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Digital Disimpaction

Nurses   (37,675 Views | 14 Replies)

1,101 Profile Views; 19 Posts

I know this is not done very often...but does it require an MD's order?

Thanks!

New Grad Lisa

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allantiques4me specializes in Brain injury,vent,peds ,geriatrics,home.

481 Posts; 5,960 Profile Views

I was thought you must have an MD. order for everything.Maybe check your facilities procedural manual.It might help clarify it.

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kstec has 1 years experience as a LPN and specializes in Geriatrics/Family Practice.

483 Posts; 8,483 Profile Views

When you have a patient sitting on the toilet attempting to dig themselves out due to constipation, no you don't get an order. I've only had to do it once, but no I didn't get an order, just documented it very delicately. And of course you gently document as to not make the facility look liable for this. Something like patient was experiencing major abdominal discomfort but with physical assistance abdominal discomfort was relieved upon bowel movement. I was told never to document that the patient had a fecal impaction, because it's grounds for negligence on the facility for not providing enough fiber and fluid or appropriate stool softeners. I'm was probably in the wrong but my patient was fine with no injury and was very happy to be relieved.

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19 Posts; 1,101 Profile Views

Very interesing...thanks for the comment!

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Zookeeper3 has 17 years experience and specializes in ICU, ER, EP,.

1,361 Posts; 11,147 Profile Views

I know this is not done very often...but does it require an MD's order?

Thanks!

New Grad Lisa

In a fresh MI, cardiac patients... for me, yes.... 13 plus years in, I won't go to the netherlands without consulting with the MD, there are too many pharmacologic options to NOTstimulate a vagus response. Our facility has no specific policy for or against. I was taught, that anytime you puncture or enter an orafice it requires an order. Now sure we drop a ton of lines and foleys, ng's and what not in an ICU setting with out calling... it comes with knowing our docs and writing a "call" order.

A regular older person without "new" cardiac issues... my peers do it all the time and don't even document it, just ask for stool softens in the am. You'll decide as you go how you practice. Everyone has a different comfort level as long as it doesn't violate policy.

For me, it isn't prudent without one, policys can't cover every instance. Should bradycardia occur, I couldn't say I didn't know better. Again, many, many nurses do without any problems.

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leslymill has 28 years experience and specializes in Med/surg,Tele,PACU,ER,ICU,LTAC,HH,Neuro.

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You need an order.

Usually there is some sort of standing order.

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calliesue has 15 years experience.

328 Posts; 7,156 Profile Views

This is interesting , I was told just last week by another lvn , that lvns are not allowed to digitally disimpact/ That it is outside our scope. Anyone else hear this?

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teeituptom is a BSN, RN and specializes in ER, ICU, L&D, OR.

4,283 Posts; 14,242 Profile Views

I believe that is strictly an MDs job myself

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1,249 Posts; 6,335 Profile Views

I believe that is strictly an MDs job myself

Tom - I certainly agree that it SHOULD be, but I've never seen a doctor do it yet! In my 20 years - I've done it maybe twice, and that was at the beginning of my career - it was mostly forbidden at the hospital where I worked.

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NurseCard has 13 years experience as a ADN and specializes in Med/Surge, Psych, LTC, Home Health.

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I've been an RN for over four years and I just did this for the first time a few days ago. I had an order to remove fecal impaction. Patient had no cardiac issues. Was not able to remove the entire thing as the patient just couldn't tolerate it, but did get out a decent amount and passed on to day shift that I was not able to remove the whole thing.

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Jo Dirt has 9 years experience.

3,270 Posts; 17,453 Profile Views

It was a standing order at the nursing home where I worked, though I would avoid doing it at all possible. I have small hands, anyway.

Also, you are never ever ever supposed to chart any form of the word impaction.

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teeituptom is a BSN, RN and specializes in ER, ICU, L&D, OR.

4,283 Posts; 14,242 Profile Views

Tom - I certainly agree that it SHOULD be, but I've never seen a doctor do it yet! In my 20 years - I've done it maybe twice, and that was at the beginning of my career - it was mostly forbidden at the hospital where I worked.

The ER Im in we passed a hospital policy stating that enemas till clear and disimpactions were not an approved procedure for the ER.

So if the Dr wants it, he does it him or herself

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