BOWEL WASH – Nurse Info BOWEL WASH – BOWEL ELIMINATION (Purpose, Contraindications, General Instructions, Methods Used, Solutions Used, Preliminary Assessment, Preparation of Patient and Environment, Equipment, Procedure and After Care)

BOWEL WASH – BOWEL ELIMINATION (Purpose, Contraindications, General Instructions, Methods Used, Solutions Used, Preliminary Assessment, Preparation of Patient and Environment, Equipment, Procedure and After Care)

UPDATED 2024

Bowel
elimination is a basic bodily function that most people carry out in private
and are often embarrassed to discuss publicly. Nurses will encounter patients
with bowel elimination issues in all areas of care. Knowledge and understanding
of both normal function and the problems that can occur with that process will
enable nurses to support and care for patients with bowel elimination problems

BOWEL WASH

Bowel wash
or colonic lavage or enteroclysis is defined as washing out colon with large
quantities of solution.

Bowel
irrigation or enteroclysis is defined as washing out of the colon after the
feces has been expelled by using large quantities of prescribed solution

PURPOSE

To prepare for diagnostic examination
or before certain surgery
To relieve inflammation
To stimulate peristalsis
To supply fluid and electrolyte those
are absorbed from intestine
To dilute and remove toxic agents
To reduce temperature in hyperpyrexia
To relieve fecal incontinence
To supply medications locally
To clean the colon of feces, gas and
barium
To treat infection and other
pathological condition of colon

CONTRAINDICATIONS

Rectal infection
Fistula in anus
Painful and bleeding hemorrhoids
Painful skin lesions around the anus
Massive carcinoma or tumors of the
rectum
Loose sphincter
Polypus and diverticula of the
intestine

GENERAL INSTRUCTIONS

A cleaning enema should be given one
hour before the colon irrigation
The bladder should be emptied before
colonic irrigations
The temperature of the solution is
kept constant throughout the procedure
Allow only 200 to 300 ml of fluid to
run into the rectum at a time
Make sure that the return flow is not
blocked
Use a smooth and flexible rectal tube
and lubricate it well
Prevent air entry into the intestines
Stop the procedure temporarily the
patient complaints of pain
Listen to the complaints of the
patient and should not ignore any discomfort however small they may be

METHODS USED FOR BOWEL IRRIGATION

Funnel and catheter
Y connection and a rectal tube
Two tube method

SOLUTION USED

Tap water
Cold water
Normal saline
Sodium bicarbonate 1 to 2 %
Antiseptic solution KNMO₄
Boric solution 1 to 2 %
Tannic acid 1: 100
Alum 1: 100

TEMPERATURE OF THE SOLUTION

Cleaning purpose 104 degree F (40
degree Celcius)
Thermal effect 110 to 115 degree F
(43.3 to 46 degree celcius)
Reducing temperature 80 to 90 degree
F (27 to 32 degree celcius) amount of water used for bowl, irrigation is 2 to 3
liters or till the return flow is clear

PRELIMINARY ASSESSMENT

Check

Doctors order for any specific
precautions
Diagnosis of the patient
General condition of the patient
Self-care ability of the patient
Mental status to follow instructions
Any contraindications
Need for any extra help
Articles available in the unit

PREPARATION OF THE PATIENT AND ENVIRONMENT

Explain the sequence of the procedure
Arrange the articles at the bed side
Provide privacy
Place the Mackintosh and towel under
the patient
Place the patient in left later
position
Keep the bucket on a low stool or
receive the out flow of fluid
Remove the back rest and extra
pillows

EQUIPMENTS

A clean tray
containing

Funnel and tubing with glass
connection
Mackintosh and towel
Rectal tube placed in a kidney tray
Vaseline
Rag pieces in a container
Hot and cold water in jugs
Prescribed solution in jug
Paper bag
Bucket
Toilet tray if needed
Clean linen if needed
Bath thermometer

PROCEDURE

Wash hands thoroughly
Prepare the solution at the required
temperature
Attach the tubing and the rectal tube
with the funnel, pour solution in it and check for any leakage
Lubricate the tip of the rectal tube
about 4 inches
Separate patient’s buttocks to
visualize anus clearly and insert tip of tube about 4 to 5 inches, while
patient takes deep breath
Lower funnel below level of rectum
and empty return flow into bucket
Fill funnel again. Pour 200 to 300 ml
of fluid each time. Raise funnel and allow fluid to run continuously. When 200
to 300 ml of fluid has gone in pinch tube before tunnel is completely. Lower
and invert tunnel over bucket and siphon fluid, noting characteristics of
return flow
Repeat this process, till return flow
is clear
Remove the rectal tube by using rag
pieces