We keep NG in for 2-3 days, pt can have as many ice chips as she wants, but we measure the H2O consumption if pt is taking *lots* of ice. (One glass ice chips=50cc water). As long as it's coming out of the NG, what's the big deal how much ice the pt gets, fluid "balance" is the key. Clamping and removing NG goes by pt indicators - bowel sounds, flatus. Clear fluids start at two or three days, with the NG clamped, and NG is removed if pt tolerates fluid for six hours. Pt starts getting nauseous, back to NPO and NG is reconnected. Docs will give us an order for "Clear fluids to Diet as Tolerated", and it is up to the nurse to assess the pt's tolerance. We are very pragmatic, and change our approach more to fit the patients experience of his own body than any one doctor's routine. Everybody is different. Also, the nurses on my ward seem to have more... power?... than others - we would not let a doctor dictate only 30 cc ice chips, unless HE wants to tell the patient that AND mete out the ice chips to a pt with a parched dry mouth! Like we're not busy enough!
Also, there are apparently two schools
of thought on feeding after bowel surgery. One is to wait three to five days, let the bowel rest and heal, recover from post-op paralytic ileus, etc. Feeding would overstimulate the bowel and lead to complications... The second theory is that feeding stimulates the bowel into action, and prevents complications by starting fluids sooner after surgery. So, as long as the pt tolerates fluids, you'd go ahead with progressing diet. I work at a large teaching hospital, and the attending surgeons take it in turns each week to be in charge of Rounds and plan of care... so the approach is totally inconsistent, but can be seen as following one or the other of those two major theories.