Feacal Management Systems???

cherrybreeze, ADN, RN · Apr 1, 2010

my essay on flexisils how fun
A common and useful intervention for patient's that are continuously incontinent is the use of a Flexisil fecal tube bag. When a patient is consistently incontinent of diarrhea, he/she is at risk for a variety of issues that may arise. The skin's integrity is at risk for breakdown when diarrhea leaves the skin excoriated and always damp. The skin will erode and break down if the stool is not properly cleaned up. Most nurses turn and reposition patients every two hours, and this amount of time for the patient to be lying in stool is not an option. Thus, the Flexisil Fecal tube was invented to reduce the risk of skin breakdown by effective fecal diversion and containment. It also prevents wounds, surgical sites, and burns from the effects of fecal contamination, which can lead to infection. It minimizes the chance of tissue breakdown and muscle atrophy by way of a soft balloon design. It also assists the nurse in not having to clean up the patient as much, as it is contained in the tube. This is beneficial to the patient, as well as the medical staff assisting with the patient's care. The tube is collected in plastic bag the same way a Foley catheter bag works. It's all a contained system, so if a sample is needed to be collected you can remove it from the bag. It is intended to make a convenient and contained method of collecting the loose stool. As a nurse on a medical surgical floor, I have been working with a Flexisil and having issues with them for the past five days. These issues will be discussed and methods involved in attempting to solve them. Over the past few nights, I have had two patients on the front hall who were dealing with fecal incontinence and the use of Flexisil fecal tubes to collect the loose runny stool. The patient in 604, E.R., had a stage four decubiti as well as C. dificile infection, causing her to have consistently orange loose runny stools. She had a Flexisil, in which 45 milliliters of free water is supposed to be instilled into the tube once inserted into the rectum. For five days I would change her on an hourly basis secondary to the Flexisil tube leaking around the site. She would put on her call light, saying she messed the bed. The assistants were fed up with cleaning her every hour and refused to go in there, stating she/he was entirely too busy obtaining post op and blood vitals, which is understandable. Sure enough I had cleaned her up almost hourly, changing her dressing that kept soiling. People have put new tubes in her rectum; have instilled more water inside the balloon, and the various other interventions, none with any results diminishing the leaking tube. This was causing a problem to the busy nursing staff, as well as creating an even more stressful environment on 6 Main. In another scenario right down the hall, W.M. had a C.diff infection as well, but her case was more challenging. Her fecal tube would not stay in, in my opinion due to anal sphincter atrophy. Her tube was reinserted several times on one eight hour shift alone, would stay in for several hours and then pop back out. Her bed would be fully saturated with loose stool, and she would not tell us, creating a situation that set her up for sepsis and skin integrity breakdown. Thus I would go in the room to check on her, knowing that her bed was potentially saturated with stool. Ways found to attempt to fix these methods would be to instill air into the balloon instead of water. The 45 milliliters of water allowed the balloon to be deflatable and movable inside the rectal canal. The air instilled created a more firm wedge inside the patient's rectum, allowing it to not be tampered with. Also, by relieving pressure from the exit site by turning the patient on his/her side, the chance that the tube would pop out was minimized. The answer to instill more water into the balloon would not be the answer, as it could create tissue atrophy and would pop out nonetheless. Patient's with rectal or colon cancer could not benefit from a Flexisil either, so the intent to review the patient's past medical history is a must before inserting any catheter. The Flexisil tube, as stated by many nursing forums online, will always tend to leak a little around the site. This is the answer for 604's case, and as bothersome as she seemed to use, the necessity to scrub her spotless every time needed to be instituted. The answer to how to keep W.M.'s tube in is a mystery, as when I instilled air into the tube, it would still pop out in two to three hours. There is no answer to the leaking Flexisil tube right now in nursing practice, and no one has really found the right answer. At 900 dollars a box once opened, each Flexisil tube is quite expensive and some hospitals do not even use them. If these patients did not have the tubes inserted at all, there would be countless amounts of issues they would have to resolve, including skin breakdown and sepsis. Flexisil fecal bags need to become more appreciated in the nursing practice, and hopefully one day someone will invent one that stays put without complications. In the meantime, I will continue to use these with patient care.

I have not read this entire "essay," as the lack of paragraphs made it impossible to follow. However, while I do comprehend that frequent loose stooling contributes to skin excoriation and breakdown, when a patient has loose stools, they are cleaned up more frequently than what a typical q2h turning schedule would be. That statement jumped out to me at the beginning and I had to address it, since it was asinine.

LouisVRN, RN · Apr 1, 2010

I have not read this entire "essay," as the lack of paragraphs made it impossible to follow. However, while I do comprehend that frequent loose stooling contributes to skin excoriation and breakdown, when a patient has loose stools, they are cleaned up more frequently than what a typical q2h turning schedule would be. That statement jumped out to me at the beginning and I had to address it, since it was asinine.

You'd think/hope that would be the case, however I have seen such horrible breakdown for these patients especially the incontinent dementia/handicapped/para pt that cant let you know when he/she has stooled, you know they've been sitting there at least two hours in it. Unacceptable? Yes, but that doesn't mean it doesn't happen.

Anoetos, BSN, RN · Oct 22, 2012

But why are they not used in every case? Avenue of pathogen entry? Infection?

Btw, we use the Bard DigniCare system as well. It's excellent. The new one even has a sample port, no more digging around in the bag.