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Bowel Washouts Rectal in Children Version4 February 2015
Bowel Washouts Rectal in Children Version4 February 2015
Bowel Washouts Rectal in Children Version4 February 2015
Guideline
1 Scope
Children’s services and special care baby unit (SCBU)/ neonatal intensive care
unit (NICU).
2 Purpose
To standardise and improve patient care.
To inform nursing and medical staff.
To provide a tool for teaching.
3 Introduction
Bowel washouts and/ or laxatives can be used to empty or clean the bowel.
Whilst the use of laxatives may be seen as a simpler, less intrusive/
embarrassing method, it is essential that the underlying problem is
considered; laxatives can be contraindicated in some conditions (eg if the
child has a mechanical obstruction - stimulating peristalsis with laxatives can
cause pain +/- perforation.)
As per the NMC code of professional conduct, a nurse must ensure knowledge
and skills are kept up to date, obtain help and supervision from a competent
practitioner if an aspect of practice is beyond your level of competence and
deliver care based on current evidence and best practice.
Equipment Rationale
Two nurses/ equivalent (in some areas one nurse and Two persons are required to
one nursery nurse may perform the rectal washout and, perform a rectal washout.
where parents are being taught, one of the persons
may be a parent).
Position all equipment ready for use: The nurse inserting the catheter
Place bowl of hot water onto trolley. needs easy access to the
Place bottles/ bags of Sodium Chloride into the bowl of catheters and KY jelly. The
hot water. other assistant needs access to
Ensure all equipment is within easy reach of the relevant the warmed 0.9% Sodium
nurse/ assistant. Chloride and vomit bowls.
Child’s lower clothing garments should be removed and To prevent soiling of child’s
a dry towel placed over the patient. clothing and to aid in keeping
the child warm.
Place a number of disposable pads under the patient. Protection of bed linen, maintain
patient’s comfort and dignity. By
placing a number of pads under
the patient initially, the wet one’s
can be removed and a dry one
is immediately available
underneath.
Nurse ‘A’ should locate the anus then apply some KY To lubricate the catheter
jelly to the tip of the rectal catheter and then gently insert
the catheter into the rectum until all the ‘eyes’ on the If all the eyes are not inside the
catheter are inside the anus. anus the sodium chloride will
not run up into the bowel but
instead, will run straight out onto
the bed.
Nurse ‘B’ primes the giving set then connects the giving
set to the end of the catheter with the clamp on.
Nurse ‘B’ repeats running in the sodium chloride (use 20 To completely clear the faeces.
ml each time in a newborn, 50 mls in an older child and
up to 100mls in a teenager) and allowing it to run out
again until the output runs clear (this may take a total of
200 mlsplus in a newborn and up to 2 litres in an older Removing the rectal catheter
child). Nurse ‘A’ should keep the rectal catheter in place each time can cause irritation to
throughout. the bowel wall.
Sodium Chloride is bypassing the Nurse ‘A’ should firstly attempt to insert the
catheter catheter further (up to max of 10 cms in an
infant/30 cms in an older child).
If the problem persists, attempt to insert a
larger gauge of rectal tube
The catheter may be blocked. Remove, assess
and clear if necessary.
If the problem still persists this may be due to
the severe degree of faecal impaction and very
hard stool. Ensure the Sodium Chloride is
warm to assist in breaking down the stool,
consider using enemas between washouts to
break down the stool. Where stools are very
hard and washouts fail, a manual evacuation
under GA may be required.
The Sodium Chloride is not running This may be because the tip of the catheter is
down the administration set against the bowel wall. Nurse ‘A’ should
remove the catheter slightly and reinsert to
reposition it.
This may be because the catheter has become
blocked with faeces, remove and assess and
clear the tube if necessary.
This may be because of a vacuum within the
administration set. Use the palm of your hand/
plunger from the syringe to cover the top of
the syringe and then remove again. This will
usually clear the vacuum.
The Sodium Chloride has been This may be because the catheter is against the
administered but has not run out bowel wall. Nurse ‘A’ should rotate the tube/
again since the syringe was inverted slightly reposition it by inserting further/ removing
slightly.
This may be because the catheter is blocked,
remove, assess and clear if necessary
This may be because the volume administered
was insufficient, pour in further Sodium Chloride
and reassess. If the Sodium Chloride still does
not run out, contact the nurse specialist/ medical
or surgical team.
The catheter keeps blocking Attempt to use a larger gauge of catheter (rectal
catheter 24 Fr can often be used in a 5kg baby with
a normal anus)
The measured volume of output is Ascertain how much fluid may have bypassed
less than that of the Sodium onto the sheets and therefore cannot be
Chloride administered measured accurately.
If there is a significant difference in volumes
(ie over 20 mls in a neonate, 100 mls in a
baby, over 500 mls in an adolescent), re insert
a rectal catheter to clear the Sodium Chloride
solution
Observe the child’s output into the nappy/
toilet over the next two hours as the Sodium
Chloride will usually spontaneously pass out.
Inform the child’s medical/ surgical team if
concerns persist.
12 References
Bonnard A et al (2003) Definitive treatment for extended Hirschsprung’s
disease or total colonic form:- laparoscopic pull through technique. Pediatric
Endosurgery & Innovative Techniques 7(3) 255-260
Royal College of Nursing (2003) Digital rectal examination and the manual
removal of faeces: The role of the nurse. Third edition. London, RCN
Publishing Company
Disclaimer
It is your responsibility to check against the electronic library that this
printed out copy is the most recent issue of this document.
Document management
Approval: Paediatric surgery- 12 February 2015
Owning department: Paediatric general surgery
Author(s): xxx
File name: 387160851.rtf
Supersedes: Version 3, March 2012
Version number: 4 Review date: February 2018
Local reference: Media ID: 3186