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Discussion

impaction

do you digitally remove bm if patient is impacted? is it true that nurses are not suppose to do that due to it causing bradycardia or is it still done?

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CNAs are not allowed to remove fecal impactions in our facility - only licensed personnel are allowed, due to the bradycardia issue.

unfortunately, yes we do remove impactions. cnas are not allowed to remove them. keeping track of residents bms is so important so this does not happen, but occasionally it will, even with good monitoring. we have "laxative night" on weds and suns and "enema night" on thurs and mons, which seems to work pretty well. if a resident does not go in 3 days, they get the lax, and if they still have not gone then they get an enema or supp on the next day.

  • Expert

I've done manual disimpactions before. You have to be very careful and gentle about it. If you don't feel comfortable doing it, call the doctor and tell him.Your profile indicates you are an RN. Are you new to working in LTC? I don't want to sound like I'm lecturing you, but you need to know that impactions are a serious issue with the state inspectors. If they find them happening with regularity (pun intended ha! ha!) the facility will get cited because they are preventable with good nursing care and monitoring. (1) I would report any impaction to the patient's doctor immediately or the state is going to cite the facility for not reporting a change in condition (2) ask for an order to manually disimpact, but the doc may order something else like an oil retention enema or some other enema or laxative, (3) get orders for something to prevent this from happening again since prevention is the watchword here (4) start doing diligent monitoring of daily BMs, and (5) follow up with the CNAs if that is where some of the responsibility of monitoring of the BMs lies. Theoretically, an impaction should never happen if daily monitoring of BMs is being done. This is basic nursing care. In LTC you need to know who your patients are who are likely to develop this kind of problem do diligent prevention and monitoring with them. Every patient who has a constipation problem should have specific preventative orders on their chart to cover this condition and they should be followed as written or the doctor notified so they can be changed as appropriate to the patient.

We are not allowed to digitally remove without the residents permission, you also have to go through a check list of things beforehand. Mostly the residents who become impacted with us are the independent ones who go to the toilet unaided and can be difficult to keep track of.

Have you tried abdominal massage, done properly by a trained therapist it works really well.

We had a Reflexologist some time ago who actually had to stop doing a certain foot massage because ...well let's just say it worked too well!:lol2:

The answer here is NO. We do not disempact patients. We give suppositories and enemas but we do not disempact. It is a very dangerous thing to do.

I have, in 16 years, only had occasion to do that twice.Both times on terminally ill residents who,despite supps and enema,just did not have the energy to move and begged me to help them.As CapecodMermaid said it is very dangerous especially on the elderly and frail as you can easily tear or even perforate the bowel.

Not allowed to do it over in the UK anymore as far as I am aware.

This usually has to be in the residents bowel program and doctor ordered. It is not done by cnas because there are nerves and arteries that can be damaged that can cause death if this procedure is carried out by untrained persons. Most patients I have assisted the licensed nurse with removing an impaction were patients that had such diseases as multiple sclerosis and had no ability to defecate normally. We had a resident once who had to be regularly disimpacted every 4 days if no bm. But this was the last measure done if all the laxatives and suppositories had failed. Yes, it is still done and very regularly at some hospitals. The order read digital evacuation if no Bowel movement Q 4 days.

We do on the rare occasions it is necessary.

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