Bowel Preparation

Penyusun : Nicholas David Marcellis

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

Quality & Patient Safety Committee
CLINICAL POLICIES, PROCEDURES & GUIDELINES MANUAL


Conclusion
No significant infectious risks to Mechanical
Bowel Preparation and bowel washout
Possible lower infection risk
Other more qualitative benefits
intraoperatively
VALUABLE!
Thank You