Author: J Siddall, H Inkster Date: June 2018 Job Title: Consultant Obstetrician, Practice Educator Review Date: June 2020 Policy Lead: Group Director Urgent Care Version: 5.0 ratified 1/6/18 Location: Policy hub/ Clinical/ Maternity/ Postnatal/ GL796 Only valid on date last printed Page 1 of 11 Bowel complications after caesarean section guideline (inc. Paralytic Ileus) – GL796 Approval Approval Group Job Title, Chair of Committee Date Maternity & Children’s Services Clinical Governance Committee Chair, Maternity Clinical Governance Committee 1 st June 2018 Change History Version Date Author, job title Reason 4.0 June 2016 S Bailey (Marsh Ward Mngr) H Inkster (Practice Educator) Reviewed and amended to be consistent with Trust policy for NGT (CG202) 4.1 Sept 2017 H Inkster (Practice Educator) M Redfearn (Acting Marsh Ward Manager) Reviewed & amended against Trust policy for NGT (CG202) which itself has been updated in response to CAS Alert NHS/PSA/RE/2016/006 - Nasogastric tube misplacement: continuing risk of death and severe harm. 4.2 Dec 2017 H Inkster (Practice Educator) Pg 3 to 6 - Clarification of use of Ryles tube in Maternity 5.0 April 2018 Jane Siddall (Consultant Obstetrician) H Inkster (Practice Educator) Reviewed Pg 2 – Overview updated, diameter of the caecum changed from 10cms to 9cms Pg 3 - Ryles tube added and IV fluid balance & monitoring clarified To be read in conjunction with CG202 Trust policy for correct use of Nasogastric Feeding Tubes in Adults
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Bowel complications after caesarean section guideline (inc ... protocols and... · Request prompt obstetric review if paralytic ileus is suspected. In Maternity we use Ryles Tubes
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Author: J Siddall, H Inkster Date: June 2018
Job Title: Consultant Obstetrician, Practice Educator Review Date: June 2020
Policy Lead: Group Director Urgent Care Version: 5.0 ratified 1/6/18
Reviewed and amended to be consistent with Trust policy for NGT (CG202)
4.1 Sept 2017 H Inkster (Practice Educator)
M Redfearn (Acting Marsh Ward Manager)
Reviewed & amended against Trust policy for NGT (CG202) which itself has been updated in response to CAS Alert NHS/PSA/RE/2016/006 - Nasogastric tube misplacement: continuing risk of death and severe harm.
4.2 Dec 2017 H Inkster (Practice Educator) Pg 3 to 6 - Clarification of use of Ryles tube in Maternity
5.0 April 2018 Jane Siddall (Consultant Obstetrician)
H Inkster (Practice Educator)
Reviewed
Pg 2 – Overview updated, diameter of the caecum changed from 10cms to 9cms
Pg 3 - Ryles tube added and IV fluid balance & monitoring clarified
To be read in conjunction with
CG202 Trust policy for correct use of Nasogastric Feeding Tubes in Adults
Author: J Siddall, H Inkster Date: June 2018
Job Title: Consultant Obstetrician, Practice Educator Review Date: June 2020
Policy Lead: Group Director Urgent Care Version: 5.0 ratified 1/6/18
Maternity Guidelines – Bowel complications after CS inc. Paralytic ileus (GL796) June 2018
Abdominal x-ray is required to confirm colonic dilatation (large bowel >6cm, caecum
>9cm). Perforation presents with severe abdominal pain, a rigid abdomen and signs of
sepsis from faecal peritonitis.
Management
Request prompt obstetric review if paralytic ileus is suspected.
In Maternity we use Ryles Tubes for non-functioning bowel i.e. paralytic ileus and only used for aspiration of gastric juices used for short term use only NEVER for feeding.
If Ryles or NG tubes are to be placed this should be in accordance with trust guidelines
(see Trust policy for Nasogastric tube placement in Adults ver 10 CG202) by appropriately
trained staff. Clinical Skills (bleep 160) or Outreach Team (bleep 250) may be available to
help with NG tube placement.
Initial management is conservative and should focus on:
Analgesia (avoid opiate analgesics)
Antiemetic’s
NBM to rest bowel
IV fluids and fluid balance monitoring
Recommended fluid “one salty two sweet”
1L x N Saline +20mmol KCL 8 hrly
1L Dextrose + 20mmol KCL 8 hrly
1L Dextrose + 20mmols KCL 8 hrly
As maintenance only need to consider losses/insensible losses, thus up to 4L per day
Ensure adequate VTE prophylaxis
Investigations should include:
U&E to assess for electrolyte imbalance
Abdominal +/- erect chest XR if perforation suspected
NB: All referrals to surgeons must be made at consultant to consultant level to ensure that senior review takes place
References
1. Acute colonic pseudo-obstruction after caesarean section The Obstetrician and Gynaecologist 2006 (8); 207-213