Question about bowel resection patients and when to advance diet

[deespoohbear]

I was just curious to see what other facilities are doing in regards to these surgeries. At the hospital I work at we get bowel resection and colectomy patients often. Our hospital has 2 surgeons, Dr. A and Dr. B. Both surgeons' patients come back from OR with a NG tube in place. Dr. A likes low intermittant suction and Dr. B likes cont. low suction. Dr. A will usually let his patients have ice chips and small amounts of 7-up to help keep their mouth moist. Dr. B may allow 30cc's ice chips each shift and that is it. Dr. A usually pulls the NG in a couple of days (once the patient starts having bowel sounds and flatulence). Dr. B will leave the NG tube in for a week sometimes (or longer) and just let the person have ice chips. Even if the person has good bowel sounds and passing flatuelence the tube will remain. That just seems like an awfully long time to not give anyone any substantial food. I know that you can't push a person's GI tract after such major surgery but geez that seems like a long time. I would just like to know about other facilities and surgeons and they way the deal with bowel resections and partial colectomies. Thanks for your input.

[canoehead, BSN, RN]

WE let them have ice only when the NG is in and pull the NG according to the amount of drainage it has (minus the ice of course) and with the return of bowel sounds. We also sometimes check residuals Q4H without suction before pulling the tube. Then they start on clears and gradually increase according to tolerance, which is mostly left with the nurse. For myself, I go slowly, and wait until they are hungry for more substantial food before I give it. Some nurses advance them as long as they are not actively vomiting (ugh)

[shannonRN, BSN, RN]

we have about 5 surgeons who do bowel resections...i can't remember all of their protocol. we have a list on the unit. one doc allows ice chips and hard candy with the ng, some of the others want them kept npo. we usually start a clamping schedule(clamp 3, open 1) with the patients a few days post-op...if they tolerate the clamping the ng is pulled. the diet is advanced depending on the md...the majority start advanced with there are bowel sounds and pt is passing flatus...then again, when they begin having stools. we all know what a monumental feat that can be!!! :wink2:

[pebbles, BSN, RN]

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.

[Fgr8Out]

I've seen every imaginable post-op treatment for our bowel resection patients. But by far, the most frequently heard comment among our surgeons is..."if you fart, we'll feed you."

LOL needless to say, our patients are quite the musical group with this sort of incentive. :roll :roll :roll :roll