This is a process of passing a catheter into the rectum with warm normal saline to deflate the abdomen of gas and faecal matter. The procedure is usually prescribed by the paediatrician and carried out by the paediatric nurse/nurse.
Aims
· Decompress the large intestine of impacted faecal matter
· Provide temporary management for diseases such as Hirschprung’s disesase
· Serves as preoperative management for closure of stoma
· Provides comfort and prevent complications
Requirements
a. Warm saline (20ml/kg body weight)
b. Two receivers
c. Bedpan
d. Foley’s catheter size 18-26
e. Mackintosh with towel/bed mat
f. 50ml bladder syringe
g. Sterile gauze
h. Examination gloves
i. Water-based lubricant
j. Rubber apron
k. Tissue paper
l. Coloplast irrigation bag
Steps
1. Establish rapport (Refer to steps)
2. Explain procedure to child and care giver/family (Refer to steps)
3. Use a developmentally appropriate approach in handling child
4. Perform physical assessment of child for the following:
· Abdominal distention; note visible bowel loops and veins, consistency of abdomen, soft, firm or tight
· Bowel action or nasogastric aspirate; time, frequency, amount, consistency, colour and amount
5. Ensure requested radiological investigations such as abdominal X-ray has been done
6. Obtain informed consent
7. Provide privacy and maintain child’s dignity
8. Perform five moments of hand hygiene
9. Put child on couch covered with mackintosh and towel/bed mat
10. Ask for assistance and involve caregiver during the procedure
11. Position neonate on back with legs in froglike position and older children on their left side with knees drawn up with the buttocks facing the egde of the bed
12. Put on rubber apron and don examination gloves
13. Put warm saline in a receiver and prime catheter with solution
14. Lubricate catheter up to 5cm gently insert into the rectum
15. Insert catheter gently to the length of between 10-15cm depending on the age of child
16. Or according to the ward’s protocol
17. Draw 50ml of warm saline and connect to catheter and push gently
18. Do not use excessive force when there is resistance
19. Rub back of waist to stimulate expulsion
20. Wait for expulsion of the content into a receiver or bedpan and repaete inflation of saline
21. Perform this till the rectum is cleared of faecal matter OR
22. Put saline in coloplast irrigation bag, hang it at shoulder level and prime the tubing with water by releasing the clamp slowly to expel air
23. Release the clamp slowly and allow the saline to flow into the rectum
24. Reduce the flow of saline using the clamp if the child complains of cramping
25. Encourage the child to take in deep breaths
26. Use diversional techniques to relieve child of discomfort the clamp once the solution has flown into the bowel
27. Remove the cone gently and leave the child to sit on the toilet seat or bedpan until the content is expelled
28. Allow the child to remain in the position for a minimum of 20 minutes to ensure all contents are expelled
29. Inform doctor if there is retention of normal saline
30. Inspect the abdomen for any deflation
31. Remove catheter from rectum and leave child clean and dry
32. Observe the colour and consistency of stool
33. Encourage mother to bath child after procedure
34. Express appreciation to child and caregiver for their cooperation
35. Dispose off, decontaminate and clean all used items
36. Document findings, manually/electronically
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