Subject(s)
Dermatitis, Irritant/nursing , Ileostomy/adverse effects , Pouchitis/nursing , Referral and Consultation , Skin Care/nursing , Colectomy/methods , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/surgery , Dermatitis, Irritant/etiology , Follow-Up Studies , Humans , Ileostomy/methods , Male , Middle Aged , Pouchitis/etiology , Skin Care/methods , Wound Healing/physiologyABSTRACT
BACKGROUND: Postoperative ileus is a temporary disturbance in gastric and bowel motility following surgery. The risk for postoperative ileus following gastrointestinal and urinary ostomy surgery is significant because both procedures require extensive surgical manipulation and reconstruction of the bowel. Chewing gum is advocated for treatment because it acts as sham feeding, potentially stimulating gastric and bowel motility through repetitive stimulation of the cephalic-vagal complex. OBJECTIVES: This Evidence-Based Report Card reviews and evaluates evidence related to the safety and efficacy of chewing gum as an intervention to reduce the duration of postoperative ileus. SEARCH STRATEGY: We systematically reviewed the electronic databases CINAHL and MEDLINE from January 1996 to November 2009, using the terms "ileus" and "chewing gum." We also searched the ancestry of the 21 articles returned by this review and searched Google Scholar. We included any study or meta-analysis of multiple studies that compared chewing gum to no treatment in patients undergoing abdominal surgery and creation of an intestinal or urinary stoma. We evaluated the following outcome measures: (1) time to passage of flatus, (2) time to passage of stool, or (3) length of hospital stay. Three meta-analyses and 4 studies met inclusion criteria. RESULTS: Results of meta-analyses support the use of chewing gum for treatment of postoperative ileus. Chewing gum was consistently found to reduce time to passage of flatus and stool. One meta-analysis found that chewing gum reduced hospital stay but two found no difference. Analysis of studies reveal mixed results when chewing gum was compared to standard postoperative care in patients undergoing surgical reconstruction including ostomy surgery or creation of an orthotopic neobladder. The studies we reviewed were characterized by multiple limitations in design quality including small sample sizes, absence of multicenter trials, and lack of subanalyses of patients undergoing ostomy surgery. IMPLICATIONS FOR PRACTICE: Current best evidence suggests that chewing gum should be offered to selected patients with the intent of decreasing postoperative ileus. A careful nursing assessment of the patient's mental status, aspiration risk, and dentition is needed before initiating the intervention. In addition, further research is needed to develop more clearly defined parameters for chewing gum including frequency and duration of chewing and its use in patients with nasogastric tubes.
Subject(s)
Chewing Gum , Ileus/therapy , Ostomy , Evidence-Based Medicine , Humans , Ileus/physiopathology , Postoperative ComplicationsSubject(s)
Dermatitis, Irritant/etiology , Ileostomy/adverse effects , Adult , Dermatitis, Irritant/nursing , Humans , Male , Skin Care/nursingSubject(s)
Crohn Disease/surgery , Ileostomy/adverse effects , Referral and Consultation , Skin Ulcer/nursing , Colectomy/methods , Crohn Disease/diagnosis , Female , Follow-Up Studies , Humans , Ileostomy/methods , Nursing Assessment/methods , Ostomy/nursing , Patient Care Planning/organization & administration , Risk Assessment , Severity of Illness Index , Skin Care/methods , Skin Ulcer/diagnosis , Skin Ulcer/etiology , Treatment Outcome , Wound Healing/physiologySubject(s)
Urinary Bladder Neoplasms/surgery , Urinary Diversion/methods , Urinary Diversion/psychology , Urinary Incontinence/etiology , Abdomen/anatomy & histology , Aged , Equipment Design , Female , Humans , Quality of Life , Urinary Incontinence/prevention & control , Urinary Incontinence/psychologyABSTRACT
OBJECTIVE: We evaluated a new fistula and wound management system; ostomy and wound care nurses were queried about willingness to use the product in future patients, product wear time and pouch leakage, perifistular skin condition, access for wound care, pouching time, patient mobility and comfort, odor management, pouch flexibility, adhesiveness, and erosion. A health economic assessment was also done. METHOD: Twenty-two patients (5 males and 17 females) with an abdominal fistula participated in the study. Participants tested 75 pouches, representing an average of 3.4 pouches per subject. The investigator at each site who performed the pouch changes completed a questionnaire at baseline, during the test, and after testing the pouches. Participants also completed a set of questions after each test pouch was removed. RESULTS: In 21 of 22 cases, the nurses would consider using the new system on future patients. After each pouch removal, patients were asked whether they were able to move around while wearing the test pouch and they answered yes 95% of the time. The new system was found to have significantly longer wear time than traditional systems (P = .003), but the average time spent on changing the pouches was not significantly different (P = .07). Access for fistula and wound care was rated as excellent in the new pouching system, and comfort was rated as very good. CONCLUSION: The results of the study suggest that all of the key requests received from nurses for an improved system for fistula and wound management were met by the new system.
