Page 20 - HPB Handbook - May 30 2022 (Flipbook) v2

Page 20 of 22

discretion of the treating surgeon is recommended. If a drain is present, we check drain (and serum) amylase on Day 3 prior
to removing the drain.

Epidurals: There is not strong evidence to support their use following upper abdomen surgery. It is our institutional practice
to recommend epidurals for patients undergoing Whipple surgery. Early removal of epidurals (and Foley catheters) is
recommended, in consultation with the APS.

Post Whipple MD Order Set
OR Day POD#1 POD#2 POD#3 POD#4-6 D/C Day
Diet NPO diet diet diet DAT DAT
Activity Activity as per To ward if stable To ward if stable Activity as per CPW OT/PT, D/C home
CPW Activity as per CPW Activity as per CPW Activity as per D/C letter
CPW
Vitals As per monitored Daily weights As per nursing protocol Daily weights
unit protocol Daily weights
Invest. & CBC, PT/INR, CBC, Lytes, Creat, CBC, Lytes, Creat, LFT, Amylase fluid, if Day 4, 6
Blood Lytes Creat LFT, Bili, Amylase Bili Amylase drain present CBC, Lytes,
Work CXR PT/INR D/C glucose if BS Creat, LFT, Bili,
Glucose QID Glucose QID normal Amylase

Interven- NG to low gomco D/C inv. monitoring D/C central line, CCAC screen D/C letter, FU
tions Minimize drain use foley, drains Social work, Info
if needed Consults
Drugs Periop antibiotics Restart preop meds Wean epidural D/C epidural PO pain meds D/C scripts on
VTE prophylaxis IV maintenance + Start PO pain meds D/C octreotide Add bowel chart
Octreotide replacements VTE prophylaxis PPI or H 2 blocker regimen 28 days of VTE
Famotidine Wean O 2 Octreotide VTE prophylaxis VTE prophylaxis prophylaxis for
APS to monitor VTE prophylaxis PPI or H 2 blocker Taper IV saline PPI or H 2 blocker oncology patients
IV maintenance + Octreotide APS to monitor lock D/C letter & or high risk post
replacements PPI or H 2 blocker Taper IV saline lock, scripts on chart D/C
O 2 APS to monitor when drinking well