In this section
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).They are:
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.
Meconium Plug: Inspissated (thickened) and immobile meconium causes a transient form of distal colonic or rectal obstruction.
Hirschsprung Disease: It always affects the rectum and usually a variable length of the distal large bowel. It is characterised by a lack of normal development of the nerve supply to the bowel wall (ganglion cells). This prevents effective peristalsis and results in a functional intestinal obstruction.
Meconium Ileus: This form of obstruction is caused by thick, tenacious meconium which is unable to be propelled through the small intestine. Usually the bowel is not damaged and remains in continuity. It may also be associated with volvulus, intestinal atresia or perforation.
Peristeen®: Peristeen ®is a bowel washout system that can be used to manage faecal incontinence and chronic constipation for children over 3 years of age.
See nursing assessment guideline.
Assess and record any signs of bowel obstruction in the EMR flowsheets. These include:
Medical orders by the treating surgeons/senior medical staff must be active in the EMR. 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 and treatment protocols should be individualised based on underlying condition.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
Link to nursing documentation guideline
1. Observe and document
Note any reduction in abdominal distension
Amount of decompression
2. Washout result
There is a risk of reabsorption of saline, especially if most of the solution is not expelled. In the case of retention of instilled solution
Bowel perforationNausea and vomitingAbdominal discomfort
evidence table can be viewed here.
Please remember to
read the disclaimer.
The development of this nursing guideline was coordinated by Jess Smith, Butterfly Ward, and approved by the Nursing Clinical Effectiveness Committee. Updated April 2019.