Looks Can Be Deceiving 

Submitted by Heather Miller, RN

Tags: bowel perforation health care jp drains nursing

Looks Can Be Deceiving 

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At about 2:30 PM I received a patient from the OR. It was a male patient, we will call him Bob, and he was 61 years old. Bob was a fairly healthy man. He had a surgical history of ventral hernia repair with mesh, laparoscopic gastric banding, and a few other minor procedures. His medical history consisted of hypertension and a recent history of abdominal pain and fevers over the past couple weeks. Surgery today was to find out where his pain was coming from. During surgery they found that his mesh was severely infected so they removed it and they also evacuated an abdominal abscess.

Bob was a very pleasant man. His vital signs were completely normal. His assessment was mostly normal for a post operative patient. Only abnormalities were hypoactive bowel sounds and of course he had a large abdominal dressing with 2 JP drains in place. The JP drains had only a small amount of sanguineous fluid in each of them.

A short time after his arrival the surgeon came by to see him. He explained that his mesh was infected so it was removed but also told him that his intestines were very inflamed. He stated that they looked for any perforations in his bowel for the last 30 minutes of the procedure and didn’t locate any but due to the inflammation it would take several day to tell for sure if any were present.

Bob was recovering very nicely. He required very little pain medication. His family came to visit him and I let them stay by his bedside for the duration of his recovery room stay. Bob was laughing and visiting with his family and was pretty much ready to go back to his room. I asked his family to step out for a moment so I could empty his JP drains. I emptied them into a basin and I noticed that they were very dark. I inspected them a little closer and I noticed it had a greenish tinge to it. Remembering what the surgeon had said about the possibility of a bowel perforation I got concerned and called the surgeon.

Minutes later the surgeon came out of the OR. I showed him the fluid I had saved and he asked me to send it to lab to check for the total bilirubin level. I immediately sent it. He spoke to the family and informed them that they would wait for the results but would probably be going back to the OR. He said he would come back and speak to them once the results were back. The strange thing was that Bob didn’t look like a patient that needed to go back to the OR. He was completely stable and laughing and talking with his family, but looks can be deceiving!

About 45 minutes passed and the surgeon came back he stated that the bilirubin in the JP fluid was 10 times higher than his blood lab level so they needed to take him back to the OR. He explained what they would do and answered all of the family and patients questions. The doctor thanked me for being so observant and notifying him so quickly. The family also thanked me repeatedly as well. A short time later the patient returned to the OR.

Less then an hour later the patient came back to recovery. They had found the perforation quickly and repaired it. The patient recovered quickly and returned to his room. Once again he thanked me for being so observant and noticing that there was a problem.