Enhanced Recovery Programme for Colorectal Surgery

Enhanced Recovery Programme for Colorectal Surgery Hospital admission, after surgery and discharge advice Patient information Page 1 of 10 Introd...
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Enhanced Recovery Programme for Colorectal Surgery

Hospital admission, after surgery and discharge advice

Patient information

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Introduction This leaflet will explain what will happen when you come into hospital for your operation. It is important that you understand what to expect and feel to be able to take an active role in your treatment. Your surgeon will have already discussed your treatment options with you, including the risks, benefits and any alternatives at your out patient appointment and you will have been given information in the pre assessment clinic by the enhanced recovery team. There will be many different health professionals involved in your care during your hospital stay and there will be a clear plan for any after care when you are discharged from hospital. This leaflet will answer some of the questions that you may have but if there is anything that you and your family are unsure about, then please ask. What do I need to bring with me into hospital? Please bring with you a change of clothes, a night gown or pyjamas, slippers and dressing gown as well as a box of tissues or hand wipes. Which medicines should I take with me into hospital? It is important that you take all your medicines with you in their original containers so they can be continued without delay. Will I get any medication to take home on discharge? You will take home the medicines you brought in with you, unless they were changed during your hospital stay. We will provide any extra medicines you may need, such as painkillers or antibiotics, from the hospital pharmacy. When do I come into hospital? You will be admitted to one of the surgical wards either the afternoon before your surgery or the morning of your operation itself. This will be confirmed by letter which you will receive either before or during your pre assessment clinic appointment, even if you have already been given a date by the surgeon. What happens when I am admitted? A nurse will check all your information with you, including contact details for next of kin. You will be requested to wear an identity bracelet at all times whilst you are an inpatient.

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Bowel Preparation When you are admitted to the ward you may be required to take laxative drinks to clear out the contents of your bowel. It is important that you drink plenty of clear fluids to replace what is lost, to avoid feeling sick, dizzy or developing a headache. If you are not required to take the laxative drink you may just need to have an enema 2 hours before your surgery to clear the lower end of the bowel. Some patients may not require any bowel preparation at all. Your individual bowel preparation will have been discussed with you in the pre-assessment clinic prior to your admission. Preventing blood clots Whilst you are in hospital you will be given a daily injection of tinzaparin into your upper arm. This helps to reduce the risk of blood clots (thrombosis) developing in the legs by thinning the blood. You will also be asked to wear compression stockings (TEDS) which also reduce the risk of developing blood clots. You will also need to wear these compression stockings (TEDS) for 4 weeks after you are discharged from hospital. If you need a stoma (ileostomy/colostomy) If you have been informed that you may require a stoma you will be seen by one of the stoma care nurses in the pre-assessment clinic. You will be seen again prior to your surgery to mark a suitable site on your abdomen for your stoma if this has not been done at your pre assessment clinic appointment. Whilst you are in hospital the stoma care nurses and the ward nurses will continue to help you learn to manage your stoma, if you have a stoma after your surgery. Eating and Drinking On the day before your surgery you will be able to eat and drink as normal unless you are required to take the laxative drinks to clear the contents of your bowel. If this applies to you it will have been discussed at the pre-assessment clinic.

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A key aspect of the enhanced recovery programme is that you will be given clear carbohydrate drinks (Pre-op) before your surgery. The benefits of these drinks are that they will give you the much needed energy which you will require to help you recover. You will have been given instructions at your preassessment clinic appointment on when you need to take them. If you are being admitted the afternoon before your surgery the ward staff will provide you with these drinks. A few hours after your surgery you will be able to start drinking and you may even be able to have something light to eat if you are not feeling sick. It is important that you eat and drink early after your surgery. We will encourage you to have normal food as well as nourishing drinks which will be available for you when you are in hospital. It is important that you drink at least four high protein, high calorie drinks each day after your surgery as your body needs more nourishment to help heal your wounds, reduce the risk of infection and help your overall recovery.

Sickness It is important that we relieve your sickness to allow you to feel better and so that you can eat and drink normally. After surgery sometimes a person may feel sick or be sick. This is usually caused by the anaesthetic or other medications which we use. You will be given medication during your surgery to reduce this, but if you feel sick please tell a member of staff who will be able to give you something for this. Pain control Effective pain control is an essential part of the enhanced recovery programme as this will allow you to start walking around, breathe deeply, eat and drink, feel relaxed and sleep well. If your pain level is too great to allow you to do any of these activities, you must speak to the nursing staff caring for you so that your pain control can be reviewed. You may have a drip in your back (epidural) which allows a continuous supply of pain relieving medication to be given. This is usually removed two days after your surgery, and you will then be offered other effective pain relieving medicines, usually in tablet form. Page 4 of 10

Tubes and drips Whilst in theatre a tube (catheter) will be placed into your bladder so that your urine output can be measured. A drain may be inserted into your abdomen to allow any bloody fluid from the surgery to be drained away. Your catheter will usually be removed the day after your epidural has been removed. The drain will usually be removed after 2-3 days. You will have a drip put into a vein in your arm and you will be given fluid through this to ensure you do not become dehydrated. The fluids will normally be removed the day after surgery, but you will still have a plastic needle (cannula) in place for a couple of days. You may be given extra oxygen to breathe after the operation until you are up and about. None of these devices mean than you are not able to get out of bed or walk about, although you may require staff to help you initially when doing so. Staying out of bed and walking Following your operation, it is important that you start doing your deep breathing exercises as soon as you wake up. The physiotherapist will have taught you how to do these exercises at the pre-assessment clinic. Staff will help you out of bed as soon as possible after your surgery. This may be on the same day if you are well enough. You will spend two hours out of bed the first time out, and then at least six hours out of bed each subsequent day. It is important that you do your circulatory exercises every hour whether you are in the chair or in bed, the physiotherapist will have also shown you how to do these at the pre-assessment clinic. You will be encouraged to build up your walking distance each day, back towards your usual ability before surgery. To help you do this the physiotherapists will come and see you several times a day from the day of surgery. It is very important that you mobilise with the physiotherapists and the ward staff regularly. By doing your deep breathing exercises, being out of bed and by walking regularly, research has shown that you are less likely to develop problems after surgery. They can reduce the chance of any chest or circulation problems, and

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helps your bowel function return to normal more quickly. By avoiding all these problems you are more likely to get home sooner. Will I need further treatment after my surgery? It usually takes approximately a week for the histology results to be known. This is when the piece of bowel which has been removed during your surgery is sent to the pathology lab to be examined. You will be given an appointment to see your surgeon a week after your surgery to discuss the results from your surgery and you will be informed if any further treatment such as chemotherapy is recommended. Important Discharge Information When you leave hospital Complications should not happen very often, but it is important that you know what to look out for. During the first two weeks after surgery, if you are worried about any of the following, please phone the telephone numbers on this leaflet. If you cannot contact the people listed, then ring your GP. Contact Numbers Monday – Friday 0900 – 1700

Colorectal Nurse Specialist 0191 4453151 or 0191 4820000 bleep 2041

1700 – 0900

Nurse in Charge - ward 9 0191 4452009 Nurse in Charge –treatment centre level 2 0191 4453005

Saturday – Sunday 24 hours

Nurse in charge – wards 9 and treatment centre Level 2 same numbers as above.

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Abdominal pain It is not unusual to suffer gripping pains (colic) during the first week following removal of a portion of bowel. The pain usually lasts for a few minutes and will go away completely in between episodes. Severe pain that lasts for several hours may indicate a leakage of fluid from the area where the bowel has been joined together. This is a rare complication but can be very serious. Should this occur it may also be accompanied by a fever. Occasionally a leakage may occur which makes you feel generally unwell, causes a fever but is without pain. If you have severe pain lasting more then 1-2 hours or have a fever and feel generally unwell, you should contact us on the telephone numbers provided. Your wound It is not unusual for your wounds to be slightly red and uncomfortable during the first 1-2 weeks. Please let us know if your wound is:  becoming inflamed, painful or swollen  starting to discharge fluid Your bowels Your bowel habit may change after part of your bowel has been remove and may become more loose or constipated. This should settle into a more normal pattern over a period of time. If you are constipated we would advise that you drink plenty of water, take regular walks and make sure that you eat regular meals, 3 or more times per day. This is especially important during the first two weeks after your operation. If constipation lasts for more than 3-4 days, then taking a laxative is advised. If you are passing loose stools more than 3 times per day for more than 4 days, we advise taking medication such as loperamide (Imodium). You also need to ensure that you drink extra liquid to replace the fluid loss.

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If you have a stoma The stoma care nurses will provide a supply of equipment needed to care for your stoma on your day of discharge. A follow up appointment to see you in the stoma care clinic will also be arranged prior to discharge. Diet A balanced, varied diet is recommended and you should try to eat 3 or more times a day. You may find that some foods upset you and cause loose bowel motions. If that is the case you should avoid those foods for the first few weeks following your surgery. If you have a stoma, the stoma care nurses will give you specialist advice on your diet. It is important that you obtain an adequate amount of protein and calories to help your body heal. If you are finding it difficult to eat, you may benefit from having 3-4 high protein, high calorie drinks such as Build-up or Complan (available in supermarkets and chemists) to supplement your food. If your appetite does not improve after a few weeks, or you are losing weight without trying, you may benefit from a consultation with the dietician; ask your GP, Consultant or Colorectal Nurse to refer you. Exercise, hobbies and activities We encourage activity from day one following surgery. You should plan to undertake regular exercise several times a day, increasing this daily during the four weeks following your operation until you are back to your normal level of activity. Taking up your hobbies as soon as possible again after surgery will also enable you to maintain your activity and will benefit your rehabilitation. The main restriction we would place on exercise or activities is that you do not undertake heavy lifting for at least six weeks following your surgery. As a general rule, once your wounds are pain free, you can undertake most activities. Work Many people are able to return to work within 2-4 weeks following their surgery. If it involves a heavy manual job then we would not advise heavy work until six weeks following surgery, and discuss your return to work with your GP or Consultant. Page 8 of 10

Driving Do not drive until you are confident that you can drive safely. It is also best to check with your insurance company before you start driving again. Sexual Activities Feeling tired and weak after an operation naturally affects your sex drive. As you start to feel better your sex drive should return to normal. It is important that you and your partner discuss your feelings openly. Sexual intercourse can be resumed as soon as you feel comfortable, generally about 2-4 weeks after surgery. Occasionally following surgery or radiotherapy to the rectum, nerve and blood vessel damage can occur. In men this may cause ejaculatory problems and /or maintaining an erection. In women it may cause discomfort during sexual activity or vaginal dryness. These problems are usually temporary due to inflammation and swelling after surgery; however in some instances it may be permanent. If you experience problems of this nature please discuss it with your surgeon or colorectal nurse specialist as specialist help is available. Finally… If you have a problem or concern or if you have any questions which have not been answered in this information leaflet then please contact us on the number provided. Hopefully we will be able to deal with you problem or concern over the phone, but if you have a problem that requires a physical assessment then we will advise you whether you should come back to see the colorectal team at the hospital, or whether you should make an appointment to see your GP. Acknowledgements: Amber Reid Colorectal Nurse Practitioner Gloucestershire Royal Hospital Tracey Virgin – Elliston Stoma nurse Specialist West Middlesex University Hospital Data Protection Any personal information is kept confidential. There may be occasions where your information needs to shared with other care professionals to ensure you receive the best care possible.

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In order to assist us improve the services available your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews. Further information is available in the leaflet Disclosure of Confidential Information IL137, via Gateshead Health NHS Foundation Trust website or the PALS Service

Information Leaflet: Version: Title: First Published: Review Date: Author:

NoIL319 1 Enhanced Recovery Programme November 2010 November 2012 Claire Egglestone/Tracy Pinchbeck/Enhanced Recovery Team

This leaflet can be made available in other languages and formats upon request

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