PROSTATECTOMY Robot

Pathway Radical Laparoscopic Robot Assisted Prostatectomy

Always check with Chief first: these are “guidelines” only. Orders must be approved by Chief prior to implementing. May change with time/patient/ attending and Chief.

--N: PCA until tolerating house diet usually at noon on POD1, then convert to oral; usually Vicodin. Toradol is often written for these patients but is sometimes held if bloody case or elevated creatinine. The resident who performs the surgery will be the one to write for this.

--Cardiac: home meds. Hold Aspirin/Plavix until approved by Attending/Chief

--Pulm: wean O2, early ambulation night of surgery preferred, chest PT if requiring oxygen on POD1

--GI: POD1 clears in am, Mechanical soft diet starting at noon and to be continued until patient passes flatus. Nothing per rectum.

--GU: HLIV when po intake >400cc. Foley stays in!!! Never deflate balloon or reposition foley. Foley should always be attached to cath secure. Check with Chief prior to flushing these foleys (sometimes these patients can have clot retention and may require gentle flushing). JP drain is removed around 12-2pm if output is less than 60cc since midnight (always check with Chief or Dr. Hu first). Send for JP creatinine stat if there is a question that the output is too high that way we can decide if patient goes home with the JP or not.

--Labs: CBC or HCT on POD0 and POD1. Check to be sure Hct is okay prior to discharge. If Hct is low, ok to repeat a stat hct in early afternoon to check for stablilty. --Discharge home POD1 around 2pm if all of the above is ok.