaluated in the 2017 endoscopy patient satisfaction survey
  • We will work with our pain service to develop a recommended best practice for Nitrous Oxide use in the wider hospital setting