Digitally removing fecal impactions

[LouisVRN]

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...

[NurseCherish]

At my hospital, we are allowed to do it if we have an order.

[rabbitspbc]

hmm.. probably off topic but my son also has a vagal response whenever he gets constipated. he's 8 and it scares me to death when he passes out.

[leslie :-D]

digital disimpaction is routine care in my hospice facility.

not that it happens a lot, but if a pt gets opioid-induced impaction, we (nurses only) remove it.

ultimately it is a comfort measure.

leslie

[JulieCVICURN, BSN, RN]

We don't need a doctor order to do it in my unit, however, you can bet we'll usually wait until we have one because NOBODY wants to do it.

[MassED, BSN, RN]

yep - and I have worked in places where the RN's have done it (not a fan), or the MD's have to - they assume that responsibility if a patient vagal's or worse. I don't want that. MD order - usually MD's perform. Though haven't dealt with that often in the ED.

[MassED, BSN, RN]

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

not when I lived in N.C. Probably facility specific.

[MassED, BSN, RN]

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.

holy "crap!" haaaa!!! That is a wow moment. That's some digging, to be sure.

[Phlavyah]

ok, I am mortified!! Has any of you ever said "I can deal with it (pooh)" and when it was time to get down to business, puke din front pf the pt of families or supervisor? I'm so scared to have that happen to me!

[nursinger]

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

This is why it is wise to have doctors do this procedure. At our facility nurses used to do it until someone perforated a pts bowel and he died. The policy was changed to a doctors only procedure.

[massrn116]

Either way it would be a good thing.....nothing worse than getting a NH patient with fecal impaction, worse smelling stool ever.