Passing gas after surgery...
- 0Feb 1, '08 by MikeyJGenerally speaking, how long after laparoscopic surgery should the patient begin passing gas? Is there a general rule as to how long before the doctor should be notified? And finally, any nursing interventions to promote passing gas?
- 0Feb 1, '08 by ginger58One thing I might add also is when I had laporscopic gyn surgery, the CO2 they pumped in really put pressure on my bladder and when I went to urinate hours later I became very lightheaded on the toilet. It was 30 years ago but I remember something like that happening. It was very frightening. I don't remember anyone being worried about passing gas.
- 2Feb 2, '08 by BaByNuRsE07Hi,
On our general surgery unit, we expect a pt to begin passing gas by post-op day 2.
Ambulating will work wonders to help pass gas when the abdomen is distended. Sometimes a little ginger ale helps too.
When making rounds, most of our surgeons ask if the pt is passing gas in order to advance their diet by day 2.
Hope this helps!
- 10Feb 2, '08 by TiredMDAlthough there is really no good evidence for it, we traditionally describe a "normal" postoperative ileus as lasting 2-3 days, and "paralytic" postop ileus as >72hrs. The small bowel will normally return to normal function before the colon, which is why we hear bowel sounds before the patient starts passing gas or pooping.
The duration of the ileus will be dependent on a number of factors, including the type of surgery, the type of anesthesia, any postoperative narcotics being used, and whether or not the patient is being fed.
As mentioned above, walking is a commonly accepted method to speed the return of bowel function, and some studies seem to bear it out. Interestingly, gum chewing has also been shown to reduce the time to ileus resolution, as has early feeding, NSAIDs, and laxatives.
The General Surgeons love asking about flatus. Personally, I don't. Too often patients either don't know they are passing gas or don't like to admit it. There is also some question as to whether flatus is a true marker of ileus resolution.
I try to get them out of bed as soon as possible, keep them on a good bowel regimen, and wait for stool. Ortho doesn't see nearly as many paralytic ileuses as General Surgery, so that usually does the trick.
- 4Feb 2, '08 by sharannIt can take hours to a day or 2. IT also is extremely(REALLY) painful. As a former lap hyst patient and as a recovery RN I have experienced this from both ends (ha ha ends...). The gas pains can also cause chest pains and shoulder pains(both referred from gas trapped under the diaphragm. It can be worse than labor pains. Please, medicate heavily for this because until the patient gets walking(a few hours) the pain will be horrible at times. Don't judge the surgery based on those "little band aids). It is bad.
Walkining and turning in bed from side to side makes things move.
Tired MD, I heard about the gum chewing as well moving things along. Stimulates digewstive enzymes and peristaltsis.
- 0Feb 2, '08 by NurseNatureSo... in school we are taught to check each quadrant for 5 minutes before declaring no bowel sounds... my question is this- do all you practicing nurses actually do this on each assessment post-op? I don't see how the nurses would have time to do a twenty min bs check, especially when you don't expect them to have any for at least one day. Just wondering.
- 3Feb 3, '08 by putmetosleepQuote from FutureNurseLoriSimply put....NO. I don't know a single nurse who listens for 5 minutes for BS in each quadrant. Interestingly, the AACN recommends 2-5 minutes in each quadrant. If I've listened for 2 minutes in one quadrant and not heard any bowel sounds, I'm going to say that they are extremely hypoactive or more than likely absent. Period. If my pt is 3-4 days post-op, I might listen a little bit longer. But there is no way in **** bedside nurses have the time to do this. Besides, when is the last time you saw an MD listen for 5 mins in each quadrant?So... in school we are taught to check each quadrant for 5 minutes before declaring no bowel sounds... my question is this- do all you practicing nurses actually do this on each assessment post-op? I don't see how the nurses would have time to do a twenty min bs check, especially when you don't expect them to have any for at least one day. Just wondering.