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Nasogastric & gastrostomy tubes to remain on free drainage

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					        Best Practice Guideline: Care for patient requiring a Fundoplication
                              Department of Surgery
                 Women & Children’s Directorate (Yorkhill RHSC)

Introduction
The following Best Practice Guideline should be used when admitting a patient for
fundoplication procedure.

Consent in Principle At the time of decision for surgery (outpatient department,
inpatient ward) consent in principle should be obtained. This will consist of a discussion
with parents & patient explaining following points
        Proposed procedure and any alternatives (open / laparoscopic)
        Need or otherwise for a gastrostomy
        Risks and benefits of the procedure
        Significant complications of the procedure
        Written information relating to above should be given/posted to parents
        Approved information leaflets should be used if available
        Contact with gastrostomy support nurse should be arranged if appropriate

Waiting List booking form
        Should note type of fundoplication(open or laparoscopic)
        Possibility of gastrostomy tube insertion
        Consider need for HDU / ITU bed

Admission
        Specific requirements assessed
        Any problems relating to underlying neurological disability should be assessed
        Current drug therapy noted and prescribed
        If a gastrostomy tube is in situ or proposed inform gastrostomy support nurse
        (Bleep number 2973 / 2328)

Investigations
        Routine investigations; FBC & U&E’s
        Consider need for LFTs, clotting screen
        Blood group and save +/- cross match
        Chest X-ray

Formal consent
        Informed consent obtained & signed in context of any additional questions from
        parents
        Insertion of gastrostomy tube requires specific consent
        Possibility of conversion to open procedure must be mentioned if laparoscopic
        procedure is proposed

Preparation for theatre
        Ensure that colon is not distended or loaded by bowel evacuation / enema if
        needed

Post –operation
        Post –operative written instruction must define; Level 3 or higher monitoring
        classification
        Nasogastric & gastrostomy tubes to remain on free drainage & aspiration for
        minimal of 24 hours

Fundoplication care            Version: 1.0                       Page 1 of 1
Author: Mr PAM Raine           Ratified: General Surgeons Group   Issue Date: October 2006
Review Date: October 2008      Q-Pulse ref: YOR-SUR-003

				
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Description: Nasogastric & gastrostomy tubes to remain on free drainage