Nutrition Initiation and Advancement Clinical Pathway — PICU/PCU
Nutrition Initiation and Advancement Clinical Pathway — PICU/PCU
Bowel Regimen to Prevent Constipation
Patients should have at least one stool every 24 hours. Upon initiating feeds, resume home bowel regimen or consider the regimen below. If the patient does not have a bowel movement for > 48 hours, escalate per the recommendations below.
Constipation Definitions
- Delay or difficulty in passing stool present for > 48 hours, sufficient to cause pain, stress, discomfort
- Straining lumpy, or hard stools with more than 1/4 of defecations
- < 3 bowel movements per week
Initiation of Bowel Regimen
- If on a home bowel regimen that has not been restarted, resume regimen.
- Ensure continued and adequate hydration
- If no home regimen, start/consider:
- Docusate BID
And/OR - Senna or Bisacodyl BID
And/OR - Polyethylene glycol BID
- Docusate BID
Escalation of Bowel Regimen for Constipation
These recommendations are additive interventions. Do not discontinue the ordered bowel regimen.
- Continue baseline bowel regimen.
- Administer enema x1 OR suppository x1 and/or rectal stimulation in addition to established bowel regimen
- Re-evaluate in 12-24 hours
- If no bowel movement, repeat intervention x2 (enema OR suppository) & re-evaluate in 12-24 hours
- Add Lactulose to established bowel regimen (Polyethylene glycol + Lactulose may cause increased abdominal distension due to gas)
- Monitor for bowel movement for 12-24 hours
- If no bowel movement results, consider next steps to include manual disimpaction.