Inserting an Indwelling Fecal Drainage Device

Inserting an Indwelling Fecal Drainage Device

Equipment
■ Fecal device kit: contains soft silicone catheter tube, a syringe, and a collection bag.
■ Water-soluble lubricant.
■ Approximately 100-mL container of tap water or saline (per manufacturer’s directions).
■ 500 mL of lukewarm irrigant (water or saline).
■ 60-mL Luer-Lok syringe and a catheter-tip syringe (if not contained in the kit); protective skin-care dressing (e.g., Stomahesive).
■ Tape, scissors, linen-saver pad.
■ pH-balanced soap and water or recommended skin cleanser.
■ Procedure gloves, mask, and goggles.
■ Be Safe! Internal fecal catheters are not approved for children.

Assessment
■ Assess recent bowel pattern. If no bowel movement for 2 or more days, the patient will likely need a bowel prep or enema before the procedure.
■ Also check that a primary care provider has performed a digital rectal exam.
■ Be Smart! The treatment plan may need to be changed if you discover the following:
■ Presence of any indwelling anal or rectal device (e.g., thermometer for continuous temperature monitoring).
■ Suppositories or enemas are a part of the current treatment plan. Collaborate with the primary provider, as needed.
■ Be Safe! If the patient has a history of bowel disorders within the last 12 months (e.g., proctitis, recent rectal surgery; rectal injury or tumor; large and or inflamed hemorrhoids), contact the primary care provider immediately; an internal fecal catheter is contraindicated.

Post-Procedure Reassessment
■ Be Safe! Identify factors that increase the risk for bleeding, including anticoagulant and/or antiplatelet therapy and certain lab results (PT, PTT, platelets). These require careful patient monitoring.
■ Be Safe! Internal fecal devices are not intended for use longer than 29 days.
■ Be Safe! Monitor for rectal bleeding. It may indicate tissue necrosis, bowel perforation, or fistula formation; device must be removed.

Key Points
■ Obtain assistance as needed.
■ Don PPE.
■ Place the patient left side-lying and remove any indwelling device.
■ Cleanse and dry perineal area; clip hair as needed.
■ Prepare the device according to instructions (e.g., remove residual air from the balloon).
■ Connect the catheter to the collection bag. Clamp and hang the bag lower than the level of the patient.
■ Lubricate the balloon end of the catheter generously with watersoluble lubricant.
■ Spread buttocks and gently insert the balloon end of the catheter.
■ Inflate the retention cuff with water or saline.
■ Remove the syringe from the inflation port; gently tug the catheter.
■ Be Safe! If you used an introducer to insert the catheter, be sure to now completely aspirate the air from it.
■ If the device has anchoring straps, apply protective skin care dressing and tape one strap to each of the patient’s buttocks.
■ Position the tubing, avoiding kinks; position the collection bag lower than patient.

Documentation
■ Chart:
■ Date, time, and type of collection device used.
■ Your assessment of the perineal skin.
■ Patient’s tolerance of the procedure.
■ Characteristics and amount of stool in the collection bag (output).
■ Patient/family teaching.