Gastric Sleeve or Bypass Protocol

Pathway for Gastric Sleeve or Bypass (see gastric bypass orderset) •Compression Stockings•SCDs•Type and Screen•Lovenox40 mg subqx 1 dose•Cefoxitin prior to incision•Scopolamine patch •Continuous pulse oximetry•Bariatric stage I diet (sugar free clear liquids)•Ambulate TID•Incentive spirometry 10x/hour•D5 ½ NS + 20 meqKCL @ 75 cc/hr•Compression Stockings•SCDs•Scopolamine patch •Cefoxitin x 3 doses•Zofran Q8H standing Initiate POD1•Check CBC•Start lovenox40 mg Q24H if CBC okay•Multivitamin Qday(2 chewable tablets)•Thiamine Q24HContinue from POD0•Bariatric stage I diet •Ambulate TID•Incentive spirometry 10x/hour•D5 ½ NS + 20 meqKCL @ 75 cc/hr•Compression Stockings•SCDs•Scopolamine patch •Zofran Q8H standing Initiate POD2•Stop IVFContinue from POD0/1•Bariatric stage I diet •Ambulate TID•Incentive spirometry 10x/hour•Compression Stockings•SCDs•Scopolamine patch •Zofran Q8H standingDischarge home if adequate PO (stop lovenoxon DC) Pre-OperativelyPOD 0 POD 1POD 2 Updated 1/2019 Pathway for Gastric Sleeve or Bypass (see gastric bypass orderset)Type II Diabetes (differences in protocol for type II DM noted in red) •Compression Stockings•SCDs•Type and Screen•Lovenox40 mg subqx 1 dose•Cefoxitin prior to incision•Scopolamine patch •Follow endocrine recommendations from pre-operative consult •Continuous pulse oximetry•Bariatric stage I diet (sugar free clear liquids)•Ambulate TID•Incentive spirometry 10x/hour•D5 ½ NS + 20 meqKCL @ 75 cc/hr•Compression Stockings•SCDs•Scopolamine patch •Cefoxitin x 3 doses•Zofran Q8H standing•Endocrine consult Initiate POD1•Check CBC•Start lovenox40 mg Q24H if CBC okay•Multivitamin Qday(2 chewable tablets)•Thiamine Q24HContinue from POD0•Bariatric stage I diet •Ambulate TID•Incentive spirometry 10x/hour•D5 ½ NS + 20 meqKCL @ 75 cc/hr•Compression Stockings•SCDs•Scopolamine patch •Zofran Q8H standing Initiate POD2•Stop IVFContinue from POD0/1•Begin bariatric stage II diet •Monitor blood glucose per endocrine•Ambulate TID•Incentive spirometry 10x/hour•Compression Stockings•SCDs•Scopolamine patch •Zofran Q8H standingDischarge home on POD 3 if adequate PO and adequate blood glucose control(stop lovenoxon DC) Pre-OperativelyPOD 0 POD 1POD 2 Updated 1/2019