Adult Bowel Care Policy.pdf - NHS North Somerset

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11.4 Insertion of Suppository A suppository is a medicated solid formulation prepared for insertion into the rectum. Once inserted the temperature of the body will dissolve the suppository from its solid form to a liquid. The administration of a suppository requires skill and competence on the part of the practitioner, as well as their compliance with the NMC guidelines on the administration of medicines (2008) and local drug administration policy. 11.41 Indications for administration Suppositories may be a useful tool in the management of chronic constipation, particularly when combined with other interventions such as oral agents and preventative measures. They may also be used to empty the rectum in preparation for investigation and for other procedures such as colonoscopy. Suppositories may be used as a route of drug administration for local effect (haemorrhoid medication) or to be absorbed for systemic effect by the vascular network surrounding the rectum (analgesia, antibiotics). The rectal route of drug administration is particularly useful for patients who are fasting or nil-by-mouth before or after surgery. 11.42 Precautions/considerations Care should be taken in the administration of suppositories to patients who have undergone rectal or lower colonic surgery, or who have experienced an obstruction, as the risk of perforation may be increased. This risk may also be increased in patients who have undergone gynaecological surgery or radiotherapy. Any pathology of the perianal region should be considered and risks assessed. Digital rectal examination, according to organisational policy, should be performed prior to administration to assess faecal loading and any abnormalities. The risks associated with suppository administration are considered to be low but suppositories can be detrimental and at worst fatal to the patient if administered in the wrong circumstances. Expert advice should be sought from specialist practitioners in any of the circumstances mentioned above. Suppositories are occasionally prescribed to be administered via a stoma. Again, it is important that expert advice should be sought in such situations. There has been some controversy over the correct insertion technique with regard to which end of the suppository to insert first – the apex (narrower end) or base (blunt end). In a small sample study (Abd-el-Maeboud et al 199, cited Higgins 2007) suggested that if suppositories are inserted apex first the circular base distends the anus and the sphincter may not close completely. However, there is as yet insufficient research evidence to be conclusive about which end of a suppository should be inserted first. Higgins, D. (2007) For full procedure see appendix 4 Doc File Reference Issuer: Policy No: Issue Date: Issue No: Review Date: Page: Adult Bowel Care Policy PS 337 06/2009 1 06/2010 14 of 42 14
11.5 Insertion of Enema Before considering the use of an enema for treatment of constipation please refer to the continence formulary for guidance on treating with high dose Movicol (Macrogol 3350) An enema is a liquid preparation that is introduced into the body via the rectum for the purposes of producing a bowel movement or administering medication. An enema may be required for the following: • Acute disimpaction of the bowel; • Bowel clearance before bowel investigations or surgery; • To soothe and treat bowel mucosa in chronic inflammatory bowel disease such as ulcerative colitis and Crohn’s disease. There are two main types of enemas – evacuant and retention. 11.51 Evacuant An evacuant enema is designed to prompt the bowel to expel faecal matter or flatus, together with the contents of the enema. Phosphate and sodium citrate (Microlette) are the most common types. Possible risks associated with phosphate enemas have been raised (Davies, 2004) so an assessment of need is vital. A recent systematic review of the adverse effects of phosphate enemas (Mendoza, 2007) found an absence of conclusive evidence. Those aged under five and over 65 appear to be most at risk, especially older people with chronic renal failure and/or diseases that alter intestinal mobility. 11.52 Retention A retention enema is designed to be retained in the rectum. The most common are: • Steroid and aminosalicylate preparations; • Arachis oil enemas, which soften and lubricate impacted faeces. They contain groundnut and peanut oil, which means they should be avoided in patients with a nut allergy. Nurses must have a sound knowledge of the use, action, dose and possible ill effects of administrating an enema. Volume retention enemas are contraindicated in all spinal injury patients. Kyle G (2007) For full procedure see appendix 5 Doc File Reference Issuer: Policy No: Issue Date: Issue No: Review Date: Page: Adult Bowel Care Policy PS 337 06/2009 1 06/2010 15 of 42 15
Page 1 and 2: Adult Bowel Care Policy Author(s):
Page 3 and 4: 1. Purpose of the policy 1.1 To ens
Page 5 and 6: 5 Training and Competence 5.1 All p
Page 7 and 8: 8 Acute Bowel Care Problems Nurses
Page 9 and 10: Recent Change In Bowel Habit. Can i
Page 11 and 12: 10 Understanding Faecal Incontinenc
Page 13: 11 Understanding Procedures involve
Page 17 and 18: • anorectal conditions that could
Page 19 and 20: 13 References Chelvanayagam S, Nort
Page 21 and 22: Any of the above abnormalities shou
Page 23 and 24: Appendix 2 Procedure for Undertakin
Page 25 and 26: eak it up, stop and refer to the me
Page 27 and 28: Appendix 4 Insertion of Suppository
Page 29 and 30: Inform patient of insertion of supp
Page 31 and 32: abnormalities observed. anal skin t
Page 33 and 34: Equipment required Coloplast Perist
Page 35 and 36: Problem Advice Pain occurs when pum
Page 37 and 38: Norton C 2008. Guidelines for the u
Page 39 and 40: on the tip of the Peristeen anal pl
Page 41 and 42: Appendix 9 Specific competencies re

Adult Bowel Care Policy.pdf - NHS North Somerset

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