Bowel preparation
From WardWiki - Foundation Doctor Helper
Bowel preparation is a very commonly prescribed medication in colectomy patients yet is poorly taught and there is considerable variability both in its use and also in the choice of agent. This article will give the most salient points and suggest a list of agents used. Please refer to trust guidance or consultant preference before prescribing bowel preparation as nurses will be uneasy in using agents they are not familiar with.
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When and when not to use
- Do NOT use in emergency surgery or where there is absolute bowel obstruction (no flatus)
- Do NOT use in bowel obstruction, even when passing wind, without consultant approval (this means on the day of prescription, not two weeks previously in outpatients).
Perforation of a viscus is likely in such cases with catastrophic consequences.
- Though not dangerous there is almost no value in giving bowel prep for right hemicolectomy and it is seldom done.
- DO use in elective total or left hemicolectomy; there are a number of surgeons who do not use bowel prep in any case and it is worth knowing this in advance; certainly when prescribing for other consultants.
- Keep patients on clear fluids the morning of procedure.
- As part of bowel prep ensure any antiplatelet agents and coumarin anticoagulation have been appropriately stopped on managed.
- For colonoscopy ensure any iron medications have been stopped ONE week prior to procedure.
Bowel prep
An excellent guide from the endoscopy unit in Edinburgh is summarised below but available in full here.
Picolax
Use with caution in the elderly where dehydration is a particular problem.
- Give one sachet of sodium picosulphate afternoon ( about 2pm) before procedure and early morning of procedure. Give with low residue diet or with clear fluids only. IV fluids should be considered as Picolax is very dehydrating.
- Check U&E before anaesthesia and certainly before discharge home
Klean Prep
This is done the day before procedure
- Dissolve ONE sachet in ONE lite of water / clear juice and drink over ONE hour
- Repeat cycle until FOUR sachets have been consumed
- Senna may or may not be used to speed up the process
On the day on the procedure have the patients down for clear fluids only - no milk.
- Check U&E before anaesthesia and certainly before discharge home
Moviprep
Similar to Klean Prep but this bowel prep has half the volume:
- ONE litre of Moviprep on the morning and again ONE lite of Moviprep in the evening.
- ONE litre of MOVIPREP consists of TWO sachets (A and B) dissolved in ONE litre of water. This should be drunk over one to two hours. This should be repeated with the second litre of Moviprep
Fleet
This phosphocitrate agent should be avoided in renal failure patients due to high phosphate content.
- ONE bottle on the morning and ONE bottle in the evening prior to procedure.
