In this section
Note: This guideline is currently under review.
Rectal washouts are performed to decompress the lower intestine and deflate the abdomen by removing gas and stool using small amounts of Sodium Chloride 0.9% (normal saline).
a. Performed in babies and children to relieve low intestinal obstruction, e.g. suspected Hirschsprung disease (HD), meconium plug disease, meconium ileus or intestinal dysmotility.
b. Used as a mode of temporary management in proven cases of Hirschsprungs Disease until definitive surgery is performed (for 4-12 weeks depending on each case).
c. Used in the management of patients admitted with enterocolitis.
d. Used preoperatively in patients undergoing closure of stoma procedures.
e. May be used in the management of constipation in children
Neonatal procedure must be performed initially by a
surgeon and further washouts need to be ordered by the consulting surgical team
following patient review.
This guideline is to assist clinicians performing rectal washouts for patients of all ages at the RCH.
nursing assessment guideline.
Assess and record any signs of bowel obstruction. These include:
2. Increasing Nasogastric aspirate
Note: Green vomitus/nasogastric aspirate
indicates the presence of bile, making bowel obstruction more likely. If
present, notify surgical team immediately.
3. Abdominal distension
4. Bowel action
Note: Routine measurement
of abdominal girth is not used as an accurate method of determining abdominal
Medical orders for rectal washout must be written clearly by the treating surgeons/senior medical staff. Orders should include:
Note: Use only Sodium Chloride 0.9% solution
Perform rectal washout as prescribed. The frequency of washouts is determined according to the effectiveness of decompression of the bowel.
Notify the surgical team if two successive washouts fail to achieve abdominal decompression.
Orders should include specific size, and length of catheter to be inserted
Confirm orders with treating surgeon/doctor if they vary from the above guide
2. 60mL catheter tip syringe
3. Sodium Chloride 0.9% sachets
Ensure Sodium Chloride 0.9% sachets are warmed prior to use (warm to touch- Do Not use the microwave). Neonates, especially premature neonates may cool quite rapidly if the solution is cold. The volume of saline to be used is determined by the surgeons and should be written as an order.
Use only water based lubricant.
5. Gloves/incontinence sheets
Use incontinence sheets to protect soiling of the bed.
Link to nursing documentation guideline
1. Observe and document
Note any reduction in abdominal distension
Amount of decompression
2. Washout result
evidence table can be viewed here.
Please remember to
read the disclaimer.
The development of this nursing guideline was coordinated by Trudy Holton, Clinical Nurse Educator, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated March 2016.