‘Rectal Wash-Out’ secara ringkasnya adalah cara kami mengeluarkan najis daripada badan Muhammad Solehuddin..kerana masalah usus yang dihadapinya, Muhammad Solehuddin adakalanya sukar untuk membuang air besar..sehubungan itu, prosedur ini perlu dilakukan sekiranya Muhammad Solehuddin tidak membuang air besar sepanjang hari..
Bagi pengendalian prosedur ‘rectal wash-out’..terdapat beberapa prosedur yang perlu dilaksanakan..artikel lanjut penerangan prosedur ini adalah seperti dibawah..
Clinical Guidelines (Nursing) : Neonatal Bowel Washout (Rectal)
Neonatal Bowel Washout (Rectal)
1. Introduction
Rectal Bowel washouts are performed to decompress the bowel and deflate the abdomen by removing gas and stool using small amounts of Normal Saline 0.9%.
They are:
Performed in babies with Hirschsprung's Disease (HD) or to relieve low intestinal obstruction due to meconium plug, meconium ileus. or intestinal dysmotility of prematurity.
Used as a mode of temporary management in proven cases of HD till definitive surgery. (This may be for 4-12 weeks depending on each case)
2. Parameters
This Guideline is to assist clinicians performing Rectal Bowel Washouts for neonatal patients within the neonatal unit at the RCH. It does not include older patients outside of the neonatal unit requiring bowel washouts
Procedure must be ordered by the Surgical Team following patient review.
3. Definition of terms
Hirschsprung's Disease: A rare disorder of the bowel, most commonly of the large bowel (sometimes
called megacolon), where there is a lack of nerves, known as ganglion cells in the bowel wall. This prevents effective peristalsis and results in intestinal obstruction
It affects four times as many boys as girls with an increased incidence in infants with Down Syndrome 1
Meconium Plug: This condition is the most common and mildest form of mechanical distal obstruction of the newborn. Inspissated and immobile meconium causes a transient form of distal colonic or rectal obstruction. The aetiology of this disorder is unclear. It is most common in preterm infants.
Meconium Ileus: The obstruction is mainly caused by thick tenacious meconium. The sticky meconium is unable to be propelled through the intestine, usually the gut is not damaged and continuity is not disrupted 1. Meconium ileus occurs in 15% of infants with Cystic Fibrosis.1 In others, the condition is associated with volvulus, atresia or perforation.1
4. Assessment
Physical
Assess and record any signs of bowel obstruction these include
Vomiting
Note - frequency, colour and amount
Is it bile stained?
Note: Green bile staining indicates bowel obstruction, if present notify Surgical Team
immediately
Abdominal distension
Is abdomen tight or shiny
Determine and record degree of distension of the abdomen prior to performing bowel washout
Bowel action
Time since last bowel action
Note - frequency, consistency, colour, +/- blood
Note: Measurement of abdominal girth is no longer used as an accurate method of determining
abdominal distension
Investigations
Abdominal X ray
Rectal biopsy
Barium Studies
Medical orders
Medical orders for bowel washout must be written clearly on the treatment order sheet MR55B by the treating surgeons/senior medical staff. Orders should include:
Frequency
Size of tube
Length to be inserted.
Amount (mls) Saline solution .9% to be instilled - Maximum per procedure 20mls/kg
Note: Use only saline solution 0.9% - the use of other solutions or concentrations in this patient group may be dangerous
Procedure
Perform bowel washout as prescribed. The frequency of washouts is determined according to the
effectiveness of decompression of the bowel
Notify surgeons if two successive washouts fail to achieve abdominal decompression
Documentation
Observe, and document
Amount of decompression
Note reduction in abdominal distension - Is the abdomen soft, palpable?
Washout result
Volume colour consistency amount and type eg. stool/meconium
Equipment Special Consideration
Catheters
The catheters used should be soft. Do not use Naso Gastric Tubes with a weighted tip.
Nelaton catheters are softer and less likely to damage mucosa
Orders should include specific size, and length of catheter to be inserted
Weight Size Length to be inserted
Weight < 2kg Size 8FG Nelaton 2-3cm
Weight > 2kg Size 10FG Nelaton 5cm
Confirm orders with treating surgeon/doctor if they vary from the above guide
Syringe
Terumo 60mls catheter tip syringe
Normal Saline Sachets 0.9%
Ensure normal saline sachets are warmed prior to use (warm to touch). Infants, especially
premature infants can cool quite rapidly if solution is cold. Volume of saline to be used is
determined by the surgeons and should be written as an order
Lubricant
Use only water based lubricant
Incosheets
Use inco-sheets to protect soiling of bed
Process Consideration
Position infant, usually on his/her back with legs inmthe frog position
Select appropriate sized catheter for use
Warm normal saline solution and prime catheter
Lubricate tip of catheter and gently insert into the rectum.
Length determined by surgical instructions
Instil saline in 10 - 20 ml aliquots (by pushing in with syringe plunger) over 1-2 minutes(there should be no resistance when injecting the normal saline).
Remove syringe and let fluid run into nappy/kidney dish
Procedure may be repeated twice if return is not clear
If there is saline retention or return is not clear contact surgeon
Remove catheter from the rectum
Note and record results of bowel washout accurately on fluid balance chart (MR55B)
Special
Use inco-sheets to protect soiling of bed
Do not use excessive force if resistance is felt.
Contact medical staff if unsure
Do not pull back on syringe to aspirate, allow the saline to run out naturally
Do exceed maximum of 20ml/kg
5. Complications
Reabsorption of saline
In premature infants, there is a risk of reabsorption of saline, especially if most of the solution is not
expelled. In the case of retention
- contact the surgical team
- consider U+Es
- record volume of saline retained
this article finished here
Artikel ini tiada gambarajah..Jadi, kami cuba 'google' artikel lain yang ada gambarajah, untuk memudahkan pemahaman dalam prosedur ini..
Neonatal Rectal Wash-Out Figures
Credit to St George’s Healthcare NHS Trust
Credit to St George’s Healthcare NHS Trust
0 comments :
Post a Comment