I'm a new ICU nurse and 2 days ago I gave my first ever enema, period. But it was apparently a really weird enema, 0.5 of Vanco in 1L NS to be retained for 60 minutes, was my order. The patient had major C. Diff colitis and was on IV Flagyl and PO Vanco 500mg already. She was also on bowel rest, receiving TPN and had a NGT to intermittent low wall suction except for when I clamped it after giving PO meds. So apparently this Vanco enema was some sort of act of desperation because the IV & PO therapies weren't really working. I asked for help on this treatment because a) it was my first enema ever and I wanted to make sure I was doing it right, and b) I've never heard of Vanco in enema form. But everyone I approached sort of went "*******" o_O including 3 senior nurses, the pharmacy, and my group leader. But my gl helped me give it anyway, putting the solution in a soapsuds enema bag/tube, but the whole 60 minutes retention goal was absurd...it came pouring right out the second it went in because the patient couldn't hold it. AND what came out was all bloody and full of clots. So we stopped it after 200ccs, and told the docs. But the attending wanted us to keep at it anyway. So, we tried again with a 3 way foley and inflated the 30cc balloon and clamped it after the solution went in in order to try to keep it retained. No luck. the solution came pouring out despite the balloon, around the catheter. she retained maybe 80cc of the entire enema, and I only asked her to try to retain it for maybe 10 minutes so as not to torture the poor woman any more because it was clear that the vast majority of it came out already anyway. Long story short, that order was d/ced.
only 1 other senior nurse had experience giving it before and when she did, she said she didn't even finish the infusion, she just said "this is dumb, its coming right out, I'm not doing this." =/
so...I was wondering, has anyone else received an order like this before? and have you had more luck than we did with it? how did you administer it? and ...does it even work?
For those using flexiseals with the larger volumes (1L), how do you get it into the port? Is there a way to connect an enema bag to the port or do you have to syringe it all in ?
It is my understanding that vanc and/or flagyl through the gut instead of IV is the best way to treat C-diff. The IV route is not as effective. We have done the vanc and flagyl enemas. We infuse through the flexiseal. We actually infuse it with an IV pump into the infusion port of the flexiseal. Works pretty well.
I think this is pretty new. I had a pt with cdiff that turned into toxic megacolon. He was receiving ng and pr vanco. Pharmacy told me it is supposed to work like a topical-the best thing to do is retain as much as possible. Ideally, I would have put in a flexiseal and clamped it off, and then injected the vanco through the irragation port, but the resident sort of freaked out about that because of the cdiff-I guess it makes the rectum pretty fragile. So I did what you did-a 30 french foley with the balloon inflated. It sort of worked. Actually the pt's sepsis resolved and he was started on tube feeding again about a week later. In the end, it didn't make difference though, because he just didn't want to live.
Vanco enema's are a great way to treat C-Diff in patients who cannot take oral Vanco. The best way to give Vanco Enema's is with Hollister's Actiflo rectal bowel cathether. This catheter has a medication port and a "stop flow" which will enable you to retain the medication into the patient for the prescribed "dwell time" that the physician orders. The Flexiseal does not have this component on their device and it is difficult to maintain the fluid into the recum by "rigging" the cathether. Which is also off label use of the device and could be a legal issue for you if your patient has an adverse event. I recommend checking out the Actiflo on the Hollister web site. -MLRN
tri-rn
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For those using flexiseals with the larger volumes (1L), how do you get it into the port? Is there a way to connect an enema bag to the port or do you have to syringe it all in ?