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Percutaneous Cecostomy Insertion - Preprocedure Management - |
| Preoperative laboratory studies: Most
patients who have a C-tube placed are in otherwise good health, except for their fecal
incontinence. For this reason, we do not routinely order preoperative laboratory studies
on this patient population. In select cases, where the medical history is unknown or
raises a suspicion of a bleeding diathesis, a coagulation profile, platelet count and
hemoglobin level are obtained. Because C-tube insertion is an elective procedure, an
uncorrectable coagulopathy is an absolute contraindication. Candidates for C-tube placement are maintained on a strict clear fluid diet for 2 days prior to the procedure to help assure a clean bowel preparation. Up to 45-ml sodium phosphate oral solution (mfg) (4-6 year olds: 10-ml; 7-9 year olds: 20-ml; 10 years and older: 45-ml) is administered the night before the procedure (or per NG tube for patients that can't tolerate oral administration). The patient is admitted to the hospital on morning of procedure with a repeat dose of sodium phosphate as needed according to the results of the preprocedure abdominal radiograph. Patients fasting for a procedure (see Sedation, Analgesia and General Anaesthesia, below) should not become dehydrated, and orders for maintenance intravenous fluids should be part of the preprocedure order regimen. EMLA cream is applied topically to the prospective tube insertion site (right lower quadrant and flank) two hours prior to the procedure. A rectal dose of acetaminophen (15 mg/kg) is given one hour prior to the procedure. Patients are given a combination of gentamicin (2.5 mg/kg), ampicillin (20 mg/kg) and metronidazole (10 mg/kg) as a single pre-procedure dose, and continue the same dosages three times per day for several days following the procedure. A flat plate of the abdomen is taken prior to the procedure to confirm the adequacy of the bowel preparations. |