Retroperitoneal Lymph Node Dissection

Pathway Retroperitoneal Lymph Node Dissection

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: epidural/PCA until able to tolerate toast/crackers, and then convert to orals. Ask if Toradol is okay (make sure Creatinine is normal and risk of bleeding is low). Oral pain med is usually Oxycodone and Tylenol.

--Cor: home meds, IV until POD 1. No aspirin/Plavix until approved by Attending/Chief.

--Pulm: wean O2, early ambulation, chest PT if patients are requiring O2 on POD 1. If on Bleomycin precautions please write order to limit use of O2 and wean with goal of >89%. --GI : D/C NGT POD1, NPO POD1, may chew gum, POD2 Clear sips up to 30cc/hr non-carb, usually until flatus, some will start clear liquids on POD2-3 until flatus. Once they pass flatus, may start clears toast and crackers but always check with the Chief. May start oral pain meds once tolerating toast and crackers. Dulcolax suppository is often used for these patients.

--GU: Maintenance IV fluids starting POD1. HLIV once tolerating >400cc clear liquid diet. Usually (check with chief first) If on Bleomycin precautions please write order for limited IV fluid. Will tolerate urine output of 20cc/hr.

--Heme: ambulate POD1, pneumoboots, ??SQH??

--Labs: Basic metabolic, mag until on house diet, CBC, POD 1 and 2.

--Discharge without services POD 3-5