Digitally removing fecal impactions

[LouisVRN, RN]

It is debated on our floor whether or not RNs are able to do this. The pts on our floor are not monitored, and we have no policy mentioning it. Is this a state by state thing? Or is there a general concensus? I'm assuming at the least there would have to be a doctor's order...

[alem-tsahai]

You should ask your manager.

I worked in one hospital for years and we were not allowed to do it. I went to another hospital and I was expected to do it. Not sure if it's the state that makes the decision of who digitally disimpacts, but your manager should definitely know.

ugh, not my favorite nursing task at all.

[Nascar nurse, ASN, RN]

In general... yuck. But none the less, there have been times that there is just no choice - it's there, it's stuck, it just isn't gonna move without some help!

I have one Dr. that I work with frequently that has a hang up about this. Seems no matter what we call him about, we need to do a rectal check and r/o impaction. "Seriously.. what has that got to do with ear pain".. Told him he will NEVER be my primary Dr. because of it :)

[caliotter3]

I thought there had to be an order for it. I have come across some CNAs who do it and I have told them that they are not to be doing invasive procedures.

[mamamerlee, LPN]

I only ever did one of these. You need an order, and sometimes the doc will order an oil-retention enema first. That sometimes helps to soften the stool and make the paddage easier. Try to get an order for Lidocaine jelly lubricant if possible; that should make it less painful.

Don't use more than 2 fingers, DO wear at least 2 gloves on the hand you will be using!

Best wishes!!

BTW, many people do this to themselves when they get constipated.

[ItsTheDude]

heck, i think cna 2's can do it in nc.

[Zookeeper3]

Anytime you enter an orifice you need a doctors order. I'm on old cardiac nurse so know that with any patient with a strong heat history I will NEVER EVER stimulate the rectum and nerves that can cause my patient to brady down.

I will however agressively adjust the bowel routine including mag citrate, laxatives, suppositories and enemas... but digitally removing.... never ever, ever.

If you've ever coded on a toilet in the bathroom... you'll appreciate the vagal response and have a healthy respect for it by treating impaction with aggressive meds or enemas.

[nursinger]

Check your policy. :)

[skittlebear]

I know this is a little off topic, but what about ear irrigation? Do you actually need an order to do this as well?

[Zookeeper3]

I know this is a little off topic, but what about ear irrigation? Do you actually need an order to do this as well?

yup. any orifice requires an MD order,,,,, ngt falls out, theoretically you need an order to put it back in. work in an MD office... they dang well better write for an ear irrigation to cover you... should you pop an infected ear drum... with no order for irrigation, thinking it was wax? Good luck with that.

[ukstudent]

BTW, many people do this to themselves when they get constipated.

I had a patient that did this. Came in the hospital for open heart surgery. Needed a longer stay in the SICU to get off vasoactives and the vent. Was doing great, sitting up in bed eating breakfast with order to transfer to the floor when he started GI bleeding. Huge amounts of lower GI bleeding. Finally after placing out all the pads with large amounts of blood on them on the floor so the docs could see just how much blood he was losing they did a stat colonoscopy. The GI attending was so excited he called all the residents to come into the patients room to see an arterial rectal bleed. Seemingly it is quite rare.

He had eroded the skin down to the artery by all the prior digging. I had to do a teaching plan for the patient about constipation and the dangers of self digital disimpacting.

As for the question, i have done it with a doctors order.

[diane227, LPN, RN]

You should have a physician order for this procedure. Have the patient lie on their left side and make sure you lube up well. It is a good idea to double glove and gown up as well. Put down a chux pad because you will need to have a place to wipe off the stool as you extract it. Performing digital stimulation of the rectum can result in stimulation of the vagus nerve and thus bradycardia so you should be monitoring the patients vitals throughout the procedure. If the patient has hemorrhoids you should expect some slight bleeding with this procedure. In addition, if I have a patient with any cardiac history, I place them on a cardiac monitor during the procedure