management of bowel obstruction without a tube
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Management
- NG tubes are uncomfortable & may increase secretions
- most palliative care patients are not surgical candidates
- parenteral nutrition & intravenous rehydration is almost always reserved for surgical candidates
- parenteral nutrition for surgical candidates with complete or partial bowel obstruction[3]
- reduce intestinal secretions
- glycopyrrolate 0.2-04. mg SC every 2-3 hours
- for partial obstruction, attempt reversal (especially if functional)
- continue stimulant/bulk combination agents
- octreotide
- 5-10 ug/hr to start
- 250-750 ug/day, continuously
- for complete bowel obstruction, put the bowel to rest
- morphine IV or other opiate
- scopolamine
- 0.8-2.4 mg QD
- Transderm Scop 0.3 mg/24 hours (delayed effect)
- hyoscyamine 0.125 mg SL every 3-4 hours
- haloperidol 5-10 mg/24 hours