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.

[wooh, BSN, RN]

Gum. Reglan. Starting sips of clears. Waiting on gas/bowel sounds/whatever before starting PO is old school. A small amount of PO tends to "trigger" the bowels to start working again.

[netglow, ASN, RN]

I was thinking the same possibility Canes. So if also no true BM but yes to some liquid fecal you very well might be at that point - with distention and sharp pain on palp (not good) would mean must look by surgeon.

[JustaGypsy]

Ask it nicely? (just couldn't help myself...)

[leslie :-D]

rectal tube.

leslie

[suanna]

X-Ray shows active ileus?! No nursing intervention is going to do much at this stage. I would be very cautious of anything PO- even sipps&chips. I've had patients with an ileus rapidly distend with very little intake. Before you know it you have an aspiration pneumonia or post portem care to add to your list of duties. With a current ileus I am surprised the docs haven't ordered an NG tube of some sort to relieve the upper GI tract. Until the ileus pattern resolves in the bowel you are playing with fire to put anything in from above. Reglan( metoclopramide ) has been used but with little sucess in my experience. It can also make an elderly patient (and my wife) NUTS!!! Dulcolax RS may be more helpful since it stimulates action in the gut distal to the ileus. As for walking, it can't hurt but recent studies showed no improvement in GI motility with patients that participated in a regular postoperative walking program and those who were on restricted activity of bed&chair. Pneumonia improves but not pooping. Keep in mind, if you increase your patients activity you are going to need to increase thise fluid intake (IV?)to compensate for insensible loss through perspiration and the like. Daily weights, mucous membrane assessment and good mouth care become VERY important for this patient. A parched cracked mouth is a great place for Candida(Thrush) to set up shop, A Candida pneumonia or even oral thrush isn't going to make your patient any happier. SORRY for the long post from a simple question about the gasses we pass. I'm a surgical intensive care nurse and I can get carried away in my care planning.

[AgentBeast, MSN, RN]

Can or two of Budweiser usually gets me gassy.

[rnmi2004]

Pull his finger?

OK, seriously 12 days is a long time to not even be passing gas. I agree with the position changes. At this point, anything oral isn't going to get to the part of the intestines that needs to be encouraged to move along. Reglan helps with stomach/ upper intestine motility, so that probably won't help either.

What about an old-fashioned soap suds enema?

Is the patient taking a lot of narcotics? I'm not sure if it will help this far post-op, but maybe a dose of Relistor might help get things moving.

[tokmom, BSN, RN]

Hmm, what about an NG, reglan and lots of mobility?

[eriksoln, BSN, RN]

Early aggressive ambulation.

But 12 days is past that point. Rectal tube and w/e to help the diet along (fiber tablets etc).

[imanedrn]

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?

I personally deal with a lot of GI distress. Obviously different from post-op issues, but yoga is a lifesaver for me.

[NRSKarenRN, BSN, RN]

medpage today - mev healthcom - management of postoperative ileus

persistent postoperative ileus should prompt investigation of whether it is secondary to a problem relating to the procedure, such as a leak, abscess, retained foreign body, or mechanical obstruction. other secondary causes may include pneumonia, pancreatitis, or urinary tract infection. primary issues are related to surgery or opioid treatment and can occur after an extended case with a lengthy lysis of adhesions and prolonged case length. a normal white blood cell count and fever curve, good urine output, and minimal abdominal pain are reassuring and are consistent with primary causation.

ileus

new therapies in the treatment of postoperative ileus

[K+MgSO4, BSN]

NO fibre tablets or GI stimulants. It will put pressure on the suture lines. Mobilisation, rectal tube ? decompression C scope, NG tube, regular metaclopramide (maxalon) Get the senior surgeon to explain to you why (s)he not concerned.