Whipples Pancreatico-Duodenectomy
| Actions | Day 0 | Day 1 | Day 2 | Day 3 | Day 4 | Day 5 | Day 6 | Day 7 | Day 8 | Discharge |
|---|---|---|---|---|---|---|---|---|---|---|
| Monitoring | Hourly obs (minimum) Cardiac monitoring Oxygen via mask | 2-4 hourly obs (min) STOP oxygen and cardiac monitoring | 4-6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | 6 hourly obs (min) | Obs stable |
| DVT Prophylaxis | TED Stockings Clexane 6hrs post-op | TED Stockings Clexane | TED Stockings Clexane | TED Stockings Clexane | TED Stockings Clexane | TED Stockings Clexane | TED Stockings Clexane | TED Stockings Clexane | TED Stockings Clexane | Home with Clexane for 28 days |
| Pain Control | Epidural IV paracetamol | As per day 0 | As per day 0 | REMOVE epidural Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Oral analgesia | Pain controlled |
| Ranitidine | IV - 50mg TDS | IV - 50mg TDS | IV - 50mg TDS | ORAL - 150mg BD | ORAL - 150mg BD | ORAL - 150mg BD | ORAL - 150mg BD - FINAL DOSE DAY 6 | |||
| NG Tube | In place | In place | Spigot if <500mL in 24hrs | REMOVE if <500mL in 24hrs and not vomiting | ||||||
| Abdominal Drain | In place x2 | In place x2 | In place x2 | Check drain fluid for Amylase (DFA). * For pancreatic leak, DFA should be >3x serum amylase REMOVE if NO bile/enteric/pancreatic leak | Patients can be discharged home if they have a pancreatic leak but are otherwise well | |||||
| Urinary Catheter | In place | In place | REMOVE unless contra-indicated | |||||||
| IV Fluids | In place | In place | If drinking well STOP | STOP | ||||||
| Investigations | CXR in recovery/HDU, FBC, LFTs, U&Es, Clotting screen - APTT & PT | FBC, LFTs, U&Es, Clotting screen - APTT & PT | FBC, LFTs, U&Es, Clotting screen - APTT & PT, Amylase (DFA) | FBC, LFTs, U&Es | FBC, LFTs, U&Es | All results acceptable level | ||||
| Eating and Drinking | Sips of water | Sips of water | Free fluids | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Normal diet and free fluids CREON 40,000 with meals CREON 25,000 with snacks | Eating and Drinking Understands how to use CREON, TTA includes CREON |
| Wound Care | None | Check wound, only change dressing if leaking | If wound is dry, REMOVE dressing | Wound satisfactory Wound care advice given |
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| Exercise | Keep head of bed raised to at least 30° Show & encourage deep breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out and mobilise 2-4 times Encourage breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out and mobilise 4 times Encourage breathing & leg exercises | Keep head of bed raised to >30° Assist pt to sit out and mobilise 4 times Encourage breathing & leg exercises | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Keep head of bed raised to >30° Mobilise fully | Independently mobilising as to pt's norm |
| Personal Care | Assist pt with personal care | Assist pt with personal care | Encourage pt to self-care and dress in day clothes | Encourage pt to self-care and dress in day clothes | Pt dressed in day clothes | Pt dressed in day clothes | Pt dressed in day clothes | Pt dressed in day clothes | Pt self-caring as normal | Pt self-caring as normal |