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!

This patient probably needs to be in a nursing home. Patients who need skilled nursing every day are improperly placed in an assisted living. Also, a patient who cannot evacuate by themselves in case of fire, needs to be transferred to a nursing home. Your facility should have a 24 hour state hotline posted on the board. You can make an anonymous complaint of inappropriate placement, if you have enough reason to believe that the gentleman should be at a nursing home.

Digital stim is a nursing skill and it is invasive. It can also set of vagal stimulation which can cause slowing of the heart and have cardiovascular consequences. You willl have to find out from your BON, if this skill can be delegated. If yes, then a licensed nurse should check you off and you will perform the skill under his or her license.

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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!

Dig stim for 45 minutes is a wifely duty, not a nursing duty. He will have to put a ring on your finger to do that.:jester:

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Specializes in Vents, Telemetry, Home Care, Home infusion.

most bowel programs take 30-60 minutes to complete for those with a spinal cord injury. digital stimulation + manual disempaction after suppository/enema usually only takes 5-15 minutes. i was taught this as part of my nuses aid training n snf in early 70's. i find it ironic that personal care assistants in group homes and those caring for rehab clients can perform this service in pa but our certified nursing assistants are not permitted by our home health agency policies.

spinal cord injury bowel management & programs

big difference in someone with spinal cord injury affecting bowel evacuation versus cardiac patient who may develop bradycardia from vagal nerve stimulation. if bowel program not mantained in spinal injury (or full bladder from retention) can have opposite effect: autonomic dysreflexia with severe hypertension and is life threatening.

autonomic dysreflexia after a spinal cord injury

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Karen again it is the certification issue. If you have any kind of paper- license, certificate, etc. then you have a scope of practice. Some kinds of providers have nothing saying that they CAN'T do it. That is why we can teach laypeople in home health to do anything- IVs, central lines, vents, wound packing, etc. Grey areas perhaps, but designed to protect anyone who has specialized training. You and I benefit too in that we can always refuse to do procedures that do not fall within our scope. I have enough liability thank you, without going beyond my scope. So do CNAs.

I know the nurses who did the bowel programs at my agency had Looong visits to do this, it was not a 15 min thing. BMs are no simple matter to those who have no muscle control and tone. You people are forgetting that this is not the same as a person who is simply bedfast but has muscle control. You are making it sound like somethng kinky. Rehab nursing is very specialized, especially for quads and paras. Imagine having to lay in bed and poop without being able to actively push. It does not just fall out you know.

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

I got my training from an R.N. I was doing it about every day on someone with no contraindications.

There are things that a C.N.A. might not know about this, as is true in many cases. I'm glad I was oriented

by R.N.s

One of the things I remember talking about in class was a, "VAGAL RESPONSE," which is one of the risks.

Vagal response - definition of Vagal response in the Medical dictionary - by the Free Online Medical Dictionary, Thesaurus and Encyclopedia.

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Specializes in NICU, Post-partum.
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.

I would disagree with that.

It's the possibility of the vagal response from the digital removal, that is the invasive part of the procedure. If that patient vagals down unexpectedly, there had better be someone there to revive him...if not, that CNA is SOL.

In my state, it requires an order from a physician and a CNA cannot do it.

No way if I was a CNA, would I do it.

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My brother-in-law was a quad from age 18. He always had his sitter do his "bowel training" as he called it.

That was TN and AL over a 50-year period. Neither apparently required a license for it, just enough strength

to get him from the bed to the BSC.

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Wow, this has really turned into quite a thread!

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Specializes in Peds/outpatient FP,derm,allergy/private duty.
My brother-in-law was a quad from age 18. He always had his sitter do his "bowel training" as he called it.

That was TN and AL over a 50-year period. Neither apparently required a license for it, just enough strength

to get him from the bed to the BSC.

That isn't unusual at all. I've been surprised at the complexity of some of the procedures home health aides do on a regular basis -- such as changing out the trach (that only doctors, specially trained nurses, and RTs are supposed to do) and catheterizations.

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Specializes in multispecialty ICU, SICU including CV.
Wow, this has really turned into quite a thread!

Definitely has. I keep getting updates. I am really surprised to find out that this is a "licensed only" function in some areas. It isn't here (state of MN) and it didn't even occur to me that there could be state regs on something like this with that kind of specificity. Good grief. I guess it keeps the lawmakers busy. :uhoh3:

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