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Post by Admin on Jan 5, 2015 21:31:03 GMT
How to manage post-op ileus?
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Post by Admin on Jan 5, 2015 21:47:01 GMT
As it remains the most common cause of delayed recovery after colorectal surgery, and we've sometimes talked about it in our emails, I thought it might be useful to have a thread dedicated to the subject. It would be interesting to see how people go about preventing and manging POI when it occurs.
Our local rate of ileus runs at around 10%. We have all the usual ERAS elements in place and recommend that patients chew sugar-free gum 3-4 times a day, but when ileus occurs, the management of it varies according to the consultant. One prefers an in & out NGT ie. aspirate and remove immediately, some like to leave them in until passage of flatus, one likes to leave NGT in situ but spigot it but there's no standarised protocol on management as I can't them them to agree on one. I would like to add a guideline for management of POI into our colorectal ERP pathway so if anyone has any advice on how I can get nine consultant colorectal surgeons across two sites to agree on it, I'd be grateful!
[Last edited Aug 05, 2014]
Jayne Mundy
Enhanced Recovery Programme Nurse Facilitator
Western Sussex Hospitals NHS Trust - Worthing Hospital
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Post by Admin on Jan 5, 2015 21:47:32 GMT
angie.balfour@nhslothian.scot.nhs.uk said Jul 31, 2014
Hi Jayne......I agree that Post Op Ileus is one of the biggest challenges for ERAS in Colorectal. The key is to avoid it if possible but once the patient has an Ileus - that's it and it is a matter of waiting till it resolves. When I went to Sweden & Denmark, they use the "in and out" method. Here in Edinburgh - all of our 13 surgeons leave the NG tube in until gut function returns (which can be 1-6 days depending on the patient) The problem is while they are in this situation, they are NBM and have IV fluids being poured into them which causes gut oedema and guess what, even more gut disfunction!! They feel terrible, bloated and nauseated so are very reluctant to mobilise which only makes matters worse.
I believe that we need to concentrate on avoiding ileus if possible (less opiates/ early feeding/ mobility etc) but once the patient has an ileus, I'm not sure what the recommendation would look like as it is so patient specific.
Does anyone else have any protocols for the management of Post Op Ileus???
Cheers
Angie
Enhanced Recovery Nurse
NHS Lothian
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Post by Admin on Jan 5, 2015 21:47:51 GMT
Jayne said Sep 08, 2014
We are now looking at individual cases of POI every three months in order to establish whether it was a primary ileus or secondary to sepsis for example. This should give us more exact figures for our ileus rate which appears to have reduced this year so far, but it's too early to say for sure.
We recommend that patients chew sugar-free gum postoperatively, and I am quite interested in whether this helps to restore gut function any quicker once POI has occured - there are a lot of RCTs and literature reviews around to suppport the use of chewing gum, but interestingly it only appears to be effective in the absence of dietary intake, so not really a lot of use for it in Enhanced Recovery Programmes where patients resume eating and drinking quite quickly postop. But when a postop ileus occurs requiring NG decompression and oral intake has to be stopped, there could be an indication for sham feeding with chewing gum - I always get my patients to continue chewing gum if they have a POI - but as far as I'm aware there are no published RCT's as yet on this.
Jayne Mundy
Enhanced Recovery Programme Nurse Facilitator
Western Sussex Hospitals NHS Trust - Worthing Hospital
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