Slimeball enema Urgent

Geez - I just thought it meant give the enema to a slimeball - my bad.:chuckle

Geez - I just thought it meant give the enema to a slimeball - my bad.:chuckle

This thread is sooo funny!!:chuckle ONLY on a nursing site could you have such a conversation and no one find it unusual. lol @ swapping recipes!

I think I am scarred for life from the "donor stool" story tho:stone

Since we are talking enemas....I will tell yall what I did.

I started a fire giving an enema once. I worked in a nursing home. We had to evacuate 48 patients.

It was a quiet night at the nursing home. At 10pm, my supervisor made the comment..."it sure is quiet tonight". 10 minutes later Mr N requested a SSE. While standing by his bedside priming the tubing of the bucket, I ACCIDENTALLY spilled a small amount of water on the heater panel (it was a very old building and a very old heater) I quickly wiped up the water, so I thought. A few minutes into the enema, I clamped the tubing because he was feeling distended. So I am standing there talking away when all the sudden I smelled a strange smell. right after that WHOOOOOOOOSH!!! FLAMES AT MY BACK!!! I pulled the covers up over him and the CNA and I evacuated Mr N IMMEDIATELY! (remember that I had clamped the enema tubing and the enema bucket was sitting at the bottom of the bed under the covers now) We ended up evacuating the entire hall due to smoke although we got the fire out with the extinguisher. We even had to put pillows at the door of each room as we evacuated the patients there was so much smoke. When the fire dept got there....the fire chief said "how did this happen?", my supervisor just pointed her finger at me and said "ask HER ".

The whole time all this was happening, I kept going to Mr N asking if he was ok. since I had given him an enema I was worried he needed changing. He kept telling me that he was ok but he was more worried about me than anything. He thought I had gotten burned. I kept telling him I was fine but he kept insisting he didnt need anything. About 3 hours later, they were able to move all the patients back to their rooms. Mr N was put in a different room for the night. The night shift supervisor just so happened to be the one to take Mr N to his new room. While straightening up his bed...GUESS WHAT SHE FOUND!! I had TOTALLY forgot about the enema bucket in his bed and the TUBING STILL UP HIS REAR END!!!!!! :imbar

This was 5 years ago and I STILL have never lived this one down. I am now known as the Queen of the Flaming Enema. Mr N fondly refers to me as his "little firebug".

thank God noone was hurt!

About 6 months later, we had another heater fire on another wing at shift change. It was just from the heater being old. As the firemen came up the stairs, the night shift supervisor was right behind them. She took one look at me on the unit and yelled '' OMG WENDY WHAT HAVE YOU DONE THIS TIME???" :chuckle

However, there is that "donor stool" enema (actually, it's just an insertion way up high, like a suppository) as a radical treatment for C. diff--that's actually been discussed via the listserv before. Theory is that healthy stool (say, from a family member) implanted in the colon of a C. diff patient might alter the flora in their colon and stop the ravages of the C. diff. People thought that was a joke, but it's apparently an accepted treatment.[/quote)

I have never ever heard of "donor stool" enema and how on earth would you give it? Having worked in LTC for many many years... I have seen too many sweet souls pass on from dehydration due CDiff. Can you share any more info?

however, there is that "donor stool" enema (actually, it's just an insertion way up high, like a suppository) as a radical treatment for c. diff--that's actually been discussed via the listserv before. theory is that healthy stool (say, from a family member) implanted in the colon of a c. diff patient might alter the flora in their colon and stop the ravages of the c. diff. people thought that was a joke, but it's apparently an accepted treatment.[/quote)

i have never ever heard of "donor stool" enema and how on earth would you give it? having worked in ltc for many many years... i have seen too many sweet souls pass on from dehydration due cdiff. can you share any more info?

the thread on which it was discussed here on allnurses was called "stool transplant???" if you type it into the "search" feature, you will find 49 posts. it is a very real, life saving treatment, thought up by infectious disease people. i'll copy and paste one post from that thread, with a link to an article--however, i was unable to access the article at this time--it came up "page not available--" but there are probably others out there, in infectious disease journals.

in fact, here is a link to a "c.diff database" in which it is described as one of the treatments that proved helpful to someone or several someones.

http://www.cdiffsupport.com/database.html

here's one of the posts from that previous thread:

"read that jounal article someone posted about this procedure...

people can die from long-term infection with c.diff (pseudomembranous colitis). the cure rate with this procedure (stool transplant, i. e. stool slurry infused into pt like an enema) has almost a complete cure rate. and in about 4 days!!!!

surely a little grossness is worth that!!

http://www.east.elsevier.com/ajg/is.../ajg3277edi.htm

I pulled this article up by googling "stool transplant." It's from the Johns Hopkins site for antibiotic therapy. It describes, OMG, well, you just have to read it. I just can't see consenting to have stool delivered via NG tube--C. diff or no C. diff!! Gimme Flagyl or Vanco or just let me die...

Article is copied below. I will provide the link at the end, as there are many good antibiotic therapy update articles on that site--not just ones about stool transplants.

Recurrent Clostridium difficile Colitis: Case Series Involving 18 Patients Treated with Donor Stool Administered with a Nasogastric Tube [Aas J et al. CID 2003;36:580]:

This is a report from Duluth, Minnesota involving the authors' experience with 18 patients treated with donor stool from screened donors delivered by nasogastric tube.

Criteria for this treatment was laboratory-confirmed C. difficile colitis and at least two relapses with antimicrobial treatment.

Donors were primarily relatives who were screened for HAV, HBV, HCV, HIV, and syphilis. Stool studies included analysis for C. difficile (by toxin assay), enteric pathogens and O&P exam.

The stool was obtained within six hours of transplant, a volume of 30 gm was mixed with 50-70 ml of saline and homogenized in a household blender and then filtered with a coffee filter x2.

The transplant recipient was given vancomycin (250 mg q8h) for four days prior to transplant, and was given Omeprazole (20 mg) the evening before and the morning of stool transplant.

A volume of 25 ml of the stool suspension was delivered by nasogastric tube and then flushed with saline. The participants were 18 patients who had a combined total of 64 courses of antibiotics prior to this protocol.

All patients responded, but one patient developed diarrhea 17 days after transplant, the C. difficile stool toxin assay was positive, he was treated with oral vancomycin, responded, and did not have a subsequent recurrence.

The other patients all had a good clinical response and post-transplant supplied a total of 19 stool specimens that were positive on only one occasion for C. difficile; this is the patient summarized above.

Comment: The use of stool to treat C. difficile was actually introduced in the early 1970s prior to detection of C. difficile as the cause.

Surgical residents were used as donors and the outcome was reportedly good. Since that time there has been periodic mention of stool as perhaps the ultimate method to deal with this disease based on pathophysiology. At present, metronidazole seems to work awfully well though a small subset of patients have multiple relapses.

The "conventional" method of delivery of stool in these cases has been by enema using either diluted stool or "artificial stool" created by broth cultures of major stool bacteria.

The use of human stool has generated concern due to the possibility of transmitting an infectious agent.

A second concern is the esthetics of this process. This report is one of the first to address the issue in a long time, it uses a somewhat unique delivery system by nasogastric tube, and it includes donor screening for transmissible pathogens. The results seem good on the basis of the experience of others in dealing with multiple relapse patients.

By John G. Bartlett, M.D., posted 04-15-2003

http://hopkins-abxguide.org/show_pages.cfm?content=Apr-03_content.html#1_Apr

Okay, so this is getting gross. Interesting, but gross. I can see the rationale for the stool transplant and can even imagine possibly revising my NPR Advanced Directive (as opposed to NG or PO).

I'm puzzled about the enema recipes, though. Who first got the idea to put milk and molasses up their bums? Is there physiology behind it, or did people just start filling enema bags with anything handy until something worked?

A friend tells me milk and mustard is an instant emetic, but I've never tried it.

At least I'll have something to talk about at work, tomorrow.

What about a bubble gum enema? I vaguely remember hearing about this one?

I am sorry I have no desire to be a "Dooky or Feces Donor" for my family member!