Today is our topic of discussion Bowel Wash.
Bowel Wash
BOWEL WASH
Bowel wash or colonic lavage or enteroclysis is defined as washing out colon with large quantities of solution (Fig. 16.6). Bowel irrigation or enteroclysis is defined as washing out of the colon after the feces has been expelled by using large quantities of prescribed solution.
Purpose
- To prepare for diagnostic examination or before certain surgery
- To relieve inflammation
- To stimulate peristalsis
- To supply fluid and electrolyte those are absorbed from intestine
- To dilute and remove toxic agents
- To reduce temperature in hyperpyrexia
- To relieve fecal incontinence To supply medications locally
- To clean the colon of feces, gas and barium
- To treat infection and other pathological condition of colon.
Contraindications
- Rectal infection Fistula in anus
- Painful and bleeding hemorrhoids
- Painful skin lesions around the anus .
- Massive carcinoma or tumors of the rectum
- Loose sphincter
- Polypus and diverticula of the intestine.
General Instructions
- A cleaning enema should be given one hour before the colon irrigation
- The bladder should be emptied before colonic irrigations
- The temperature of the solution is kept constant throughout the procedure Allow only 200 to 300 mL of fluid to run into the rectum at a time Make sure that the return flow is not blocked.
- Use a smooth and flexible rectal tube and lubricate it well Prevent air entry into the intestines
- Stop the procedure temporarily the patient complaints of pain
- Listen to the complaints of the patient and should not ignore any discomfort however small they may be.
Methods Used for Bowel Irrigation
- Funnel and catheter
- Y connection and a rectal tube
- Two tube method.
- Solution Used
- Tap water
- Cold water
- Normal saline
- Sodium bicarbonate 1 to 2%
- Antiseptic solution KNMO
- Boric solution 1 to 2%
- Tannic acid 1:100
- Alum 1:100.
- Temperature of the Solution
- Cleaning purpose 104°F (40°C)
- Thermal effect 110 to 115 F (43.3 to 46°C)
- Reducing temperature 80 to 90°F (27 to 32°C) amount of solution used for bowl, irrigation is 2 to 3 liters or till the return flow is clear.
Preliminary Assessment
- Check
- Doctors order for any specific precautions
- Diagnosis of the patient
- General condition of the patient
- Self-care ability of the patient
- Mental status to follow instructions
- Any contraindication
- Need for any extra help
- Articles available in the unit.
Preparation of the Patient and Environment
- Explain the sequence of the procedure
- Arrange the articles at the bed side
- Provide privacy
- Place the Mackintosh and towel under the patient
- Place the patient in left later position
- Keep the bucket on a low stool to receive the out flow of fluid Remove the back rest and extra pillows.
Equipment
- A clean tray containing:
- Funnel and tubing with glass connection
- Mackintosh and towel
- Rectal tube placed in a kidney tray
- Vaseline Rag pieces in a container .
- Hot and cold water in jugs
- Prescribed solution in jug
- Paper bag Bucket
- Toilet tray if needed.
- Clean linen if needed .
- Bath thermometer.
General Instruction for Bowel Wash
General Instructions
- A cleaning enema should be given one hour before the colon irrigation.
- The bladder should be emptied before colonic irrigations.
- The temperature of the solution is kept constant throughout the procedure.
- Allow only 200 to 300 mL of fluid to run into the rectum at a time.
- Make sure that the return flow is not blocked .
- Use a smooth and flexible rectal tube and lubricate it well.
- Prevent air entry into the intestines.
- Stop the procedure temporarily the patient complaints of pain.
- Listen to the complaints of the patient and should not ignore any discomfort however small they may be.
Methods Used for Bowel Irrigation
- Funnel and catheter
- Y connection and a rectal tube
- Two tube method.
Solution Used
- Tap water
- Cold water
- Normal saline
- Sodium bicarbonate 1 to 2%
- Antiseptic solution KNMO
- Boric solution 1 to 2%
- Tannic acid 1:100
- Alum 1:100.
Temperature of the Solution
- Cleaning purpose 104°F (40°C)
- Thermal effect 110 to 115 F (43.3 to 46°C)
- Reducing temperature 80 to 90°F (27 to 32°C) amount of solution used for bowl, irrigation is 2 to 3 liters or tillthe return flow is clear.
Preliminary Assessment
- Doctors order for any specific precautions.
- Diagnosis of the patient.
- General condition of the patient.
- Self-care ability of the patient.
- Mental status to follow instructions.
- Any contraindication.
- Need for any extra help.
- Articles available in the unit.
Preparation of the Patient and Environment
- Explain the sequence of the procedure.
- Arrange the articles at the bed side.
- Provide privacy.
- Place the Mackintosh and towel under the patient.
- Place the patient in left later position.
- Keep the bucket on a low stool to receive the out flow of fluid.
- Remove the back rest and extra pillows.
Equipment
- A clean tray containing.
- Funnel and tubing with glass connection.
- Mackintosh and towel.
- Rectal tube placed in a kidney tray.
- Vaseline Rag pieces in a container .
- Hot and cold water in jugs
- Prescribed solution in jug.
- Paper bag
- Bucket.
- Toilet tray if needed.
- Clean linen if needed .
- Bath thermometer.
Procedure for Bowel Wash
Procedure
- Wash hands thoroughly.
- Prepare the solution at the required temperature.
- Attach the tubing and the rectal tube with the funnel, pour solution in it and check for any leakage.
- Lubricate the tip of the rectal tube about 4 inches.
- Separate patient’s buttocks to visualize anus clearly and insert tip of tube about 4 to 5 inches, while patient takes deep breath.
- Lower funnel below level of rectum and empty retur flow into bucket.
- Fill funnel again. Pour 200 to 300 mL of fluid each time..
- Raise funnel and allow fluid to run continuously.
- When 200 to 300 mL of fluid has gone in pinch tube before tunnel is completely.
- Lower and invert tunnel over bucket and siphon fluid, noting characteristics of return flow.
- Repeat this process, till return flow is clear.
- Remove the rectal tube by using rag pieces.
After Care
- Remove rectal tube by using rag pieces.
- Discard rag piece in to K-basin.
- Place patient comfortably, provide bedpan if needed.
- Change linen if soiled, replace equipment after cleaning.
- Hand wash and record the procedure in nurse’s record sheet.