Goal: The patient expels feces with assistance and is free from trauma with minimal patient discomfort.
1. Verify the order. Bring necessary equipment to the bedside stand or overbed table.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around bed and close the door to the room, if possible. Explain what you are going to do and whyyou are going to do it to the patient. Discuss signs and symptoms of a slow heart rate. Instruct patient to alert you if any of these symptoms are felt during the procedure. Have a bedpan ready for use.
5. Adjust bed to comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Position the patient on the left side (Sims’
position), as dictated by patient comfort and condition. Fold top linen back just enough to allow access to the patient’s rectal area. Place a waterproof pad under the
patient’s hip.
6. Put on nonsterile gloves.
7. Generously lubricate index finger with water-soluble lubricant and insert finger gently into anal canal, pointing toward the umbilicus.
8. Gently work the finger around and into the hardened mass to break it up and then remove pieces of it. Instruct patient to bear down, if possible, while extracting feces to ease in removal. Place extracted stool in bedpan.
9. Remove impaction at intervals if it is severe. Instruct patient to alert you if he or she begins to feel lightheaded or nauseated. If patient reports either symptom, stop removal and assess patient.
10. Put on clean gloves. Assist patient, if necessary, with cleaning of anal area. Offer washcloths, soap, and water for handwashing. If patient is able, offer sitz bath.
11. Remove gloves. Return the patient to a comfortable position. Make sure the linens under the patient are dry. Ensure that the patient is covered.
12. Raise side rail. Lower bed height and adjust head of bed to a comfortable position.
13. Remove additional PPE, if used. Perform hand hygiene.
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