Page 2452 - Saunders Comprehensive Review For NCLEX-RN

medications to induce vasoconstriction
and reduce bleeding.
m. Instruct the client to avoid activities
that will initiate vasovagal responses.
n. Prepare the client for endoscopic
procedures or surgical procedures as
prescribed.
4. Endoscopic injection (sclerotherapy)
a. The procedure involves the injection of
a sclerosing agent into and around
bleeding varices.
b. Complications include chest pain,
pleural effusion, aspiration
pneumonia, esophageal stricture, and
perforation of the esophagus.
5. Endoscopic variceal ligation
a. The procedure involves ligation of the
varices with an elastic rubber band.
b. Sloughing, followed by superficial
ulceration, occurs in the area of
ligation within 3 to 7 days.
6. Shunting procedures
a. Description: These procedures shunt
blood away from the esophageal
varices
b. Portacaval shunting involves
anastomosis of the portal vein to the
inferior vena cava, diverting blood
from the portal system to the systemic
circulation (Fig. 69-20).
c. Distal splenorenal shunt: The shunt
involves anastomosis of the splenic
vein to the left renal vein; the spleen
conducts blood from the high-pressure
varices to the low-pressure renal vein
(see Fig. 69-20).
d. Mesocaval shunting involves a side
anastomosis of the superior mesenteric
vein to the proximal end of the inferior
vena cava.
e. Transjugular intrahepatic portosystemic
shunt (TIPS): This procedure uses the
normal vascular anatomy of the liver
to create a shunt with the use of a
metallic stent; the shunt is between the
portal and systemic venous system in
the liver and is aimed at relieving
portal hypertension.

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