How do you induce passing gas post-op?

[bjaeram]

So it's 12 days since surgery to remove a bladder and make a new one from intestine. Still no gas, nausea with the littlest bit of oral intake. Is this ever normal? The doctor doesn't seem concerned and just wants to wait. I'm concerned the patient is frustrated and was supposed to be home already. Xray shows ileus. Otherwise healing well from surgery. Are there any tricks to get things moving other then moving. He does walk the halls a lot already.

[netglow, ASN, RN]

12 days?! Sheesh. Distension? Tympany/pain on palp? Bowel movement?

[MassED, BSN, RN]

hold on, lemme go ask my husband...

[jmqphd]

For the normal patient who is sort of distended: Have them lie on one side with their knee pulled up (as if you're going to give them an enema.) Have them lie there for plus or minus 10 minutes. Then lie on their backs for an equal amount of time. Then lie on their other side with their knee pulled up... about the same amount of time. The principle is that gas will rise to the "top" and the bubble of gas will work its way through the sigmoid.

For someone who is deathly ill with constipation (and I've seen it happen) a cholinomimetic drug will cause peristalsis and relax sphincters. But this patient has suture lines in the gut and it could be (almost certainly will be) too forceful for this patient.

For the same reason, the surgeon probably won't order any enemas? The notion is to keep any pressure off the sutures. Having said that, gas accumulation could put tension on a suture line also.

Good luck.

[1icurn.jn]

chewing gum if ok with MD.

[P_RN, ADN, RN]

NG tube?

[ImThatGuy, BSN, RN]

Stand him on his head. Gas rises right? Right. Then apply gentle yet firm squeezes to the lower (now upper) abdomen.

Journal of Relief.

[hiddencatRN, BSN, RN]

Look up the yoga poses called cat and cow. You basically get on your hands and kneed and alternatively arch your back and extend your neck and butt. Also, lying on your back and hugging your knees and rocking side to side works too

But holy cow, 12 days?? Isn't that concerning?

[casi, ASN, RN]

Has he had a bowel movement?

[canesdukegirl, BSN, RN]

Did this pt have a Kock pouch procedure?

I think that perhaps increasing some oral intake would help to a degree. What is the pt taking for nausea? Zofran? What kind of narcs are they on? It is helpful that the pt is ambulating. I am as concerned as you are that this pt has not had any gas. What do you find on auscultation of the abdominal quadrants?

I would try to encourage fluids if the pt is able to tolerate it. Start slowly, of course. If the pt is not able to tolerate PO, inquire about different medications to abate nausea. I know that MDs are trying to stay away from Phenergan (and rightly so because there is not a reversal drug for Phenergan) because in days past, MDs would routinely prescribe Phenergan and various narcs post op. This left the pt feeling extremely groggy and not at all open to the thoughts of ambulating.

If your pt cannot tolerate PO after exhausting anti-emetics and also has absent or diminished bowel sounds, I would be concerned about obstruction.

[thehipcrip]

If the patient is on a regular diet, have him/her eat a half-3/4 cup serving of prunes, which act as a stimulant to peristalsis and provide much needed fiber. If the prunes don't stimulate the production of gas, this is not just a sluggish bowel.

[Katie5]

If pt is able to tolerate oral intake, give him beans or eggs.

Ghastly smell-astounds me sometimes!