[SheaTabRN]

Have you guy's heard of giving a "quadrant replacement" with a newly admitted gastroschisis. There is very little info on the net about this and even most all of my fellow nurses really didn't know what it was all about. I know that the baby is prone to lose a lot of water through the exposed intestines. Is the "quadrant replacement" similar to "fluid resuscitation" that we give burn victims? Does anyone know how they decide how much to give??

Thanks!

Tab

[RN from OZ]

I have nursed a few of these bubs in Oz but have not heard
of this. we wrap the bowel in wet gauze and irrigate frequently.

[acuteobrn]

I in no way have experience with this but I did see something interesting on TLC about this...The child was born with so much bowel outside that when they went to the OR they found it wouldn't all fit without causing further damage. So they created a fluid filled pouch that the bowel was incased in and sutured it the opening that the infant already had in the abdominal wall. They then began gently "squeezing" in more bowel a little every day until it was replaced, took about a week or so, then went back and repaired the abdominal wall. Was pretty interesting, baby did well with this too. Don't recall the name of the procedure though, I wonder if this applies to that "quadrant replacement" thing??? Just a thought.

[SheaTabRN]

AcuteObRn... I think you are referring to placing the bowel inside a Silo. This is a silastic material that protects the bowel while allowing time for the abdominal wall to stretch so that it can accomodate the intestines. I was referring to the additional fluids that are sometimes given to a gastroschisis baby (the doc called the fluids quadrant replacement). No one that was asked on my unit was familiar with it. Bizarre! I can only assume it is given because the baby is prone to lose excess fluids with exposed guts?????
Thanks for your reply. "quadrant replacement" does sound a lot like the procedure you're describing. I should have been more specific. Have a wonderful day! Tab

[acuteobrn]

Hey Tab, thanks for the clarification...just thought I would take a stab at it...I am interested what the final answer is though. Things like this give my brain cells their daily excersize Sounds interesting. I like NICU nursing, some of the things that you all can do there amazes me. I use NICU nurses all the time in bad deliveries and most are so good at what they do!!! Have a good one!

[dawngloves]

I'm not sure, but I think it would be difficult to give fluid replacement in such large amount, like they do for burn pts, to a neonate. Such a huge margin of error for overload.
We ship all our gasteros out so we just bag 'em and roll 'em. I think the "quadrent replacement" is the slow squeezing of the intestines in the silo into the abdomen you just mentioned.

[SheaTabRN]

For anyone who is interested....

I asked one of our docs last night about this... since it was my first night back! He said that no one really does it anymore and that it was a ARNP who did. The quadrant replacement (in an article, I believe he said...) was suggested to be given to babies with a variety of different gut disorders. It is based on the number of quadrants affected by the disorder. This is not a certain formula and the M.D. told me that I would have to read the article... but something like and PLEASE don't quote me: Maintainance: 100cc/kg/day and 25 cc for every quadrant affected. Voila! Must not be very popular at all since I can't find a darn thing about it with GOOGLE!

Peace!

Tab