CNA doing Rectal Stimulation for Fecal Evacuation?

Nurses General Nursing

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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!

CNAs (STNA's), in my state are not allowed to do this.

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Protrend I applaud you for the clinical reasoning demonstrated in your knowing when to ask about scope of practice issues. If you are privately hired by family/patient as a CNA, then you are as accountable to the scope of practice permitted for CNAs in that state as you would be if employed by a healthcare agency/organization. Do check the scope of CNA practice for your state and if you still have questions, call the regulatory body ti seek further clarification. Meds with anticoagulant properties (esp in light of the hemorrhoid) and other meds that the pt may be receiving (eg hemodynamic altering), can factor into the safety of the procedure. Rectal stimulation affects the vagal pathway which can alter heart rate and BP. Each patient has his or her own set of health history and treatment factors to be considered with the administration of any procedure or therapy. Your question has great merit. If you are working for an agency, you can consult with the RN supervisor, who may know the patient clinically and can consult with the pt's physician if necessary.

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Specializes in Spinal Cord injuries, Emergency+EMS.
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.

the irony being that a full rectum is one of the top causes of an episode of AD ( along with over full bladders )

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This is not taught to CNAs in their skills set and is not in their scope. A home health agency I worked for had RNs going to the homes of several quads for rectal stim 3 times a week for years and years, all paid for by insurance at about $100 a visit. A private caregiver who is not a CNA has not scope of practice, so they can do it, as can a layperson. Anyone who has a scope of practice has to be careful to do only what they are allowed to do and have been trained to do. If the CNA is certified you should be able to check with the board on the CNA scope. If rectal suppositiories are involved aren't they a med? Can CNAs give meds there? This is a tricky area.

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Excellent point....these interesting catch 22 situations tend to arise regularly in healthcare don't they?

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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:

Long term care is a whole different ballgame. This is a normal treatment regime that they use. I know where you are coming from after working in telemetry myself, I was shocked to hear that people do this, but the HAVE to do it to avoid impactions which are much more dangerous.

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Specializes in LTC, Neurology, Rehab, Pain Management,.

What I'm wondering is, how long is this procedure being done for? I am wondering this, because we had a patient recently for respite for two weeks or so and he was telling me his wife did this digital stimulation for him at home for 45minutes! I am not doing this for 45 minutes, that's for dang sure!

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Specializes in Spinal Cord injuries, Emergency+EMS.
What I'm wondering is, how long is this procedure being done for? I am wondering this, because we had a patient recently for respite for two weeks or so and he was telling me his wife did this digital stimulation for him at home for 45minutes! I am not doing this for 45 minutes, that's for dang sure!

odd, assuming there is faeces in the rectum even doing a manual evacuation should only be a matter of a couple of minutes and depending on the bowel management plan for the individual if you 'pre treat' with suppositories or a micro enema the digital examination / manual evacuation is usually only to get the 'last bits' or to check the rectum has cleared

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What I'm wondering is, how long is this procedure being done for? I am wondering this, because we had a patient recently for respite for two weeks or so and he was telling me his wife did this digital stimulation for him at home for 45minutes! I am not doing this for 45 minutes, that's for dang sure!

Hmmmm...might send this in a totally different direction here. Earlier comments all pretty good. OP has good query as to her responsibility - and I agree needs to further explore the order, the responsibility, etc...

A 'bowel program' used for a quad or para is very common - and 'usually' involves a set schedule of a pre-suppository, a dig-stim, and then a bowel movement. Most pts need assistance.

However, I'm commenting on the above situation. A comment made by a man in respite care to his nurse about his wife doing a dig-stim at home for 45 minutes - I'm going to bet the farm it was not done for "therapeutic" reasons. AKA prostate milking?

Whatever works. Been in those positions too where the pt really "needed" this dig-stim several times a day because his "doctor" told him it was necessary. Asked any nurse he saw - CNA's as well. No wonder his wife needed respite....

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Specializes in med surg, geriatric, clinical, pool.
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:

This is exactly what I thought! I would not. I refused stimulation on a para once. Being untrained at this, you could damage the rectum or he could code on you because you are stimulating the vagus nerve which goes to the heart.

And hemmorhoids have a large blood supply.

What would you do without a nurse in the building? Too many things to go wrong.

Try the stool softners, an enema, or a suppository first.

The answer to this question depends on the rules and regulations of the state you are licensed to work in.

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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.

Telling a nurse to do something because you are "pretty sure" it is allowed is a risky way to go. Call the BON if you don't KNOW and ask them or research it. Yes, in my state it is an invasive procedure and I am suprised a nurse would have to ask about letting a CNA do it.

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Specializes in LTC, assisted living, home-care.

:twocents: Sorry, but I am going to crack up... "To poop or Not to poop" seems to be the question. :jester: Guess I had a wine too many... Sorry... LOL

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