Peter van Mourik

84 Chapter 4 5. The nurse opens the 50 mL collection tube containing PBS0 or storage media (Ad-DF+++ with additional gentamicin (50 µg/mL) and vancomycin (50 µg/mL)) at 4°C and properly labelled for the rectal biopsies (with clean gloves). 6. Apply lubricant (e.g. K-Y Jelly) to the rectal suction biopsy device. 7. Carefully introduce the suction biopsy device rectally, approximately 5 cm distance from the anal verge. 8. Position the opening of the suction biopsy device between 45 and 90 degrees laterally from the dorsal side to avoid arteries (see figure 2). 9. Obtain a biopsy from the rectum/ colon, with a defined suction pressure of 30 kPa/0.3 Bar. 10. Release the rectal (colon) biopsy from the device by twirling and shaking the frontal side in the collection tube containing 20 mL storage media at 4 °C (either PBS0 or Ad-DF+++ with additional gentamicin (50 µg/mL) and vancomycin (50 µg/mL)) and until the biopsy is visible in the fluid. 11. Repeat steps 5-10 until a minimum of 4 good quality biopsies have been successfully isolated and collected (all biopsies can be collected in the same tube). 12. After the procedure the nurse firmLy closes the collection tube and takes off her gloves. 13. Maintain the collection tube with the biopsies on ice at ~4°C in a styrofoam box 14. After the procedure is finished the patient should remain in the hospital for an additional hour to check for potential rectal bleeding. In case of severe or persistent rectal bleeding a qualified physician should be consulted. 15. When no complications are observed the patient can be discharged. 16. Inform the patient about potential late onset rectal bleeding. In case of late onset rectal bleeding a qualified physician should be consulted. Figure 2. Cross-sectional view of the colon with advised positioning of the rectal suction biopsy device opening