GoLytely Prep, on a GI Bleed

[BertinaRN, ASN, RN]

I work a busy Med-Surg unit normally but last night I was sent to CCU. Talk about being a fish out of her tank...LOL. Anyway I had a GI bleed pt which for me is second nature, but then they asked me what should have been a simple question, I later found citical thinking is truley my friend.

"Why do I have to drink this when every time I pass stool it is nothing but blood, is the doctor trying to make me bleed to death?"

After a long discussion and some re-assurance that the doctor's goal was only to prepare for a colonscopy my patient did begin the prep. They were on hemogram draws every six hours so when lab came I requested they wait until after a few BM's. Before the start of the prep the Hgb was 11.7 after two BM' s I called lab, results showed the hemoglobin went to 9.5, I had to notifiy the MD, thank goodness I asked lab to come back or there wouldnt have been a way to catch the drop, the next blood draw would have been long after the prep started working. Anyway the patient received 2 units PRBC' s and they were fine, but then I had to hear "I told you the doctor is trying to kill me" for fifteen minutes.

I know that it is important for the colon to be clear, but I also understand why my patient with a GI-Bleed was scared to start the GoLytely prep. My patient finished the prep, had tons of stool so I hope they did well through the night. It was my first time in CCU. I have only been an RN since July of 2008, but it was one of those rare nights when I felt confident as a nurse. Even though I was the fish out of its bowl.

Just sharing my experience, have a great day everyone.

Bertina

[Reno1978, BSN, RN]

Good job!

GI bleeds can be severe and you can see a drop in Hgb like that fast if it's severe enough.

I don't believe GoLytely would exacerbate the bleed since it is routinely given to GI bleed patients prior to colonoscopy, to identify the source of the bleed, or bowel surgeries. I can understand that the patient would think that it would exacerbate the problem because if he was actively bleeding into the GI tract, liquid stools probably look very bloody, and that would be very scary!

Although a 2.2g/dL drop in Hgb is a significant change, it was due to the active bleed rather than the bowel prep, in my opinion.

[Virgo_RN, BSN, RN]

Agree with the above. GoLytely simply evacuates bowel contents, it does not promote bleeding. The drop in H&H would be a/w the active bleeding, not the bowel prep.