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This document discusses bowel preparation prior to surgery. It provides a brief history of bowel preparation, which has been used since the late 1900s to reduce stool bulk and prevent disruption of surgical anastomoses. Various mechanical bowel preparation methods were used throughout the 20th century, including low residue diets, enemas, and irrigation solutions. More recent randomized controlled trials from the 1990s onward have shown no benefit to mechanical bowel preparation. The document also outlines the aims, equipment, and procedure for performing a bowel washout to optimally clear the bowel prior to surgery with minimal discomfort.
This document discusses bowel preparation prior to surgery. It provides a brief history of bowel preparation, which has been used since the late 1900s to reduce stool bulk and prevent disruption of surgical anastomoses. Various mechanical bowel preparation methods were used throughout the 20th century, including low residue diets, enemas, and irrigation solutions. More recent randomized controlled trials from the 1990s onward have shown no benefit to mechanical bowel preparation. The document also outlines the aims, equipment, and procedure for performing a bowel washout to optimally clear the bowel prior to surgery with minimal discomfort.
This document discusses bowel preparation prior to surgery. It provides a brief history of bowel preparation, which has been used since the late 1900s to reduce stool bulk and prevent disruption of surgical anastomoses. Various mechanical bowel preparation methods were used throughout the 20th century, including low residue diets, enemas, and irrigation solutions. More recent randomized controlled trials from the 1990s onward have shown no benefit to mechanical bowel preparation. The document also outlines the aims, equipment, and procedure for performing a bowel washout to optimally clear the bowel prior to surgery with minimal discomfort.
Pembimbing : dr. Mangalindung O,SpB Definition Low residue or clear liquid diet 3 days prior to surgery and NPO at midnight Preoperative antibiotics Mechanical Bowel Prep History Mechanical Bowel Prep since late 1900s Mechanical Bowel Prep before colorectal surgery generally accepted in late 1960s Reduce bulk of stool preventing disruption of the the anastamosis 1970s: Practice of Routine MBP Dietary Restriction, Enemas, and Large Volume Saline Irrigation via NGT 1971: Nichols and Condon Describe Favorable Clinical Experience with Bowl Prep 1972: Hughes Presents Early Challenge to Dogma of MBP 1980: Development of PEG-based Solutions Tolerated Better Mechanical Bowel Prep 1990s: Trauma Literature Accumulates Regarding No MBP 1994: One of First RCT Showing No Benefit with MBP 1994-2000s: Several Other Trials Follow 2009: Cochrane Review Shows No Benefit of MBP J. S. Hourigan, MDUK Department of Surgery Grand Rounds
Decrease Volume of Intraluminal Content and Fecal Load Decrease the Bacterial Counts Avoid Major Spillage Improve Healing of Anastomosis Decrease Infectious Complications Improve Patient Outcomes Historical Variation and Combination Castor oil / senna / bisacodyl / phenolphthalein / Na picosulfate / Mg citrate Enemas: tap water / soap suds / tannic acid Isotonic Solution Caused electrolyte imbalances and fluid shifts Mannitol Osmotic diarrhea, electrolyte imbalances and fluid shifts Poly Ethylene Glycol 1980 Osmotically balanced Fewer electrolyte imbalances 4L salty intake in short time not tolerated Sodium Phosphate Smaller doses Significantly higher tolerability and patient acceptance* Not recommended in renal failure/CHF/cirrhosis *Kastenberg Kastenberg, Clinical Gastroenterology, 2007
Bowel Wash Out AIM To optimally clear the patients bowel prior to surgery; to attain an empty clean colon, and to do so with least possible discomfort and embarrassment for the patient To relieve constipation
Equipment Trolley Rectal tube/Cone/urethral catheter and Enema bag OR Enema administration kit IV pole Blue mackintosh under sheets Gloves and apron Bedpan Towels Procedure
Explain to the patient the rationale and procedure for the bowel wash-out Maintain patient privacy at all times. Collect and organise equipment. Perform hand hygiene (moment 1) Assist patient to lie in the left lateral position, with buttocks close to the edge of the mattress. Cover and keep patient warm, the procedure may take some time. Place blue sheet under the bottom, have bed pan nearby if required Perform hand hygiene (moment 2) Fill Enema bag with tap water and prime line (If not using administration kit- attach rectal tube to bag prior to priming line) Insert lubricated rectal tube gently into rectum Release clamp on tubing and allow water to run into rectum (maximum 500mls at any one time)
Quality & Patient Safety Committee CLINICAL POLICIES, PROCEDURES & GUIDELINES MANUAL Procedure Close clamp and remove tubing from rectum Have the patient hold until urge felt, then empty bowels in toilet or pan. Repeat this process until there is a good result or the return is clear. Advise the patient that there may still be some fluid in the bowel, and upon standing they may need to go to the bathroom and pass the water, or offer them use of a bed pan. Help the patient reposition to a comfortable position Dispose of equipment and waste appropriately Perform hand hygiene (moment 4) Document results Stop procedure immediately if patient complains of pain. Notify medical team if return unsatisfactory or patient unable to tolerate washout
Conclusion No significant infectious risks to Mechanical Bowel Preparation and bowel washout Possible lower infection risk Other more qualitative benefits intraoperatively VALUABLE! Thank You