Use of a clinical pathway in laparoscopic gastrectomy for gastric cancer

Table 1 Structure of the clinical pathway for laparoscopic gastrectomy

Activities date	1 d before OP (Admission)	Pre-OP (the day of OP)	Operation(the day of OP)	Post-OP(the day of OP)	POD 1	POD 2	POD 3	POD 4	POD 5 and 6 (D/C)
Nursing care	Admission to room: (1-3 pm)Fluid balanceSurveillance V/SWeight measurement	Room nurse:Fluid balance,Check V/S	Surgical nurse:OP preparation	Room nurse:Fluid balanceCheck V/S,drainage	Room nurse:Fluid balanceCheck V/S,drainage	Room nurse:Fluid balanceCheck V/S,drainage	Room nurse: Fluid balance, Check V/S, Drainage	Room nurse:Check V/S	Room nurse:Check V/S
	Check (Surgeon/anesthesiologist): Preoperative study Written consentProtocol for OP preparation						Remove peripheral line after start of 2nd SD
Activity	Usual	Bed rest	Bed rest	Bed rest	Ambulation	Ambulation	Ambulation	Ambulation	Ambulation
Treatment procedure	Skin preparation No Levin tube Breathing exercises use of IS Bowel preparation: Magcorol solution, 250 mL: Dulcolax supplement, 2 sup		Surgical nurse:Foley catheterInsertion	Breathingexercises: use of IS	Breathing exercises: use of IS	Breathing exercises: use of IS	Breathing exercises: use of ISremove JP		Surgeon:Wound S/OEvaluation on D/C criteria
			Surgeons: OP	Anesthesiologist:PCA (Fentanyl 3000 mg)
Medication		Prophylaxis: TE	Prophylaxis: ATB	Prophylaxis: ATBMucolytic agent	Prophylaxis: TE
				Anesthesiologist: PCA	PCA	PCA
Medication on demand				Pain killer: (IV) Demerol NSAIDs Antiemetics	Pain killer: (IV)Demerol NSAIDs Antiemetics	Pain killer: (IV)Demerol NSAIDs Antiemetics	Pain killer: (IV)Demerol NSAIDs Antiemetics	Pain killer: (Oral) NSAIDs	Pain killer: (Oral) NSAIDs
Laboratory test				Laboratorytest	Laboratory test		Laboratorytest		Laboratorytest
Diet	Usual diet at breakfastNPO after breakfast	NPO	NPO	NPO	SOW: post 24 h OP		LD at breakfastSD after G/O	SD	SD
Education and information	Information on CPPermission		Information on leaving OP room				Education: diet for patient and/or relative	Education: diet for patient and/or relative	Information on D/C

OP: Operation; V/S: Vital signs; IS: Incentive spirometry; NPO: Nil per os; CP: Clinical pathway; TE: Thromboembolic; ATB: Antibiotic; PCA: Patients controlled analgesia; IV: Intravenous; NSAIDs: Nonsteroidal anti-inflammatory drugs; POD: Postoperative day; SOW: Sips of water; JP: Jackson-Pratt; LD: Liquid diet; SD: Soft diet; D/C: Discharge; S/O: Stitch out; G/O: Gas out.