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The B.C.I.R
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What is a B.C.I.R?

The Barnett Continent Intestinal Reservoir (BCIR) is one type of intestinal ostomy. The BCIR was modified from the Kock pouch.
The BCIR is a surgically-created pouch, or reservoir, on the inside of the abdomen, made from the last part of the small intestine (the ileum), and is used for the storage of intestinal waste.

The pouch works by storing the liquid waste which is drained several times a day, using a small silicone tube, called a catheter. This catheter is inserted through the opening on the abdomen into the pouch. The capacity of the internal pouch increases steadily after surgery.

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Why would you need this?
Some people are unlucky and not born perfect. In my case I was blessed with a disease called Ulcerative Colitis. Ulcerative colitis (UC) is an inflammatory disease of the large intestine,
commonly called the colon. UC causes inflammation and ulceration of the
inner lining of the colon and rectum. This inner lining is called the
mucosa.The inflammation causes the colon to empty frequently resulting in
diarrhea. As the lining of the colon is destroyed ulcers form releasing
mucus, pus and blood.
Drug treatment is effective for about 70-80% of patients; surgery becomes
necessary in the remaining 20-30%.
In my case I was the 20-30% so I had the first surgery called an Ileostomy.That I will also explain in another area.
So far if you have the disease called Crohns you are not able to have this surgery. People with colon cancer are also able to have the B.C.I.R done.

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Everything and anything about the B.C.I.R
This is everything I have learned and things I have added to other peoples thoughts.

What does the word "STOMA" mean?

Stoma means mouth. When we speak of stoma we are referring to that part of the bowel which has been brought to the surface of the skin on the abdomen. After your operation, the stoma will appear slightly swollen,oval or round in shape and lie flat on your abdomen. It may be covered in mucous and dried blood. A catheter tube will be inserted through the stoma to drain the bowel movements from the Barnett Pouch. The mucosa of the stoma is red like the skin which lines the inside of your mouth. It is red because of the rich blood supply. This is a healthy sign. You might think that because of the stoma is red it is painful but it is not. You can touch the stoma without feeling pain because there are no nerves in the stoma. When the stoma is touched it feels wet and sticky because of the mucous. This helps to keep the skin of the stoma healthy and moist. Always check your stoma to ensure that it remains red in color. Cleanse with ordinary warm water.A small amount of bleeding is normal. Use a soft cloth to wash the stoma to avoid abrasion.Mucous drainage from the stoma is normal. To protect your clothing cover it with a knee or elbow band aid,gauze with tape or stoma caps. Try to keep the skin around the stoma dry to prevent rashes.

Catheterization Procedure

After 6-7 weeks of healing and the catheter staying inside your abdomen it will be removed and then it is up to you to drain your pouch every 4- 6 hours. At first it seems sore to touch but after the first few times it gets easier. You will feel a fullness or pressure in the abdomen it is time to empty your pouch or sometimes you feel a lot of air bubbles moving inside also you have a lot more mucous drainage.

You will need the following equipment,

Catheter 28-30 french silicone catheter,KY jelly or any water soluble lubricant,Toilet paper

Sit or stand at the toilet Place toilet paper into the bowl to prevent splash back also place another piece under you stoma to collect any leakage. Remove protective bandage from stoma. Lubricate catheter tip. Gently insert catheter 4-6 inches in a slightly downward direction. If you come to resistance with the catheter at 2-3 inches this is probably due to the pressure of the nipple valve. Relax, take a deep breath in and continue to insert while you exhale. The catheter should slide in smoothy. Allow pouch to drain could take up to 10 minutes. Sometimes the longest part is getting nth tube in. Push with your abdominal muscles to assist emptying. Slowly remove catheter. Wipe stoma with tissue and apply a clean bandage. While your draining your pouch it is a good time to irrigate it also. This is a simple step that you learn in the hospital. The only difference is you fill your syringe with 30-60 cc of warm water then you insert it into the catheter after your done draining. You slowly inject the water into the pouch slowly pull back the syringe to empty the contents from the pouch. Once the contents come out mostly water then you remove the catheter and wipe stoma and apply bandage.

POSTOPERATIVE CARE

No doubt you will feel uncomfortable, exhausted and overwhelmed after the operation. Together the nurses and doctors and your self with monitor your progress toward a healthy lifestyle.

Here are a few points to remember.

After awaking from the surgery you will not eat or drink until your bowel begins to function by passing gas.

-You will feel discomfort depending on your pain tolerance. But it is passable by either laying on your side or placing heat on your tummy.

A drainage tube from the Barnette Pouch will continuously empty into a bedside pouch to promote healing.

-The tube will cause you no pain,when you see it it looks very sore but looks are deceiving at this moment.

A drainage tube for the Nasogastric or gastrostomy will be attached to to prevent bloating or nausea

-The nasogastric tube is inserted into the nasal passage it can be a bit annoying but just think it will be out soon.

-The Gastrostomy tube is inserted into the stomach and drains for there. It also is a little uncomfortable.

A Urinary Catheter will remain in your bladder for a few days to drain your bladder it assists to take pressure off the Barnette Pouch while healing.

-This Catheter does not cause any pain . Just do not try to remove it yourself.

Your incision will extend form your pelvic bone to just below your breast bone.

Staples are usually used to hold it closed. It will be covered by a sterile dressing.

-The incision is painful more for those with a low tolerance level but to old pro's of surgery is it less.

-The staples are uncomfortable while being removed but just think your scar is large enough you can ask the nurse to keep switching area's

There many be other drains in your abdomen to remove excess fluid to help promote healing.

-Once again usually the looks are more deceiving. Pain is little due to the fact your stomach is still pretty frozen.

Pain Control is managed with the use of a pre-programmed schedule. You will control your pain with the use of a PCA pump. (Patient controlled analgesic pump) An epidural is also offered that is when a catheter is inserted into the back and medicine is inserted in.

-The PCA pump is what you use to control your pain it must have been invented from someone that was tired of waiting for the nurses on busy days.

-The epidural is another way to manage pain but will not lie is a little painful while getting it. But will reduce your pain also when you awaken.

Hints for draining.

Sometimes food gets caught inside the tube and it is hard to drain if this happens remove tube and clean it out and reinsert. Only do this once or twice you do not want to hurt your valve.

If your stool is thick

Slowly move catheter in and out but not to much

Massage the area over your pouch to help push the contents out.

Relax breath deeply and slowly.

NEVER go beyond your 6 hour schedule.

Catheterize on awaking and before bedtime no matter the schedule.

Irrigate the pouch with 30 cc of warm water till it begins to flow easy.

Bear down like having a bowel movement to help pouch the stool out.