GAstric Bypass in the SICU

gwenith, BSN, RN · Apr 12, 2003

I worked in a facility where gastric bypass had been banned - state govt facitility when ths state picks up the cheque things like sales pitches go out the window. The emphasis was supposed to be on non surgical interventions - i.e. counselling, dietary advice etc.

We did get one lass - she did not have health insurance so the surgeon promised her to do the surgery in a private hospital and then get her transferred to out public facilitiy post surgery. We had a nightmare time just then with five major burns cases + everything else - upshot she was in the Private hospital ICU for a week - her parents had to morgage thier house to pay the bill. When we got her she more leaks than a redneck's radiator. Nasty but we pulled her through.

Now I am prety big myself and after being involved with this case can you imagine how I felt when a (nurse) friend sat me down and told me she had had gastric bypass and lost so much weight - of course most of it was in the first 3 months when all she could eat was icypoles! I sat there open mouthed thinking "doesn't this girl get it - If I went on a three month diet of ICY poles I would lose weight too - and very possibly hair, teeth and vital signs.

RNforLongTime · Apr 12, 2003

Dood, My ICU gets gastric Bypass pt's who've had the surgery in outlying hospitals, developed major complications then transferred to my facility. They end up staying in ICU for weeks, end up going back to surgery a few times for whatever reason. They require max assist of 3 or 4 people. Lovely for me as I already have a bad back to begin with!!!!!! Why anyone would have this surgery at a community hospital is beyond me. I'd rather be FAT than end up like some of these people that I've seen!!!!!!!!!

Gldngrl · Apr 12, 2003

The population of patients we see are shall we say "rural"...like the one who advised my friend that when cooking raccoon fritters in the microwave not to do so for too long because they'll get rubbery:eek: Oh and using a toothbrush with toilet paper wrapped around it to "wipe" after urinating...

nowplayingEDRN · Apr 12, 2003

All I can say is I hope that they are not reusing that tooth brush for finishing their personal hygeine after using it in that manner......YUKKY!!!!!!! :p :p

We only started doing them about 2 yreas ago. And that was only because he had a gung-ho surgeon that was looking for action that was not really available in this little army hospital. He apparently spent time training with the Doc that pioneered and perfected the procedure.

They always came out with the NGT and that is how they have done it since. As far as I know we have done probably close to 10 in the last 2 years and there have been no troubles with leaks. One reaon they use the NGT, besides minimizing nausea after the surgery, is that they want the patient to be able to tolerate their own secretions before giving them any sort of PO fluids. I would have to look into the real documented rationale on why they keep the NGT. If anyone finds it I would be interested in looking at the link.

We live in a society of instant gratification to fix all our problems and that is how I feel they are starting to use the gastric bypass procedure. There is little or no emphasis placed on healthy eating and exercise. I am no light weight but I do know that with hard work and sticktoitativeness....the weight can come off and im,prove a person's quality of life. And I do not think that there is emphasis placed on healthy eating habits and exercise for when the pouch restretches to a normal stomach size.

As for doing KUBs before discharge to check for leaks, we have start doing UGI series to check for those before removing the NTG. Makes me wonder why you want to pump a bit of radio-opaque chalk in to a person, just to possible have to reopen them and was it out of the peritoneal cavity and then repair the leak??

Going80INA55 · Apr 13, 2003

As to the NG, the other reason to have one in is to reduce the pressure on the wound.

After doing many of these procedures, I am sure the mds feel more confident in their technique. Maybe that is why no KUB or NG.

If I were the petient I would want them.

nowplayingEDRN · Apr 13, 2003

True and less pressure gives more time to start the healing process. Both the docs that do these bypass surgeries (the one has left for another facility) have been doing them for quite sometime and the one even does the entire procedure laproscopically (our hospital chief won't let him do them that way). I think that the NGT and the UGI or KUB is a safety precaution...and the Army is all about safety in their facilities so sometimes they do over kill...but I say if it keeps complications from getting away....then don't reinvent the wheel.

If I were the patient, no I prolly would not want any tubes or any more tests than needed but if it meant keeping me from coming back in because of serious complications, then I guess I could put up with it.

I am just glad to see that out here in the East it is not the only place that this "fad" has started to take hold. I was begining to think that I was in a boat floating alone in the sea of Gastric Bypass......lol

Christie

nowplayingEDRN · Apr 16, 2003

I did a little more poking and proding around on this subject. Seems that maybe my facility goes a bit over on the pain medication and the ICU stay. However, the NGT seems to be frequently mentioned but in all cases in usually removed on POD#1 and an UGI performed to rule out leaks before giving PO fluids. The catheter is also removed on that day and IV fluids D/c'd on POD#3. So, I would say it sounds more like a personal preference of the physician. Thanks to all that responded. :)

Christie

burt · Apr 18, 2003

I work in a major teaching hospital where the surgeons do several gastric bypasses each weekday. We only get the ones that "go bad" in the ICU. And, they have always gone very bad. Of, course, the surgeon always says it is because the patient is non-compliant and ate or drank too much too soon. When they get to us they are on multiple pressors along with MS04 and ativan gtts. They end up staying for months and are some of the most challanging patients to care for. I can understand why someone would want to have the surgery, but I would never do it . I don't believe the surgeons fully explain the negative outcomes of the surgery. The patients all think they will sail through it like Al Roker and Carny Wilson.

nowplayingEDRN · Apr 24, 2003

So far we have not had any of our RGB patients come back through for complications, save the one that went into PSVT 4 days post op. So I guess we are pretty fortunate. Also, money can buy you top notch medical care that the average person can not get. What they do not see or hear about is the massive plastic surgeries that these people also end up needing down the line to revise all the flabby skin that can not reduce because of the rapid weight loss. Nope, I can understand why someone would want it but I would never do it. Nope, nope, nope.

RNforLongTime · May 4, 2003

I agree. I worked with two nurses who had the procedure at a MAJOR TEACHING hospital and are doing wonderfully. The people that I see who end up with complications, I feel sorry for but I wonder if the complications would've occured if they had the procedure performed by a surgeon who is an expert rather than someone who does it "on the side" so to speak.

nowplayingEDRN · Jun 6, 2003

Well, the last 2 or 3 RGBs we have done, the surgeon has ordered UGI to rule out any leaks before allowing PO fluids and ice. So, the care is ever evolving and becoming higher quality.

I definitely feel that the outcome of the patient is directly affected by the skill of the surgeon performing the procedure.

New CCU RN · Jun 6, 2003

There is one GBP in our MICU right now that has gained 100 lbs of water weight ..... still on the vent.... POD 18