Irrigation (procedure) - v1.0

Hi Yongsheng Gao , could you review this template for me please? 

Thanks Yongsheng Gao I've updated this above.

The previous discussion in GC-1199 states "Discussed whether irrigation should actually follow the injection model and decided that it shouldn't. The conceptual difference being that in an injection the thing being injected is the substance, so direct substance is correct. In irrigations you are not irrigating the substance but rather irrigating a site/device but using a substance to do the irrigation."

However, this approach, as adopted in this template, seems problematic since Irrigation - action is a still a subtype of Administration - action, which in turn is a subtype of Introduction.  This necessarily implies that the irrigating liquid is the direct object of the Method Irrigation - action,  since it (and not the recipient site) is the thing being introduced.  Irrigation (procedure) still infers under Introduction (procedure) and  has a text definition of "Administration that washes with a stream of liquid." 

To align with the template, both the parent of Irrigation - action and the text definition of the procedure would have to be revised.  The latter would be simple enough - it could be reworded as "Washing with a stream of liquid."  If Irrigation - action is not considered a kind of introduction or administration of substance, then the most proximate parent seems to be the top-level Action (qualifier value).  (Conceivably one could argue for a parent of Removal - action,  if irrigation is considered a form of washing and therefore "removes" dirt or contamination, but this is a bit of a stretch).liquid

Yongsheng Gao 

Hi Yongsheng Gao 

I think the template can remain as-is provided that Irrigation - action is made a subtype of Action (qualifier value) and the text definition for Irrigation (procedure) is also changed from "Administration that washes with a stream of liquid" to "Washing with a stream of liquid," to remove both connections between irrigation and administration.

I can see the logic of including Procedure device in the template, since in an irrigation procedure, the device might be considered the direct object of irrigation (as in Irrigation of tube (procedure) or might be Using device (as in Irrigation with syringe (procedure), or even Access device as in Bronchoscopic lavage (procedure) (SYN Bronchoscopic irrigation).

 I am wondering, though, if it wouldn't be a good idea to add some explanation in the template and/or in the EG to clarify when the different device attributes should be used in irrigation procedures, and when a procedure site should be included. There is a lot of confusion about the use of the various "direct" and "indirect" procedure attributes, especially in combination, so I do think additional, explicit guidance on these points would be helpful:

• Should a procedure site relationship should be added when the FSN specifies irrigation of a device that is defined in terms of its anatomic location . There is inconsistency in the modeling of existing concepts:

  Irrigation of biliary tube (procedure) is currently modeled with a RG of Method Irrigation + Procedure site Indirect Biliary tract + Direct device Tube

  Nasoenteric tube irrigation (procedure) is modeled with a RG of Method Irrigation + Direct device Nasoenteral tube, with no procedure site. 

  I think the identification of the tube itself by where it is placed does necessarily implies a procedure site, but there isn't any clear guidance or consistent precedence to indicate which of the above approaches should be used.
• If a procedure site should be included, it would also be helpful to provide clear guidance on whether the body structure is the direct or indirect site.  If the intent is to irrigate (wash out) the lumen of the device, the body structure would be considered the indirect procedure site, and perhaps it is reasonable to infer that this is the intended meaning if the FSN is Irrigation (or lavage) of <device> (I think  <Device> irrigation is a bit more ambiguous, but would probably be reasonable to interpret the same way. Conversely, If the intent is to irrigate the body structure in which the tube or other device is placed, the FSN should be phrased to make that clear and the Method Irrigation would be grouped with a Procedure site Direct and Using device relationships, e..g. the clearly named and modeled  Irrigation of colon via cecostomy tube (procedure).