Adult Bowel Care Policy.pdf - NHS North Somerset

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Appendix 6 Anal Irrigation Using Coloplast Peristeen System Anal irrigation will usually only be tried after less invasive methods of bowel management have failed to adequately control constipation and or faecal incontinence. There is a relatively small evidence base for this procedure at present and so much of the advice given is based on expert opinion and practical experience. Indications for use • Neurogenic bowel dysfunction • Chronic constipation including both evacuation difficulties and slow transit constipation • Chronic faecal incontinence Rectal irrigation should only be started and carried out for the first time under the direction of the doctor, nurse or other qualified health care professional. All healthcare professionals who are considering recommending the use of anal irrigation should discuss this with the continence service. This is a medical device available on prescription. For full instructions and diagrams please see leaflet entitled guidelines for the use of rectal irrigation (Norton 2008). Relative contraindications (use only after careful discussion with relevant medical practitioner) • pregnant or planning pregnancy • active perianal sepsis • diarrhoea • anal fissure • large haemorrhoids that bleed easily • faecal impaction (clear, if possible before starting irrigation: Digital rectal examination if unsure) • Past pelvic radiotherapy which has caused bowel symptoms • Known severe diverticular disease • use of rectal medication for other diseases • congestive cardiac failure • anal surgery within past six months Absolute contraindications (irrigation should not be used) • Acute active inflammatory bowel disease • knowing obstructing rectal or colonic mass • severe cognitive impairment Doc File Reference Issuer: Policy No: Issue Date: Issue No: Review Date: Page: Adult Bowel Care Policy PS 337 06/2009 1 06/2010 32 of 42 32
Equipment required Coloplast Peristeen anal irrigation control unit Single use rectal catheter, Water bag, Leg straps (if required). Gloves and apron (if performed by health care professional) Action Rationale Explain the procedure to the patient To gain comfort and ensuring their comfort, privacy and dignity Gain informed consent To ensure legal compliance Wash and dry hands thoroughly. If assisting a patient non sterile gloves and an apron should be worn. Fill water Reservoir. Use lukewarm tap water. There is no need to measure the water temperature Assemble the equipment connect the irrigation bag, control unit and single use rectal catheter, blue to blue and grey to grey Strap pumps to lead if this is most convenient Open the packaging of the rectal catheter 2 to 3 cm, use a self-adhesive tab tab to fix the package to a vertical surface is convenient Turn the control dial to the water symbol It is important to fill the bag completely, even if the full volume will not be used: this makes it easy to control how much water is inserted and ensures the system works efficiently To ensure the system works correctly To allow ease of use To prevent the catheter and falling down To facilitate catheter lubrication Pump the control unit 2 to 3 times To prime the tubing with water and activate the self lubricating coating on the catheter Turn the control dial to the balloon To allow time to prepare symbol. Do not pump yet. Transfer to the toilet if not already on it Holding the catheter by the finger grip, gently insert into the anus as far as the finger grip will allow. If you feel any resistance while inserting the catheter never use force. Take the catheter out. Check there is not hard still blocking the insertion and gently try again. While still holding the catheter in place pump the balloon The catheter balloon will not blow up if there is hard still blocking the rectum This will inflate the balloon Now let go of the catheter. The balloon will hold it in place. Doc File Reference Issuer: Policy No: Issue Date: Issue No: Review Date: Page: Adult Bowel Care Policy PS 337 06/2009 1 06/2010 33 of 42 33
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 and 14: 11 Understanding Procedures involve
Page 15 and 16: 11.5 Insertion of Enema Before cons
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: abnormalities observed. anal skin t
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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