impaction treatment

[middleagednurse]

I work nurseline, (sometimes), and I get a lot of calls from people who are impacted. We have to advise that they go to ER. I wonder, when impacted people show up at the ER, what do you do with them? Thanks for the info.

[NurseHeart&Soul, MSN]

In my experience the treatment varies by the doctor. Some don't want to treat aggressively in the ED, hand them an enema, and send them home. More times than not where I've worked we start with an enema/soap suds enema (rarely works). Then we typically move onto literally disimpacting the person. Definitely one of the least desired procedures in my career, but the patient sure appreciates it and often feels a ton better. It's usually enough to get them to start going on their own or at least after a little help from a second enema.

What I have seen work the best and be the least invasive is warming a gel of colace (in a cup of hot water) and then removing the liquid from the gel with a syringe. A foley cathether (just the catheter) is then inserted into the rectum to try to get around the stool. Once it is as far up the rectum as possible, the colace (and a couple of other cocktail meds....drawing a blank at the moment) is inserted into the catheter, followed by warm water to flush the meds up there. The meds start to soften things up and often makes it much easier for the patient to go on their own. A total bonus for all involved!

[middleagednurse]

Thank you. I wish they would just go to the drugstore and buy an enema kit, but I am not allowed to advise that. I'm sure you ER nurses have better things to do than to remove impactions, but I guess someone has to do it.

[Anna Flaxis, BSN, RN]

The doctors do it where I work.

[bear14]

We do enema's which sometimes help but rarely and then move on to attacking it from the north and giving them Mag Citrate or go lytely.

[rearviewmirror, BSN, RN]

enema bag, put warm milk and molasses and mix that sucker up, insert far up the rear end and empty that sucker out. They will give birth to a brown baby

[amoLucia]

enema bag, put warm milk and molasses and mix that sucker up, insert far up the rear end and empty that sucker out. They will give birth to a brown baby

The makings of an HHH!!!

[Lev, MSN, RN, NP]

In my experience the treatment varies by the doctor. Some don't want to treat aggressively in the ED, hand them an enema, and send them home. More times than not where I've worked we start with an enema/soap suds enema (rarely works). Then we typically move onto literally disimpacting the person. Definitely one of the least desired procedures in my career, but the patient sure appreciates it and often feels a ton better. It's usually enough to get them to start going on their own or at least after a little help from a second enema.

What I have seen work the best and be the least invasive is warming a gel of colace (in a cup of hot water) and then removing the liquid from the gel with a syringe. A foley cathether (just the catheter) is then inserted into the rectum to try to get around the stool. Once it is as far up the rectum as possible, the colace (and a couple of other cocktail meds....drawing a blank at the moment) is inserted into the catheter, followed by warm water to flush the meds up there. The meds start to soften things up and often makes it much easier for the patient to go on their own. A total bonus for all involved!

When you remember what those meds are please let me know!! Want to try this. Beats manual disimpaction any day.

[Lev, MSN, RN, NP]

The doctors do it where I work.

Us too! Anything rectal (rectal exam, manual disimpaction) not the nurse's job. Unless it's a suppository or a rectal temp.