Show me the...poopy? :D

  1. New question:

    When a baby needs glycerin to induce a bowel movement, what is your policy/protocol? Do some doctors prefer liquid glycerine, others "tips"? Do you have a preference? Is one more applicable to one baby than another? Do I look fat in this? (Okay, that last part doesn't apply...)
    Last edit by NICU_Nurse on Aug 29, '03
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  2. 16 Comments

  3. by   dawngloves
    I guess we use "tips" meaning the solid suppositories.
    And no, you look great in that!
  4. by   Heather333
    We use liquid glycerin. Use a 6f feeding tube to instill it. Works like a charm......sometimes too well!
  5. by   NicuGal
    We are trying to get liquid, but we chop off a piece of the supp. and jam it in a TB syringe, lube it up and insert just the tip in and squeeze it in. Works great.
  6. by   NICU_Nurse
    Well, I was just wondering. ;>) I work in a teaching facility, and usually don't have a problem requesting one over the other. In fact, I prefer the liquid glycerine (talk about lubing up the system- that always seems to work like a charm), vs. the tips, which are a beeeeech to put in and keep in, and never seem to melt in my babies. They just keep shooting it out like a tiny projectile missile! However, I noticed that some MD's will always write an order for a tip, and I have specifically requested liquid glycerine in those cases. Just wondering if there was a policy or protocol somewhere that decides which is more appropriate. Personally, the tips seem a bit unrealistic for the babies, but that's JMO. Either that or I'm just a total spazz. One or the other.
  7. by   Mira
    Sometimes when a doc is out of sight for prescription and I`ve got a baby that needs help with bowel movement,I gently massage the abdomen(bearing in mind there s no contraindication)before diaper change then very gently poke the rectum with a lubricated tip of thermometer probe,I always get good results but I don`t tell anybody just in case they will think I`m horrible.I`ve work in operating room and endoscopy unit and I`ve seen the GI tract.Does anyone here have tried poking the rectum to open the bowels?Am I horrible doing it?
  8. by   NICU_Nurse
    NO! You're not horrible for doing that! I do that, also. It's called 'rectal stimulation' (pretty self-explanatory, there, huh? ) and sometimes that's all it takes. Because we don't have a policy on this either, I do get an order from the MD's (teaching hospital- they're always around) and refer to it in my charting when I do it. I was told by our best neonatologist to use a 5fr OGT lubricated well with KY since it is smaller and more flexible, and you have less of a risk of accidental damage to the delicate anal tissue. I also do very light abdominal massage before using even a PRN glycerine order, and sometimes just repositioning them, or fully flexing their legs against their stomach is enough. Gotta use creative thinking sometimes, but when it works "naturally" vs. via medication or medical intervention, that's good enough for me. ;>)
  9. by   prmenrs
    I have used suppositories--I take a child size one, cut it in 1/2 lengthwise (use a scalpel), then again so it's 1/4th. then adjust the length to the size of the kid--they rarely get more than 1/8th.

    Another nurse I know starts her shift w/"rectal stim", which is what Mira is talking about--all her kids go potty 1st thing! Just be VERY careful about how far you put the tip of the temp probe cover ~ a cm. should do it, and lubricate it, of course.

    If you think about how weak premies are, all their muscles are weak, including peristaltic muscles. So, doing rectal stim or using a suppository just makes it easier for them to go. Just a little rationale.... By the time they go home, they should be strong enough to go on their own.
  10. by   Mimi2RN
    Has anyone else had a baby with a barium impaction? Nothing was moving, we could see the problem on xray. Glycerin chips and rectal stim didn't work, two days later she was still plugged. I worked on her with vaseline and a thermometer probe, she worked with me, finally I got a solid chunk out. She was able to start things moving, got some more chunks out. f/u xray was a big improvement.
    Hope I don't have to do that again!
  11. by   Mira
    thanks to you all for the reassurance.In the unit where I work,I`ve never heard from anyone about rectal stimulation apart from glycerine chip application,doing things not the usual practice could lead you for a reprimand,I`m a junior staff so anything that I do different will be hot on the eyes of a senior (some of our seniors are scared of change),I know it`s not good beacause you should have your own logical thinking and be responsible for your own action.

    This forum is excellent,evidence-based practice.
  12. by   Mimi2RN
    Rectal stim is a usual practice, normally we will try that before getting an order for glycerin sups. It's also something that parents can do if baby has a problem at home.

    I hope that you will be able to research and use new ideas in your unit. Sometime if you can do it, go to one of the Neonatal conferences....there's a three day one in Las Vegas in September......maybe your unit would even pay for you to go.
  13. by   dawngloves
    I do rectal stim on the bigger/older kiddos, usually after a little knee to chest. Lube up a temp pobe cover and insert maybe a cm, give it a little twirl. May take a couple of minutes.
    Kristi, you can also keep a suppository on with a temp probe cover.
  14. by   Navy1Nurse
    We use "Glycerin Slivers" in other words we just take a peds suppository and a scapel and cut it down to size

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