Hello,

I work at an assisted living home and one of the patients needs rectal stimulation with a finger to induce evacuation of his fecal matter. This patient is paralyzed so he cannot do this himself. Question is should a CNA do this, we don't have any nurses in the building or Dr's. Also the patient has a large hemorrhoid and I am worried I could physically harm the patient, what should I do and is it right to tell them this is not for a CNA?

Thanks!

Did this, not even with a NA/R class. I have done this with paras and quads at home for a HH agency as a PCA many years ago (no training whatsoever!!!) Most paras and quads are on bowel programs and this might be part of their routine.

Yes, you can do it.

With the hemorrhoid, if you make it bleed -- that happens. If it's really big, probably it would have happened anyway if the patient could have sat on the toilet for themselves and defecated normally. If it's minimal and it stops, it's probably not a cause for concern. I am assuming your facility has at least a supervising nurse that comes in once in awhile. You could have her look at it if you were really worried.

Also note that "fecal impaction" is a medical problem that requires treatment. It seems that what you are referring to in the rest of your post is a normal everyday bowel program. They are not one and the same.

I was told that in my state not allowed. CNAs can not do invasive procedures. What one does as a private duty employee, though, may be a different matter.

One thing to add is it seems to take about 4-5 attempts to clear the bowel fully, can this cause damage?

I was told that in my state not allowed. CNAs can not do invasive procedures. What one does as a private duty employee, though, may be a different matter.

I wouldn't classify digital stimulation as an "invasive procedure". Pretty sure that state BONs would not either. I'd be interested to see where it is documented that CNAs can't do it.

One thing to add is it seems to take about 4-5 attempts to clear the bowel fully, can this cause damage?

A lot of the time the digital stim is done in conjunction with a stimulant-type suppository. That helps alot as it causes the bowels to move on their own some.

Hello,

I work at an assisted living home and one of the patients needs rectal stimulation with a finger to induce evacuation of his fecal matter. This patient is paralyzed so he cannot do this himself. Question is should a CNA do this, we don't have any nurses in the building or Dr's. Also the patient has a large hemorrhoid and I am worried I could physically harm the patient, what should I do and is it right to tell them this is not for a CNA?

Thanks!

Your title does not match the content of your post.

A fecal impaction is a problem that a CNA cannot handle unsupervised, but that is not what you described.

If a patient routinely needs stimulation in order to evacuate, a CNA can certainly do this - provided they have been properly instructed. However, any time you are worried you might harm the patient, you should ask for additional training.

Would training from another CNA be adequate on this procedure, or should it come from a nurse.

I saw CNAs doing this regularly while in a clinical at a SCI/TBI hospital.

I would personally err on the side of caution and try to obtain some kind of training prior to performing this. You say there are no nurses or doctors on site, but does the management have access to them? Perhaps at another LTC site they may manage? What about the patients own care providers or doctor?

If you are doing anything other than digital stimulation of the rectum, it's probably better to ask the nurse to train you. Meaning if you are removing stool with your finger. The lining of the rectum is actually pretty delicate, one of my patients has had tears from people disimpacting improperly, and another ended up with a bruise of the sacral area. I don't know how that happened!!

Maybe this resident needs his bowel progrm revised? I would not want an CNA under my license doing this, especially if I'm not in the building. I err on the side of caution!

Thanks,

Jerenemarie

well, I'm a cardiac nurse, we never ever stimulate the rectum due to the possibility of vagal stimulation. If your patient has no, no cardiac history and your policy covers you.. then I don't know, but I'd rather give the patient a glove and lube and say have at it. If you're covered in policy, you dang well better be covered to code these folks if they vagal down and code on the toilet. You just never know an unknown cardiac history.... you're better off with daily suppositories and enemas...much safer... yikes:eek:

If you are unclear on what you can or can not do as a CNA either go to your states BON website or call them to find out.

To me removing a fecal impaction would be an invasive procedure and should be done by trained liscensed personel

Digital stimulation with a routiune bowel care program could be okay if you were trained by a liscensed nurse and the training with some form of compentcy should be documented.

If somthing, anything were to go wrong, who is going to back you up saying that it was okay for you to do this....your facility sure wont