Overview
Esophageal pH monitoring is a diagnostic procedure used to measure acid exposure in the esophagus over a 24-hour period. This protocol outlines the standard procedure for both catheter-based and wireless pH monitoring.
Equipment Required
- pH monitoring device (catheter-based or wireless)
- Calibration solutions (pH 4.0 and pH 7.0)
- Recording unit
- Patient diary
- Protective equipment
Pre-Procedure Protocol
Patient Preparation
-
Medication Discontinuation:
- Stop PPI medications 7 days prior
- Discontinue H2 blockers 48 hours prior
- Stop antacids 24 hours prior
-
Fasting Requirements:
- No food for 6 hours before procedure
- No liquids for 4 hours before procedure
Procedure Steps
1. Calibration
- Calibrate probe using standard solutions
- Document calibration values
- Verify system functionality
2. Placement
-
Catheter-based:
- Insert probe transnasally
- Position 5cm above LES
- Confirm placement via manometry
-
Wireless:
- Place during endoscopy
- Attach capsule 6cm above SCJ
- Confirm attachment
3. Recording Period
- Initiate 24-hour recording
- Instruct patient on diary completion
- Review activity restrictions
Post-Procedure Protocol
Data Analysis
- Download recorded data
- Analyze key parameters:
- Total acid exposure time
- Number of reflux episodes
- DeMeester score
- Symptom correlation
Documentation
- Record procedure details
- Note any complications
- Document patient compliance
Quality Measures
- Minimum 16 hours of recording
- Complete symptom documentation
- Proper calibration values
- Adequate data quality
Troubleshooting
- Signal loss protocols
- Equipment malfunction procedures
- Patient compliance issues