Still doing it?

[ericdamiansean]

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Do your hospitals still practice bowel prep?

 

[Dr JPH]

Do your hospitals still practice bowel prep?

Seems to vary based on attending, when/where they trained and circumstances surrounding the case.

I worked with one attending who would consistently say that is didnt matter but would order preps. 😕

 

[ericdamiansean]

Seems to vary based on attending, when/where they trained and circumstances surrounding the case.

I worked with one attending who would consistently say that is didnt matter but would order preps. 😕

Evidence from Cochrane says it is not necessary...We do it all the time here as well..it's going to be a waste of money, time and discomfort for the patient to be on a soft diet for at least 2 days👎

 

[musm2008]

what if the bowel gets knicked?

 

[ericdamiansean]

what if the bowel gets knicked?

Flush with lots of saline, and you give a dose of Ceft/Cefu for a couple of days.
Even in bowel surg, you can always clean out the bowels during the surg itself, if I'm not mistaken, you introduce a cath and flush the section out.

 

[Winged Scapula]

Evidence from Cochrane says it is not necessary...We do it all the time here as well..it's going to be a waste of money, time and discomfort for the patient to be on a soft diet for at least 2 days👎

You guys put the patient on a soft diet for 2 days? Not necessary...give them a mechanical cleansing the night before which is still not necessary but for most, not as bad as clears for 2 days.

 

[ericdamiansean]

You guys put the patient on a soft diet for 2 days? Not necessary...give them a mechanical cleansing the night before which is still not necessary but for most, not as bad as clears for 2 days.

Yup, rice, noodles, porridge..no vege, fruits or meat for 2 days prior to surg. It's silly that we have to learn the regime, and most people say that evidence shows that it is not needed but it is still done and we're asked about it during exams. I would agree more on a mechanical cleaning the night before.👎

 

[musm2008]

when i was on surgery, the attendings always acted like knicking the bowel was but a big deal and always did the bowel prep, But then when I was on OB, the attendings knicked the bowel all the time, and they told me a bowel prep wasn't ncessary. Then this one pt who had a total hx got a pelvic abscess. Do you think that could be from knicking the bowel and not doing a bowel prep?

 

[ericdamiansean]

when i was on surgery, the attendings always acted like knicking the bowel was but a big deal and always did the bowel prep, But then when I was on OB, the attendings knicked the bowel all the time, and they told me a bowel prep wasn't ncessary. Then this one pt who had a total hx got a pelvic abscess. Do you think that could be from knicking the bowel and not doing a bowel prep?

I'll let the surgical guys take this one😕

 

[Winged Scapula]

when i was on surgery, the attendings always acted like knicking the bowel was but a big deal and always did the bowel prep, But then when I was on OB, the attendings knicked the bowel all the time, and they told me a bowel prep wasn't ncessary. Then this one pt who had a total hx got a pelvic abscess. Do you think that could be from knicking the bowel and not doing a bowel prep?

It would be a bit risky to ask a general surgeon about the surgical practices of Ob-Gyns as they aren't well respected with regard to technique (we're called in all the time to repair their bowel injuries). But I will curb my tendencies to comment negatively... 😉

Most likely, although it depends on what the hyster was for, whether there was any other break in sterile technique and how much spillage there was.

While traditional training has it that: a) bowel preps must always be done for colon surgery (small bowel less important) and b) injured unprepped bowel is a guaranteed abdominal infection, the dogma doesn't always hold up. Trauma literature shows us that you CAN successfully primarily repair colonic injuries in the setting of gross spillage and that it doesn't always result in sepsis or widespread abdo/pelvic infection.

Small rents in the mucosa or even through and through injuries can be primarily repaired and the patient will probably do well with a course of antibiotics and careful wound management. Wounds with gross spillage (which isn't likely to happen with the usual small enterotomies that are made intraoperatively) need to be managed more conservatively - and that may include not closing the wound, intravenous antibiotics, etc.

Truth is, that if you are doing colon surgery where you expect to divide the bowel, you'd be better off to require a bowel prep because of the risk of your anastomosis breaking down and the patient becoming septic when you spill. You'd also be well advised to pack the area around the proposed division so to catch any stuff oozing out. However, we operate on and near the bowel all the time and inadvertent enterotomies get made - its not a big deal with regards to the patient getting septic.

 

[musm2008]

Thanks, kimberli, for explaining that. I was actually on infectious disease at the time and we were called treat her infection. The OB was a jerk and denied there was an abscess. And HE pimped me during a surgery-telling me I was wrong when I answered that bowel preps were necessary. So I'd like for him to be wrong in every way possible.

 

[ericdamiansean]

The OB was a jerk

Aren't alot of them?