Colon & Rectal Surgery Patient Journey Guide Thank you for choosing Washington University Colon and Rectal Surgery. This guide outlines the enhanced recovery plan used by our team. Patients participating in such a recovery plan leave the hospital on average 2.5 days sooner and may experience half as many complications as those who do not participate. We believe this is an extremely important part of your care. Your surgeon will discuss your recovery plan with you. You will receive personalized education from our outpatient nurse prior to surgery. The goal is to allow you to go home and return to your normal activity level sooner. TREATMENT CENTERS YOUR JOURNEY TO RECOVERY STARTS NOW Our board-certified surgeons have more than 70 years of combined colon and Bring this guide along with you to all rectal surgery experience. In addition, we appointments, meetings and your stay at have nurse practitioners, ostomy nurses, the hospital. registered nurses and a full office staff to • Use this guide to learn more about what support you prior to and following surgery. will happen before, during and after Patients are treated at Barnes-Jewish surgery. Hospital and Barnes-Jewish West County • Complete the guide checklists. This will Hospital. We work closely with these help you recover as fast as you can. facilities to ensure you receive excellent • Your entire care team will refer to this care during your hospital stay. guide throughout your surgery. The information in this booklet will help you understand, prepare for and recover from your colon and rectal surgery. By becoming informed and involved, patients and family members can contribute to the success of your surgery. Washington University Colon & Rectal Surgery 1
TABLE OF CONTENTS Appointments 3 Your colon and rectal surgery 4 Getting to know your care team 5 Getting ready for surgery 6 Preparing for surgery 7 One week before surgery 8 Preparation at home 9 T he day/night before surgery 10 What to bring to the hospital 10 Washing With Pre-Surgical Soap 11 Day of surgery 13 Your hospital stay 13 Expectations and goals after surgery 14 Getting ready for discharge 16 Caring for yourself at home 17 Managing your pain 17 Your recovery timeline 18 Surgical locations 19 Lovenox® instructions 20 Colon diagram 21 Notes and questions 22 Contact Us via MyChart MyChart: Your Secure Online Health Connection Manage appointments, get test results, message your doctor, pay bills and request prescription refills online or with the MyChart app. How do I sign up? If you received an email from MyChart: Click the link and follow the instructions. If you received an activation code from your doctor’s office: Visit MyPatientChart.org and click the “Sign Up Now.” Enter the code and follow the instructions. Both sign up methods are active for 90 days. If you have not received the MyChart email or activation code, please call our office. 2 Patient Journey Guide
APPOINTMENTS Your surgeon’s office will coordinate your preoperative appointments. You will also meet with the nurse prior to surgery to discuss preparing for recovery from your surgery. It is essential that you keep these appointments. If you are unable to make an appointment call 314-454-7177 immediately to avoid delay or cancellation of your surgery. APPOINTMENTS DATE TIME LOCATION ☐ Barnes-Jewish West County Hospital Preoperative Education 1044 North Mason Road, Bldg. 4, Suite 310 Learn about your surgery experience Creve Coeur, MO 63141 ☐ Center for Advanced Medicine 4921 Parkview Place, Suite 12B St. Louis, MO 63110 ☐ Center for Advanced Medicine – South County 5201 Midamerica Plaza, Suite 2300 St. Louis, MO 63129 Getting Ready for surgery ☐ Barnes-Jewish West County Hospital Evaluation at the Center for Main entrance, registration desk Perioperative Assessment and 12634 Olive Blvd. Planning (CPAP) Creve Coeur, MO 63141 ☐ Center for Advanced Medicine 4929 Parkview Place (1st Floor) St. Louis, MO 63110 ☐ Center for Advanced Medicine – South County 5201 Midamerica Plaza, Suite 2300 St. Louis, MO 63129 ☐ Christian Hospital 11133 Dunn Rd, Check in at registration St. Louis, MO 63136 Post-Op appointment: Additional appointment: Additional appointment: Washington University Colon & Rectal Surgery 3
YOUR COLON & RECTAL SURGERY Your Diagnosis Name of your Procedure Surgeon Tentative Surgery Date and Time Arrival Time at the Hospital ☐ Barnes-Jewish West County Hospital Location of Your Surgery 12634 Olive Blvd. Creve Coeur, MO 63141 Estimated length of Procedure ☐ Christian Hospital 11133 Dunn Rd, Check in at Registration St. Louis, MO 63136 ☐ Parkview Tower 1 Parkview Place, St. Louis, MO 63110 ☐ 1st Floor Surgery Registration ☐ 3rd Floor Surgery Registration Medical Assistant Medical Assistant Phone Contact Us Office: 314-454-7177 (8 a.m. to 4 p.m., Monday to Friday) Exchange: 314-362-1242 (after hours, holidays, weekends) Fax: 888-425-7946 Mailing Address: 660 S. Euclid Ave., Mailstop 8109-37-915, St. Louis, MO 63110 ColonRectalSurg.wustl.edu 4 Patient Journey Guide
GETTING TO KNOW YOUR CARE TEAM Your care team is here to provide world-class health care in a compassionate, respectful and responsive way. While in the hospital recovering from surgery, you will be managed daily by your surgeon and his/ her colorectal surgery fellow or chief resident. In addition, a nurse practitioner, surgical resident and/or intern will be present on the patient care unit to monitor your recovery and discuss your progress with your surgeon, fellow or chief resident. Colon and Rectal Surgeon Collaborating Surgeon Your surgeon is a full-time Washington University This surgeon is a full-time Washington University physician who will guide your care and perform your subspecial-ty physician (i.e. hepatobiliary, urology, surgery. As part of a world-class academic medical gynecology or other specialty) who may work with your center, he or she will work alongside a multidisciplinary Attending surgeon to per-form portions of your surgery, team of medical professionals. should additional assistance be required. Anesthesia Team Advanced Practice Nurses and Physician Assistants An anesthesia doctor or advanced practice nurse will These state certified health-care providers are trained provide anesthetic for surgery and keep you safe during at the master’s degree level and will work with your surgery and in the recovery room. They also help treat surgeon to care for you after surgery. They will follow your pain. your progress daily and update your care team as needed. Fellows Residents Fellows are physicians who have completed their Residents are physicians who have completed medical residency and are undergoing additional training to school and are undergoing additional training in a become board certified in a specialty. While inpatient, surgical specialty. While inpatient, you will see resident you will see fellows on daily rounds, checking physicians on daily rounds, checking your progress. If your progress. you call after hours, you will speak with a plastic surgery resident on call. Registered Nurse (RN) Ostomy Nurse An individual who holds a license to practice If you have a colostomy or ileostomy placed during professional nursing in the state of Missouri. Nurses surgery, a wound ostomy nurse will assist you with are your advocates. They work with your surgeon and how to care for your ostomy at home and how to order health care team to care for you before, during and after supplies. your surgery. They will teach you how to stay safe and healthy during every step of your recovery. Registered Dietitian (RD) Case Manager/Social Worker Dietitians are licensed healthcare professionals who Your case manager is a trained registered nurse. They assess, diagnose, and treat nutritional problems. They work with your care team to help plan your discharge, will teach you about healthy nutritional habits to aid in home equipment needs, and help with insurance your recovery. questions. Your social worker is available to provide support, help with advanced directives, find community resources, and help the team in preparing you for discharge. Registered Dietitian (RD) Patient Care Technician/Student Nurse Technician Dietitians are licensed healthcare professionals who A trained individual who assists the RN in the delivery of assess, diagnose, and treat nutritional problems. They direct patient care. will teach you about healthy nutritional habits to aid in your recovery. Washington University Colon & Rectal Surgery 5
GETTING READY FOR SURGERY Preparation is an important step in your recovery. CONSIDERATIONS BEFORE SURGERY Ask questions • It is important that you understand what will happen to you before, during and after your surgery. You will be asked to sign a consent form to give the doctor permission to proceed with the surgery. Ostomy education • An ostomy is a surgically created opening, also known as a “stoma,” connecting the bowel to the surface of the body to permit the drainage of waste products. Based on your diagnosis, your surgeon will talk to you about the likelihood of a stoma. • Patients who will have an ostomy will have an education session with our ostomy nurse. You will review educational materials and receive a DVD to take home and watch. • This is an important visit and you are encouraged to bring a family member or friend with you. • Please call the office at 314-454-7177 if you are having ostomy surgery and were not given a time to meet with the ostomy nurse prior to your surgery. Support • Your main responsibility after surgery is to focus on recovery. • Consider arranging for a family member or friend to assist you with household work and other necessary errands during the days immediately following your surgery. • Transportation – you should not drive for at least two weeks after surgery; no driving while on narcotic pain medication. • Lifting – you should not lift anything heavier than 10 pounds for six weeks after surgery. Plan Ahead for Family and Medical Leave Act (FMLA) Paperwork • FMLA paperwork can be faxed to 888-425-7946, mailed to the office or given to your medical assistant. We cannot email records or FMLA paperwork due to privacy rules. • Please allow 7-10 days for FMLA paperwork to be completed and returned to your employer. 6 Patient Journey Guide
PREPARING FOR SURGERY PRE-OP PLANNING VISIT WITH THE CPAP TEAM Many patients have an appointment with a member of the anesthesia team before surgery. This is held in our Center for Preoperative Assessment and Planning (CPAP) or over the phone (TPAP). What to bring with you to CPAP: ☐ This surgical procedure guide ☐ Insurance card, driver’s license or state ID ☐ Advanced directive (if you have one) [Such as a living will, heath care proxy, or health care power of attorney document] ☐ Complete list of your current medications including prescriptions, over-the-counter, vitamins and herbal supplements At the CPAP Appointment • You will have a complete history and physical and any necessary blood tests. • You will discuss medications you take and allergies you have. • You will discuss the different types of anesthesia (the medicine that makes you comfortable during your surgery) and their risks and benefits. Please let your care team know if you’ve ever had a problem with anesthesia in the past. • You will talk about side-effects you may have from anesthesia or surgery, like: * Drowsiness * Nausea, vomiting, gas or headache * Sore throat, dry mouth, and thirst * Shivering or coldness * Soreness or discomfort Taking Medicines before Surgery • Please follow all instructions for stopping any medicines before surgery. • If you are unclear or have not been given specific instructions regarding certain medications, please call us at 314-454-7177. Washington University Colon & Rectal Surgery 7
ONE WEEK BEFORE SURGERY ☐ Stop any medications as instructed ☐ Obtain Immunonutrition drinks ☐ Obtain prep supplies ☐ Prescription medications (Neomycin, Flagyl & Zofran) ☐ Dulcolax® - One box 5 mg laxative tablets (no prescription, over-the-counter) ☐ Miralax® - 238 gram bottle (no prescription, over-the-counter) ☐ Clear or light colored liquid - One 64 oz. bottle (see below) ☐ 16oz. Gatorade®/Powerade® for the day of surgery ☐ Follow any other additional instructions provided by CPAP or your surgeon Immunonutrition Drink: Five Days Before Surgery Your surgeon recommends you drink an immune boosting drink three times a day for five days prior to surgery. Studies show that drinking an immune boosting drink reduces complications. If you choose not to purchase an immune boosting drink, it is recommended you drink three high protein nutrition drinks (ex. Boost®, Ensure®, Carnation Breakfast Essentials®) for the five days prior to surgery. Immune boosting drinks can be purchased at the hospital with the coupon your surgeon provides. If you have diabetes: To avoid high sugar/carbohydrate beverages we suggest: Glucerna® Protein Smart, Boost® Glucose Control or Ensure® Clear. Please check off each step of your prep as you complete it and bring this book with you the day of your surgery. 8 Patient Journey Guide
PREPARATION AT HOME 5 DAYS 4 DAYS 3 DAYS 2 DAYS 1 DAY DAY OF SURGERY BEFORE SURGERY BEFORE SURGERY BEFORE SURGERY BEFORE SURGERY BEFORE SURGERY // // // // // AM ☐ Mix Miralax & Clear Liquid ☐ Shower again with CHG cleanser and place in fridge (ScrubCare®/ Hibiclens®) ☐ Drink 16 oz. of Gatorade®/ Powerade® three hours before surgery. Breakfast ☐ Immune ☐ Immune ☐ Immune ☐ Immune ☐ Immune boosting drink 7-8am boosting boosting drink boosting drink boosting drink drink 10AM ☐ Flagyl® (Metronidazole) 500mg ☐ 2 Dulcolax® tabs with 8oz. clear liquid. 11AM ☐ Zofran® (Ondansetron) 8mg for nausea ☐ Begin drinking Miralax® and drink 8 oz., every 15 minutes, until finished. Lunch ☐ Immune ☐ Immune ☐ Immune ☐ Immune ☐ Immune boosting drink 12-1pm boosting boosting drink boosting drink boosting drink drink ☐ 2 more Dulcolax® tabs. 1PM ☐ Flagyl® (Metronidazole) 500mg ☐ Neomycin (Neomycin Sulfate) 1000mg 2PM ☐ Flagyl® (Metronidazole) 500mg ☐ Neomycin (Neomycin Sulfate) 1000mg Dinner ☐ Immune ☐ Immune ☐ Immune ☐ Immune ☐ Immune boosting drink 5-6pm boosting boosting drink boosting drink boosting drink PM drink ☐ Pack Your bag 10PM ☐ Shower with CHG cleanser (ScrubCare®/ Hibiclens®) Washington University Colon & Rectal Surgery ☐ Neomycin (Neomycin Sulfate) 1000mg 9
THE DAY AND NIGHT BEFORE SURGERY Bowel Prep: Day Before Surgery Bowel preparation empties the digestive system to reduce infection. Complete the following as instructed by your care team. Drink only clear liquids from the time you wake up and continue to drink your immunonutrition drink. Do not eat any solid food all day. Mix 64 oz. of clear liquid with 238 grams (one bottle) of Miralax® until the Miralax® is completely dissolved. Place in the refrigerator to chill. WHEN TO STOP EATING AND DRINKING BEFORE SURGERY It is very important to follow these instructions. Doing so lowers your chances of nausea and aspiration. Aspiration is a major lung problem that can occur if food or liquid gets into the lungs 1. A liquid is considered clear if you can see and read through it. You cannot drink any orange juice, milk or dairy products. These are clear liquids that you can drink: (avoid any colored red or purple): • Apple Juice • Crystal Light • Popsicles • Black Coffee • Gatorade® • Soda/Pop • Chicken/Beef bouillon • Kool-Aid • Tea • Chicken/Beef Broth • Lemonade • Water • Plain Jell-O • White Grape Juice If you have diabetes: Select from list above. Avoid high sugar/carbohydrate beverages ( juice/sports drinks, etc.) 2. Drink 16 oz. of Gatorade®/Powerade® 1 hour prior to your arrival to the hospital. 3. Stop drinking all liquids immediately after your Gatorade®/Powerade® above. 4. Do not smoke or drink any alcoholic beverages during the 24 hours before surgery. WHAT TO BRING TO THE HOSPITAL Pack Your Bag: ☐ Bring this booklet! ☐ Insurance card and photo ID ☐ Glasses, contacts, hearing aids, respiratory/CPAP equipment, wheelchair, cane, crutches or walker, if needed ☐ Two packs of chewing gum to help your bowels return to normal ☐ Loose, comfortable clothes; socks, slippers, bathrobe ☐ Face or hair products you regularly use ☐ Phone charger ☐ Do not bring medications or valuables such as cash, credit cards or jewelry 10 Patient Journey Guide
WASHING WITH PRE-SURGICAL SOAP (DECOLONIZATION) You can help reduce your risk of surgical-site infection if you wash properly with antiseptic soap twice before your surgery. See “A Guide for Patients Having Surgery” from our CPAP team for your 2-Day CHG Bathing [TS1] Protocol on pages 7-8. Washington University Colon & Rectal Surgery 11
THE DAY OF SURGERY Check-In • Time & Location of Arrival on Surgery Day (see page 4) YOUR HOSPITAL STAY It is our goal to keep you comfortable and to help you through the recovery process while in the hospital. • Most patients are in the hospital three to five days, but this can vary. • Situations that can affect length of stay include: * Anastomotic leak - This rare, but serious complication usually happens five to seven days after surgery. Two ends of the bowel that we join together fail to heal completely. Patients usually have severe abdominal pain, fever and vomiting. This often requires another surgery. * Wound infection - This usually happens three to 10 days after surgery. * Urinary retention - This occurs if you are unable to urinate after the catheter is removed from your bladder. This can be caused by anesthesia, pain medication, inflammation and decreased activity. The catheter may need to be reinserted until you are able to urinate on your own. Rooms and Visitors Private rooms (that are not medically necessary) are based on availability and there may be additional charges not covered by your insurance. *Scan the QR codes below for the hospital’s updated visitor policy. Barnes-Jewish Hospital (BJH) Barnes-Jewish West County Hospital Christian Hospital VISITING POLICY VISITOR INFORMATION WELCOME INFO Your Care Schedule • While at the hospital, you will have 24/7 care by our team. • Every day starts with morning rounds from 6 – 7:30 a.m. when members of your team will come visit you. • Afternoon rounds will occur anytime from 3 – 7 p.m. when your team will visit you again. • Your surgeon will make rounds throughout the day or have his/her team see you and report your progress to them. • You will have access to your nurses at all times with a call light button. Your nurse will show you how this works. Pathology Results Pathology results can take 10-14 days on average and may not be available until after you are discharged. If you have been home a week and have not received your results, then please call the office at 314-454-7177 to check on the status. 12 Patient Journey Guide
EXPECTATIONS AND GOALS AFTER SURGERY Patients who take an active role in recovery are more likely to be discharged sooner. Care plans are individualized and vary. Walking Goal: Walk at least four times daily in the hall and stay out of bed for six hours each day. • You should get out of bed within 12 hours of your surgery. • The nursing staff will help you until you are comfortable getting up on your own. • Please ask for help to avoid a fall. • Walking will reduce pain, the risk of breathing-related illnesses, development of blood clots and muscle aches. • Walking will speed up return of bowel function, which is necessary for discharge. Early and frequent walking can shorten your hospital stay. Bathing Goal: Bathe daily. • Your surgical incisions can get wet after two days. Prior to that time, you will take a sponge bath. • You will use antibacterial soap or a CHG based cleanser to reduce bacteria on your incision, trunk, arms and legs. • You may use your own face and hair products. Gum Chewing Goal: Chew gum three times daily (for about 15 minutes) beginning the day after surgery. • Chewing gum helps stimulate your bowels. • Please bring gum with you to the hospital. • If you forget, it can be purchased in the gift shop. Breathing Exercise Goal: Use an incentive spirometer (IS) 10 times an hour while awake every day. • An incentive spirometer (IS) is a tool with a breathing tube and air chamber. The hospital will provide this to you. • After surgery, normal breathing patterns change. You may start taking shallow breaths in an effort to reduce pain after abdominal surgery. The IS helps slow your breathing and helps you take larger breaths of air to fill your lungs. • Breathing exercises help prevent pneumonia and other breathing problems that can occur 13 after surgery. Washington University Colon & Rectal Surgery
Wound Care Goal: Keep dressing clean and dry. • Your dressing will be removed two days after your surgery. • Your dressing should be clean and dry. Tell your nurse if it is soiled or wet. Ostomy Education Goal (if applicable): Meet with ostomy nurse. • Empty ostomy bag. • Change ostomy bag. • Understand diet and how to get supplies. • For more details, see page 4 and 5 of ostomy book. Dietary Goal: • Most patients resume a regular diet after surgery. See page 18. • Your nurse or dietician will discuss your diet with you. • Please ask questions if you are unsure. Blood Clot Prevention Goal: Walk frequently and move your legs, feet and ankles to keep the blood flowing. • Your surgeon-led care team will determine what treatments to use to help prevent blood clots. • After surgery, you will likely take blood-thinning medication such as Lovenox® or heparin for up to 21 days. • You may have a special compression sleeve that helps squeeze your leg muscle to keep the blood moving. 14 Patient Journey Guide
GETTING READY FOR DISCHARGE Discharge from the hospital can be stressful for patients and their families. Decisions regarding your readiness to leave the hospital and the best place for you to continue your recovery can be complex. To reduce the stress related to dis- charge, we begin planning immediately following your surgery. All patients are different and we plan your care according to your individual needs. Please share any concerns or questions you have related to discharge from the hospital. It is required that you have full understanding of each of the following prior to discharge. Discuss each item with your care team. ☐ Drains/Devices to be removed ☐ Wound Care If Applicable: • Ostomy teaching • Drain care • Catheter care ☐ Bathing ☐ Activities ☐ Bowel Function ☐ Services/Equipment to be ordered ☐ Pain Management ☐ Driving ☐ Medications Instructions • You will receive a list of medicines to take at home. • Make sure you understand what they are for, how much to take, when to take them and what the side effects may be. • You will be told if there are any home medicines you should stop taking. • You will be told if a medication you were taking at home will now have a higher or lower dose than what you were used to. If so, be sure you understand whether you can use the medicine you already have at home, or if you will need a new prescription. • You will be given a prescription for any new medications. * If you want, you may have them filled by our mobile pharmacy before you go home. ☐ Nutrition ☐ Hydration ☐ Follow-up Appointments (refer to page 3) Washington University Colon & Rectal Surgery 15
CARING FOR YOURSELF AT HOME Your recovery continues at home. As you continue to heal, we are here as a resource for you. Call Your Surgeon Immediately If You: • Experience severe pain that does not get better with medication • Develop a fever above 101.5° F • Experience nausea or vomiting After you leave the hospital, • Experience persistent diarrhea or more than 10 bowel call your surgeon’s office for all movements in 24 hours questions and concerns • Are unable to urinate after eight hours Office: 314-454-7177 • Have a surgical site that has foul smelling drainage, is red or (8 a.m. to 4.pm., Monday to Friday) warm Exchange: 314-362-1242 (after hours, holidays, and weekends) • Have bright red blood from the incision, rectum or ostomy (greater than 1 cup) *a small amount of bleeding may be normal • Experience dizziness, light-headedness or extreme fatigue OSTOMY PATIENTS: • Have ileostomy output greater than 1,200 mL in 24 hours * Are unable to keep a pouch connected for 24 hours *Skin that is painful, red or irritated MANAGING YOUR PAIN • To control your pain when you go home after surgery your doctor will order multiple medications. Some of these medications are over-the-counter and others will require a prescription. It is important to use the right medication for your pain level. • You will continue to follow the same multimodal pain management program at home as you did in the hospital. Multimodal means you will take a combination of medications to control your pain. • Refer to your discharge instructions for your medications. • Always ask your doctor or nurse which medications you should take or if you are unsure of how to take them. • It is our goal that patients manage pain using the lowest dose of medication for the shortest length of time. Using a combination of over-the-counter and prescription medications can help patients achieve this goal. • Never increase the amount of a medication or add a medication without asking your doctor or nurse. • Call the office at 314-454-7177 if your pain is increasing or does not get better with the medications you have been prescribed. 16 Patient Journey Guide
YOUR RECOVERY TIMELINE This varies depending on your surgery, complications and personal health status. Week One: • Walk four times a day. • Get out of bed for six hours daily. (It is normal to be tired. Take naps and rest as necessary). • Drink a minimum of six glasses of water daily. • Eat four to six small meals (foods may taste differently, this is temporary). • Bathe daily. • Perform wound care daily. • No driving. • Do not lift more than 10 pounds. Week Two: • Staples are removed, if applicable. • Reduced need for narcotics. • Walk four times a day. • Get out of bed for six hours daily. • Eat four to six small meals. • Drink a minimum of six glasses of water daily. • Bathe daily. • Perform wound care daily. • Do not lift more than 10 pounds. • As you increase your activity, you may experience muscle aches. Ibuprofen can help. • After week two, you may be ready to drive if you are no longer taking narcotic pain medication. • Ostomy patients may need to reevaluate pouching due to changes in body shape and activity levels. Call the office to see our ostomy nurse. One Month Post-Op • Postoperative appointment • You should no longer require narcotic pain medication. • You may continue to increase activity as tolerated. • You may be ready to drive if you are no longer taking narcotic pain medication. • Return to work with approval. • Do not lift more than 10 pounds. • Ostomy patients may need to reevaluate pouching due to changes in body shape and activity levels. Call the office to see our ostomy nurse. Three Months Post-Op • You will likely have returned to work and resumed regular activities. • You will continue to get stronger and your appetite will improve. • You should begin regaining any weight lost. It may take patients three to six months to feel normal again. • Ostomy patients may need to reevaluate pouching due to changes in body shape and activity levels. Call the office to see our ostomy nurse. Washington University Colon & Rectal Surgery 17
SURGICAL LOCATIONS Barnes-Jewish Parkview Tower Main phone number: 314-362-5000 Surgical Waiting Room: 314-454-7318 Website: barnesjewish.org/Patients-Visitors/Locations-Directions/Barnes-Jew- ish-Parkview-Tower Barnes-Jewish West County Hospital Main phone number: 314-996-8000 Surgical Waiting Room: 314-996-5192 Website: barnesjewishwestcounty.org/Patient-Visitor-Information1 Christian Hospital Main phone number: 314-653-5000 Surgical Waiting Room: 314-653-4307 Website: christianhospital.org/Patients-Visitors How to Scan a QR Code 1. Open the QR Code reader or camera on your phone. 2. Hold your device over QR Code so that it’s clearly visible within your smartphone’s screen. *The phone may automatically scan the code. 3. If necessary, press the button. Presto! 18 Patient Journey Guide
LOVENOX® INSTRUCTIONS Lovenox is a blood thinning medication that is used to decrease the risk of blood clots in the lower body before and after a major injury or surgery. You should use Lovenox as prescribed. 1. Wash and dry your hands. 2. Sit or lie in a position that lets you easily see your abdomen (belly area). 3. Cleanse the site with an alcohol pad and let air dry. 4. Uncap the Lovenox syringe, and be careful to not bend the needle. *Do NOT expel the air bubble that is in the syringe 5. Gently “pinch an inch” of the abdominal tissue between your thumb and index finger. (see picture) 6. Hold the syringe like a pencil and insert the FULL length of the needle directly into the skin at a 90º angle. 7. Push the plunger all the way down. 8. Withdraw the needle from the injection site, and keep your finger on the plunger. 9. Push the plunger all the way down. This will activate the safety device which will retract the needle, and you will hear an audible “click”. This may be difficult, so sometimes you have to really push hard to retract. 10. Discard the syringe in a “sharps only” container. Select a different injection site for each injection. Do not stick the same part of your abdomen two times in a row. Remember, do not take any anti-inflammatory medications while you are taking Lovenox (such as Aspirin, Motrin, Ibuprofen, Aleve, Advil, Toradol, Ketorolac, Naproxen, Celebrex, etc.) Other Things You Need to Know • The amount of medicine the doctor orders for you will come in a pre-filled syringe. • Always use the abdomen to give the injection unless told otherwise by your doctor. There is less pain and bruising when injections are given in the abdomen. • Each time you give yourself a shot, use a different area. Rotate between the left and right side as shown on the picture. Don’t give the injection in an area that is bruised, has lesions or is over a bone. • After removing the needle, apply gentle pressure to the site but do not rub. This can cause damage, bleeding or more bruising. • Needles/syringes should be placed in a rigid, leak proof and puncture resistant container such as a laundry detergent bottle. When full, seal the bottle and dispose of it in the regular trash. Do not put in the recycle bin. * Disclaimer: This material provides general information only. It should not be used in place of the advice, instructions, or treatment given by your doctor or other health care professional. Washington University Colon & Rectal Surgery 19
COLON DIAGRAM Right Splenic Transverse Colon Le Splenic Flexure Ileum Flexure Ascending Colon Descending Colon (Right) (Le ) Cecum Appendix Sigmoid Colon Rectum 20 Patient Journey Guide
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