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Home | Articles | Admission | Elective Admission – Colorectal Surgery

Elective Admission – Colorectal Surgery

Last updated 14th May 2021

All elective colorectal patients are automatically classed as Enhanced Recovery and treated according to pathway

Clerking in patients

  1. Ensure a complete clerk in is done including past medical history, social history (patients who scores >9 on FAST score would need to be on IV Pabrinex (3 ampules TDS for 3 days) + GMAWS protocol), any recent illness
  2. Bloods
    • IV access (preferably at dorsum of hand)
    • FBC, U&E, LFT (if has history of liver disease), INR (if on warfarin)/ clotting screen, Cross-match (1x 7.5ml tube)
  3. HEPMA
    • 2 ERAS bundles on HEPMA – type ‘colorectal’ under protocol and 2 bundles will appear – medication and oral nutritional supplement. Medication includes LMWH, anti-embolic stockings.
    • Suspend any potential nephrotoxics prior to operation – including NSAIDs, ACEi. Prescribe all medications on HEPMA and then suspend these to reduce errors.
    • Antiplatelets
      • Aspirin – suspend on day of surgery
      • Clopidogrel should be stopped 7 days prior to operation
    • Unless contraindicated (Hx of peripheral arterial disease), all patients should be prescribed TED stockings
    • LMWH Dalteparin 5000 units prescribed at 1800 for post-op day till discharge

Analgesia + Laxatives

  1. Regular paracetamol (prescribe under Protocol for option of IV/oral)
  2. PRN Antiemetics – Ondansetron and cyclizine (prescribe under Protocol for option of IV/oral)

Thromboprophylaxis

  1. Warfarin
    • Patients on warfarin should have stopped their warfarin 5 days before surgery and started on LMWH (Dalteparin 5000 units) during this period
    • Check INR afternoon before surgery, if INR >1.4 give 1mg oral vitamin K and repeat INR
    • Last dose of LMWH 12 hours prior to surgery
  2. DOAC
    •  These should be stopped 48-72 hours before surgery

ERAS Protocol

  1. Enhanced recovery after surgery (ERAS) protocols are multimodal perioperative care pathways designed to achieve early recovery after surgical procedures by maintaining pre-operative organ function and reducing the profound stress response following surgery.This protocol is used for all elective colorectal resections.
  2. Please print out the ERAS pathway and fill this in – see attached link below
  3. Bowel preparation
    Right hemicolectomyMr Dreyer, Mr Ip, Mr Collins' patients - no bowel prep
    Mr Whitelaw, Mr Darabnia - 2 sachets moviprep
    Left hemicolectomy2 sachets moviprep
    Sigmoid colectomy2 sachets moviprep
    Abdomino-perineal (AP) ResectionMr Whitelaw, Mr Darabnia & Mr Dreyer - 2 sachets moviprep
    Mr Collins & Mr Ip - phosphate enema 6am day of surgery
    Anterior Resection/Total Mesorectal Resection (TME)2 sachets moviprep
    HartmannsNo bowel prep
    Pan ProctocolectomyNo bowel prep
    Total ColectomyNo bowel prep
    Reversal of IleostomyNo bowel prep
    Reversal of Hartmanns2 sachets of moviprep + phosphate enema PR 1800 day before surgery
    Reversal of loop colostomyRefer to Surgeons
    Formation of loop colostomyMr Whitelaw, Mr Darabnia & Mr Dreyer - no bowel prep
    Mr Collins & Mr Ip - phosphate enema 6am of day of surgery
  4. Moviprep – given on day before surgery, 1st sachet at approx 1100, 2nd sachet at 1600
  5. ERAS Nurse – Fiona Black (Ext – 32412) will meet the patient on the day before surgery for stoma siting
  6. Pre-op drinks
    • 6 bottles of Nutricia Pre-op drinks prescribed on HEPMA under colorectal ERAS bundle
    • 4 bottles on the day before surgery at 1800
    • 2 bottles on day of surgery – 2 ½ hours before procedure
    • No pre op drinks if diabetic or known delayed gastric emptying issues

Fasting

  1. Patients are advised to drink clear fluids (this includes tea/ coffee without milk) till 2 hours before operation
  2. Last meal should be 6 hours before operation
  3. No indications for IV fluids unless prolonged periods of fasting

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