Gastric drainage

[fortomorrow]

What are considered normal post op gastric resection drainage parameters? What would be means for concern?

[Daytonite, BSN, RN]

http://www.surgeryencyclopedia.com/fi-la/gastrectomy.html

never knew there was a "normal" post op drainage parameter. its more about comparing what is draining from shift to shift. in all the years i've been a nurse the standard is to observe and measure the output from these drains qshift and report anything abnormal. normal 24 hour i&o should be looked for. if post op output is a huge percentage of the 24 hour output, notify the surgeon. if the post op drainage begins to increase significantly from one shift to another, notify the surgeon. if blood clots or dark blood start to show up in the drainage, call the surgeon. if the patient stills has some of their stomach left and they begin to get nauseated and throw up, check the patency of any n/g tube, assess the abdomen for distension and if it is present with only scant drainage, call the surgeon.

[fortomorrow]

Thx much for the reply guess i should have been more clear with my question. Have a patient priority assignment and one of the patients had a gastric resection at 1630 yesterday. 27 hour post op, its is now 0720. His VS are WNL.Salem sump pump on intermittent suction drained 675ml of bloody green drainage during the night. Cathed at 0400 for 250 ml and dressing changed with large sero-sanguinous drainage. Is the drainage color and amount appropriate or is he a great concern.

[Daytonite, BSN, RN]

I would not be concerned. See what the next set of figures shows. If they removed the entire stomach they probably cut him up good which is why he has a lot of drainage. What are his vital signs like. If he's hemorrhaging it is more likely to show up in the vital signs and CBC.

[fortomorrow]

His hourly VS BP 112-120 over 64-70, last 114/64; pulse 80-96, last 96. The assignment doesn't give any word on labs. Thx much for your help.

[Daytonite, BSN, RN]

I wouldn't worry about his postop drainage. He's hypertensive. If he were hypovolemic (hemorrhaging or losing too much blood) he would have some of the following symptoms (I experienced some of them when I had a BIG GI bleed over Christmas week):

• elevated pulse
  
• diminished blood pressure
  
• absence of perfusion as assessed by
  
  • skin signs (you will clearly notice this)
    
    • skin turning pale
      
    • poor capillary refill on forehead, lips and nail beds
      

  [*]dizziness

  [*]feeling faint

  [*]nausea

  [*]thirst

But do monitor him for hypovolemic shock and watch what is happening with the drainage. However, hemorrhage may not always be as bold as to show up in the drainage so assess that abdomen frequently.

Stages of Hypovolemic Shock

• Stage 1
  
  • Up to 15% blood volume loss (750mls)
    
  • Compensated by constriction of vascular bed
    
  • Blood pressure maintained
    
  • Normal respiratory rate
    
  • Pallor of the skin
    
  • Slight anxiety
    

  [*]Stage 2

  • 15-30% blood volume loss (750-1500 ml)
    
  • Cardiac output cannot be maintained by arterial constriction
    
  • Tachycardia >100bpm
    
  • Increased respiratory rate
    
  • Blood pressure maintained
    
  • Increased diastolic pressure
    
  • Narrow pulse pressure
    
  • Sweating from sympathetic stimulation
    
  • Mildly anxious/Restless
    

  [*]Stage 3

  • 30-40% blood volume loss (1500-2000 ml)
    
  • Systolic BP falls to 100mmHg or less
    
  • Classic signs of hypovolemic shock
    
  • Marked tachycardia >120 bpm
    
  • Marked tachypnea >30 bpm
    
  • Decreased systolic pressure
    
  • Alteration in mental status (Anxiety, Agitation)
    
  • Sweating with cool, pale skin
    

  [*]Stage 4

  • Loss greater than 40% (>2000mls)
    
  • Extreme tachycardia with weak pulse
    
  • Pronounced tachypnea
    
  • Significantly decreased systolic blood pressure of 70 mmHg or less
    
  • Decreased level of consciousness
    
  • Skin is sweaty, cool, and extremely pale (moribund)
    

Best wishes to the patient. He has many challenges ahead in the coming months and for the remainder of his life depending on how much and what parts of the stomach were removed.