passing gas (yes I mean farting)

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    Do you make it a practice of not sending post colonoscopy patients home, or limiting their PO intake, if they haven't passed gas? Some co-workers make such a big deal of patients who are fine, belly not distended, they feel fine, but the patient cannot honestly say yes to "have you passed any gas." These co-workers keep the patients longer or page the doctors. These are out patient procedures with base line healthy patients? I may be wrong, I often am, but I don't think patients are going to get what??? paralytic ileus? after a colonoscopy? I know the colonoscope suctions out the air on its way out.
  2. 9 Comments so far...

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    My understanding is that they can be quite uncomfortable until a certain amount of the gas comes out. And excess discomfort = off shift calls to MD. I can also attest to the fact that the fact that the scope doesn't remove nearly enough of the air, for many pts to be "comfortable" - I have always felt really bloated afterwards.
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    Thanks, is there any trick to get rid of that bloated feeling? I understand your reply. I'm refering to patients who say, "I feel fine, why can't I go home." Yet the nurse keeps saying, "you have to pass gas."
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    I read somewhere that having them lie on their left side aids in their ability to expel the excess air. It makes sense if you think of the anatomy involved and the fact that "gas rises" -- lying on the left puts the rectum/anus higher than the descending colon.

    Also, please do NOT tell them that they're "all cleaned out, so all that will come out is air if you feel the need to pass gas". This is what the post-procedure nurse told me, but I had no sedation with my colonoscopy (I wanted to watch, plus I had no driver), and I *saw* the occasional little puddles of yellow liquid in there. As a result, I erred on the side of caution and only farted on the toilet -- and I was smart to do so!
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    Thanks, yes I know about the left side, but am glad you said it, I get stupider the older I get!!! I keep kind of thinking ?is it the left side or right side? Now I will remember. I usually tell the patients to let all the air/gas out so they won't get a stomach ache, won't feel bloated. I appreciate your comment. What if I assure them that if some stool comes out it of course is ok, we have padding under them and would rather clean up a little stool than have them bloated and uncomfortable? If they are sedated we don't want to get them up the the bathroom right away and don't want them to "hold it" until they can get to the toilet?
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    I think it would be good to explain to them that it will HURT if they don't start farting when they get the urge, or maybe even tell them that you're not supposed to let them go home until you hear some toots, so let 'em rip. I think even more than the sound, people are concerned about "odor" issues. Explaining that it's "air" and not "gas" might help them get over that fear.

    Another thing that will help is if they can draw their knees up to their chest a bit, kind of a fetal position. (a pillow between the knees might make this more comfortable by keeping the hips aligned better) Ever notice how babies pull their knees up when they poop? (they know what works and feels best!)

    And I just noticed your screen name... kind of appropriate that you have "brown" in your name, eh?
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    Ha Ha, brown, ok I get it, thanks. Do you work GI? Do you know anything about flatus bags? We now have these flatus bags available. It is just a lubricated slightly rigid tube with a plastic bag connected. Of course I am told, "it is easy, just insert it and you will hear some gas come out." I don't know, I get obsessive over new to me interventions, does it matter how far into the colon you insert it? The tube is about 12 inches long. One inch? Six inches? Insert until I hear some gas? Does it do any good to leave it in 5 to 10 minutes? Or is it meant to be a short in and out treatment? Also I am still confused about post colonoscopy patients. I still don't understand why passing gas in recovery matters so much? Is it ONLY for the patients comfort that we are concerned? I can't think of any serious medical consequences of a patient going home without passing gas? Re-read my original post, the patient feels fine and wants to go home, and the nurse is saying, no you haven't passed gas! Sure if the patient feels bloated and uncomfortable interventions are fine, but otherwise?????
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    Sorry, I'm not a nurse (yet) -- just someone who has spent way more time than the Average Joe in endoscopy units.

    I usually get an EGD, but this last time was a colonoscopy. I was doing it unmedicated, so I read as much as I could beforehand so that I'd know what to expect (that's where I learned the lying on your left side thing).

    As far as using flatus bags, I think your facility should have a protocol set up regarding their use. My personal belief is that they should be an "only when indicated based on discomfort" type of thing, but if your facility says that they have to stay until they fart (even when comfortable), that's up to them to mandate.

    Personally, I didn't fart for quite some time after the procedure (and that was only when on a toilet for the first few hours!). I wasn't uncomfortable or anything -- my GI must've done a good job of sucking out the air before "Elvis left the building" I guess.
    brownbook likes this.
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    Our endo unit doesn't have a "fart or you stay" policy, but we strongly encourage our pts to let it go if they feel the urge, only because the air can travel backward up the colon and really start hurting in your chest, shoulder, etc. A few of my pts have said they had no urge to pass the air, and never did, and they felt fine. Most rip huge ones which still makes me giggle every time I hear it (I have 4 sons - God knew what he was doing when he made me a boy mom AND a GI nurse, haha). We have a lot of fun with our patients where this is concerned. We put their minds at ease and tell them we are proud of them when they fart.

    A few things:

    One time I told a patient who was worried about "blow-by" (passing stool with air) that it was totally okay and the pad would take care of it, and I would get her a damp cloth to clean up if she needed it. I came in later to DC the IV and she was wiping her bottom with CAVI WIPES!!!!!!! We used to keep a container of them in the rooms but we don't any more.

    One time I had a 40ish man who was hurting horribly and nothing we did would help. He couldn't pass air and I knew that's all it was. We gave him Levsin (twice), we had him lie on his left side, knees to chest, walk around, use the toilet, nothing. Then I told him to get into the sleeping baby position (butt up) and he absolutely exploded!! He was laughing and doing these enormous farts and everyone on the unit started laughing. The great thing was, he wasn't a bit embarrassed because the relief was so huge.

    We do use the flatus bags on occasion and I have had some really good results with them. I put the pt on their left side knees to chest, lube the tip really well, and insert about 2 inches. Usually that does it, but if not, I advance another inch or so and that usually does it. They're easy to use, they're not particularly uncomfortable for the pt, and they tend to work pretty well.
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    CFitz, thanks so much, you really answered all my questions. We also keep cavi wipes at the bedside. I'll mention to our charge nurse the unforeseen dangers of this.


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