CNA doing Rectal Stimulation for Fecal Evacuation?

[protrend]

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!

[LoveMyBugs, BSN, CNA, RN]

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

[scoochy]

Please re-read the title of OP's post; it does not say "impaction," but rather evacuation.

[ZippyGBR, BSN, RN]

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.

that is the practice we adopt as a regional SCI unit micro enema or suppositories first and then digital stimulation / man evac if needed once the enema / supps have worked ...

[ZippyGBR, BSN, RN]

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:

stick to your nice clean speciality , or go away and read about neurogenic bowel , there are some Neuro /SCI patients who will only get a good bowel result and empty rectum with digital stimulation or a manual evacuation ...

some people with SCI do do their own ME, they are generally young ( or were young at the time oftheir SCI), fit( ish) paraplegics ... some high paraplegics and most tetraplegics would struggle to do their own bowel care if they could do it at all

the OP needs to be educated in the procedure same as any new of different procedure,

and to answer the question - yes we do have HCAs who can do digital stimulation and MEs - but this is in the UK

[ZippyGBR, BSN, RN]

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

perfectly normal and acceptable bowel regime for for someone with an SCI, i doubt it needs revising , unwillingness on behalf of care givers ( regaardless of registration status) to perform adequate bowel care can have fatal consequences for someone with SCI

autonomic dysreflexia anyone ?

[Intern67]

Please re-read the title of OP's post; it does not say "impaction," but rather evacuation.

It does now. It looks like the OP edited the title.

[caroladybelle, BSN, RN]

In many places, CNAs are not permitted to do this, and the duty reverts to the nurse. In some states, this always falls on the nurse.

There is no indication of unwillingness on the part of the OP, merely a commonsense question. And given that vagal stimulation can have lifethreatening implications and there is risk of hemmorhage/infection, commenting on the risk of inpaction/lack of care is not necessary - if the care is that essential and falls outside of scope of practice, the licensed nurse takes it on.

[CNL2B]

Please re-read the title of OP's post; it does not say "impaction," but rather evacuation.

I think he modified it. That is not what it originally said.

[Laurab14]

stick to your nice clean speciality , or go away and read about neurogenic bowel , there are some Neuro /SCI patients who will only get a good bowel result and empty rectum with digital stimulation or a manual evacuation ...

Not sure this comment was necessary. Each specialty can offer insight about specific complications that other departments wouldn't be thinking of.

[CNL2B]

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:

I don't follow this rationale at all. I have been working in healthcare/nursing, unlicensed and not for 13 years and attitudes like this from know-it-alls that don't really know are my absolute pet peeve. This is right up there with intern doctors that bark orders that make no sense and it screams immaturity and inexperience.

How do you figure that a suppository or enema doesn't stimulate the rectum (especially when they are stimulant suppositories) but a digital stim does?

How are you proposing that SCI patients with cardiac histories get by without pooping? And how is it appropriate, when it is within a nurses scope of practice, to hand a "glove and lube" to a patient that may or may not be able to do it (because of a high SCI, debilitation, whatever?)

Since I have been licensed (10 years), I have been working in a hospital with monitors. I would say a solid 80% of my patients have had cardiac disease of one type or another because of the nature of the specialties I have chosen to work in. Vagal responses are not "codes" -- they are typically short lived and people come out of it just fine. That said, I can see that a patient with uncorrected CAD that vagals down may not tolerate the bradycardia well due to already poor flow and it could be detrimental, but it is the rare, rare episode when someone bears down and passes out on the toilet. To have that episode lead to an actual cardiac arrest I can't say that I have ever seen (not that it hasn't happened, because just about everything has.) (I digress here, but my co-worker had a patient post-TURP code on the toilet -- due to non-cardiac issues, and the guy didn't vagal down.) On another related note, what are we going to do about the vagal episodes from vomiting (much, much more common?) Tell the patient to put a cork in it?

[Mom2boys09]

I just want to say I have two little boys I have had to do this to and it really wasn't that big of a deal. I have never had to do it to an adult, but I'm guessing it's much easier considering the adult isn't grabbing, squirming, and kicking.

[TwilightRNurse]

With a private duty patient that I had that was a quad, the insurance company did not allow the bowel program to be done by anyone other than a licensed nurse because rectal stimulation can cause autonomic dysreflexia in a quad.