Post-op radical prostatectomy orders

[stevierae]

The husbands of 2 different friends--both men are only 50--are having radical prostatectomies next month.

I know the operation, but I don't know much about post-op care these days.

When I was in nursing school--graduated in '81-- both TURP and radical prostatectomy patients went to med-surg post-op with 3 way Foleys, hooked to continuous irrigation to continually wash out clots so that urine flow would not be obstructed. You could also irrigate manually if urine was obstructed by a particularly stubborn clot. Is that still the case, or do they come back now with regular 2-way Foleys (no continuous irrigation?)

Also, like other post-op patients who are at risk for DVT, are they encouraged to ambulate ad lib, even several hours after surgery, as soon as they feel like doing so and have assistance? I know most of these patients these days have an epidural PCA, and most ORs where I have worked put both TEDS and SCDs on them intraop. Do you d'c the TEDS and/or SCDs once they are ambulatory?

I know they will get this info (hopefully) at their pre-op visits next month, but it's nice to be able to do whatever I can to lessen their wives' (my friends') anxiety if I can do so sooner.

[Marie_LPN, RN, LPN, RN]

What our urology group does:

Still prescribe the CBI post-op, so they still come back with the 3-way Foleys.

After the epidural comes out, and the effects have worn off, pt. is to ambulate as much as they can without straining or stressing themselves. The TEDS stay on all the time, the SCDs come off for ambulation, but are still used when the pt is sitting or laying down until discharged.

[RNPATL, DNP, RN]

All of the above that you all mentioned and most times the RPP patient goes home with a foley and leg bag teaching. Generally the foley stays in until the first post op visit when the physician takes out the sutures and removed the foley.

[safewaygreenbox]

Where I work the care is very different for TURP and radical prostatectomies.

TURP post op - have 3 way catheter, IVI and irrigation, ambulation the following day, TEDS untill discharge, no PCEA or PCA required. Bladder washout may be required. Best case TWOC and home without catheter otherwise failed TWOC hame with catheter for 2 weeks before re TWOC.

Radical prostatectomy post op either PCA, PCEA or both. 2 way catheter sutured to member and taped to leg to help protect anastamosis. TEDS and clexane untill discharge. Out of bed on day 2 post op for an hour or so (depending on the patient) NBM or sips at most day 1 - gradual increase to light diet when bowel sounds heard. Clips out after 10 days. Home with catheter and TWOC 2 weeks post discharge.

Kay x

[stevierae]

Thank you, all; this is very helpful. Yes, it seems to me now that it's the TURP patients who always get 3 way Foleys to irrigation--larger ones, with 30 cc. balloons--(often inflated to 45 cc.---)while the radical prostatectomy patients more often get just 16 or 18 2-way Foleys with the balloon inflated to 10-15 cc.--and no continuous irrigation, at least not routinely.