Bowel irrigation ( rectal washout ) for infants and children - Guideline for the management of

Publication: 23/02/2012  
Next review: 28/02/2025  
Clinical Guideline
CURRENT 
ID: 2858 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2022  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Guideline for the management of bowel irrigation (rectal washout) infants and children

Aim

To rationalise and streamline the procedure of bowel washouts in infants and children who have Hirschsprung’s disease, meconium ileus, a cloaca or have a distal stoma requiring irrigation.

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Objectives

  • To provide details of the procedures and equipment used.
  • To identify potential problems
  • To provide the evidence collated
  • To provide an abdominal assessment tool for guidance
  • To prevent potentially hazardous bowel infections

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Background

Bowel irrigation is a means of emptying and cleaning the large intestine using a catheter and warm sodium chloride 0.9%.

Currently there is no available national consensus regarding the procedure of rectal Washout (RWO) or Distal Loop Washout (DLWO) at less than one year of age. A literature search highlights the variability of how much sodium chloride 0.9% is used either per instillation or per procedure; which type of tube should be inserted or how far to advance the rectal tube.

However, the scanty literature found, lends itself to some of the current practice at the Leeds Teaching Hospitals NHS Trust for procedures such as:

  • a time intensive procedure as in Hirschsprung’s disease
  • a less time consuming intervention for meconium ileus
  • a brief sterile distal loop washout as for a baby who has cloaca
  • Non sterile brief DLWO/RWO once per month- or as instructed by surgeons.

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Assessment of the infant

Initial assessment of the sick infant who has or potentially has Hirschsprung’s Disease shows an indication of the urgency for a rectal washout to be undertaken.

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Types of bowel irrigation

1 Hirschsprung’s Disease (HD)

The infant with this condition is unable to pass stool or wind effectively, due to the absence of ganglion cells within the intestinal mucosa which initiates peristalsis. Therefore, rectal washouts for suspected or confirmed Hirschsprung’s Disease are the most essential part of the whole safe management of these patients in prevention of Hirschsprung’s Enterocolitis (HE). This involves RWO starting at 2 - 3 times daily after surgeons review, reducing to once daily prior to discharge, and using approximate volumes of 100mL- 150mL/ kg of warmed sodium chloride 0.9% for irrigation.

2 Meconium Ileus (MI)

This condition presents itself in the neonatal period causing intestinal obstruction due to thick, sticky Meconium within the intestines usually found as an indicator of Cystic Fibrosis. Acetylcysteine solution used as a rectal washout assists in breaking down the Meconium so it may be passed more easily.

Using smaller volumes of sodium chloride 0.9%, 50mL/kg, leave the Acetylcysteine in situ for 10 minutes and then irrigate the bowel again with warm sodium chloride 0.9% until clear.
Please see link below for further information.

http://www.leedsformulary.nhs.uk/chaptersSubDetails.asp?FormularySectionID=24&SubSectionRef=24.16&SubSectionID=A100&drugmatch=3576#3576

see Meconium Ileus (MI) Nutrition guideline

3 Post stoma surgery distal loop washout (DLWO)

Where an ano-rectal malformation is diagnosed and a colostomy is subsequently formed, it is essential to ensure the large intestinal segment from the mucus fistula to the anus is clean. 20mL/kg of warm sodium chloride 0.9% is used in 10 - 20ml increments into the mucus fistula and allowed to drain out again until the solution is clear. This is done monthly or less frequently depending on the surgeons’ advice.

4 Cloaca

A colostomy may need to be formed as a neonate for imperforate anus but there may be connecting fistulae from the colon to the vagina or bladder. The DLWO would need to be undertaken under aseptic techniques with 20mL/Kg warm sodium chloride 0.9% to prevent cross contamination. The washout needs to be requested by the patient’s surgeon. Sometimes antibiotics are prescribed to prevent infection due to translocation of bacteria that can occur during the washout.

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Hirschsprung’s Disease

Equipment

Warm sodium chloride 0.9% (100mL-150mL/kg)
Lubricating gel - alcohol free
Bowl
Measuring jug
Large bore, soft catheter (from at least size 12)
50mL bladder syringe
Apron
Gloves
Large towel/disposable pad
Changing mat
Baby wipes
Disposable bag

Procedure

Note: Bowel washouts and flatus tubes are prescribed care and should be carried as requested by the surgeon. Details of the washout need to be documented afterwards. Escalate to surgeon if the washout is not effective or does not decompress the abdomen. Washouts should be done at roughly the same time each day.

  1. Prepare equipment and ensure a safe warm environment.
  2. Wash hands and apply apron and gloves.
  3. Place infant on a changing mat in a comfortable position.
  4. Wrap a towel around the upper half of the body and expose the buttocks.
  5. Observe their behaviour, perfusion and feel the abdomen before and after the procedure. Consider use off soother/pacifier, if parents agree.
  6. Remove plunger from the syringe, connect empty syringe to the catheter.
  7. Lay onto the left side or supine to aid the flow into the large intestine. Apply lubricating gel to the tip and length of the catheter (approx 10cm), and the anus. (An empty catheter inserted at the beginning releases flatus before the start of the washout). Run 10mL sodium chloride 0.9% through the catheter and kink the tubing.
  8. Gently insert the catheter into the rectum and unkink the tubing allowing the sodium chloride 0.9% to run in whilst advancing the tubing until resistance is felt. Allow the sodium chloride 0.9% to drain out into syringe.
  9. Holding the catheter in position with one hand, fill the syringe barrel to 20mL and allow the fluid to run in, by gravity. Abdominal massage at this point is helpful to move the stool, if tolerated. Lower the syringe and allow the fluid to flow out in to the syringe. Hold the syringe in a way that you can measure the output, pour into the large collecting bowl.
  10. The procedure should be repeated until the sodium chloride 0.9% in the jug has been used or the fluid draining out is clear.
  11. Gently and slowly withdraw the catheter in 2cm increments from the anus whilst massaging the abdomen. Only remove the catheter if the tube becomes blocked with thick stool if really necessary, gently re-insert. Do not keep taking the tube out. Observe the colour, consistency and smell of the effluent.
  12. Wash and dry the buttocks, apply barrier cream.
  13. Measure the fluid in the bowl, approximately 50mL may be short due to spillages or fluid escaping around the catheter during the washout.
  14. The aim is to irrigate the large bowel, whilst ensuring all fluid inserted is expelled by the end of the procedure.
  15. Dispose of the soiled fluid in the designated sink/sluice in ward area. Soiled fluid at home can be flushed down toilet.
  16. Wash thoroughly and dry the equipment
  17. All consumable equipment is single use only whilst an inpatient. Equipment can be changed weekly at home.
  18. Assess the abdomen after the washout to ascertain effectiveness of washout.
  19. See Appendix 2 for trouble shooting advice should fluid not return.

Hirschsprung’s Enterocolitis, Signs of Infection

  • Offensive smell from stools.
  • Unusual colour of stools.
  • Looser consistency, explosive stools.
  • Blood, mucus in the stools.
  • Lethargy, poor feeding, vomiting, pallor.
  • High temperature of unknown origin.

Post procedure and the use of flatus tubes.

If the final result of the washout for HD is not entirely clear, it may be necessary to repeat the procedure later in the day. However, take notice of the abdomen and further soiled nappies later, it may not be necessary to repeat the procedure.

If there was a good result from the washout (HD) but later the baby appears to be uncomfortable and has a full abdomen, the empty rectal tube can be passed into the rectum, (without sodium chloride 0.9%); the relief from expelling flatus may be all that is required. The use of further flatus tubes can be discussed with surgical outreach nurse and reviewed on a regular basis.
Please see Appendix 3

Problem solving for rectal washout in HD (See Appendix 2)

Most of the problems with the process of the washout involve the stools that are too thick and block the tube or prevent the tube from passing into the rectum.

  • Hold the syringe barrel high and rapidly squeeze and release the catheter tubing.
  • Place plunger in top of syringe and press very gently until the sodium chloride 0.9% starts to flow then remove the plunger.
  • Gently move tube around to re-position tip of tube.
  • As a last resort, remove the tube, rinse through the catheter and re-insert.
  • Occasional specks of blood are seen in the tubing, due to irritation of the tube with the bowel wall/mucosa.
  • Fresh bleeding down the catheter - stop the rectal washout and inform the infants Surgeon. It may be requested to retry the washout after a couple of hours.
  • As weeks go by there may be some difficulty passing the tube initially, this can be eased by introducing the catheter and advancing the tube whilst the sodium chloride 0.9% is flowing in.

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Meconium Ileus

Follow the procedure for rectal washout as for Hirschsprung's Disease except use 50mL/kg in total of warmed sodium chloride 0.9%, in 20mL increments. Instil Acetylcysteine solution, leave for 10-15 minutes, and allow draining out via rectal tube.

Please see monograph for dosage and administration of Acetylcysteine: http://www.leedsformulary.nhs.uk/chaptersSubDetails.asp?FormularySectionID=24&SubSectionRef=24.16&SubSectionID=A100&drugmatch=3576#3576

see Meconium Ileus (MI) Nutrition guideline

Equipment;

Acetylcysteine- Required dose
Warm sodium chloride 0.9% (50mL/kg)
Lubricating gel - alcohol free
Bowl
Measuring jug
Large bore, soft catheter - at least size 10Fg
50mL bladder syringe
Apron
Gloves
Large towel/disposable pad
Changing mat
Baby wipes
Disposable bag

Procedure

  1. Prepare equipment and ensure a warm environment.
  2. Wash hands and apply apron and gloves.
  3. Place on a changing mat in a comfortable position.
  4. Wrap a towel around the upper half of the body and expose the buttocks.
  5. Observe behaviour and perfusion, and feel the abdomen before and after procedure.
  6. Remove plunger from the syringe, connect empty syringe to the catheter.
  7. Lay onto left side or supine to aid the flow into the large intestine. Apply lubricating gel to the tip and length of the catheter (approx 10cm), and the anus. An empty catheter inserted at the beginning releases flatus before the start of the washout. Run 10mL sodium chloride 0.9% through the catheter and kink the tubing.
  8. Gently insert the catheter into the rectum and unkink the tubing allowing the sodium chloride 0.9% to run in whilst advancing the tubing until resistance is felt. This will ensure advancing the tube is easier. Instil Acetylcysteine solution ( as per pharmacy guidance)
  9. Allow the Acetylcysteine to remain in situ for 10 - 15mins if possible. Drain out the this fluid before continuing the procedure.
  10. Holding the catheter in position with one hand, fill the syringe barrel to 20mL and allow the fluid to run in. Lower the syringe and allow the fluid to flow out again holding the syringe in a way that you can measure the output, pour into the large collecting bowl.
  11. The procedure should be repeated until the sodium chloride 0.9% in the jug has been used or the fluid draining out is clear.
  12. Gently and slowly withdraw the catheter in 2cm increments from the anus whilst massaging the abdomen.
  13. Observe the colour, consistency and smell of the effluent.
  14. Wash and dry the buttocks, apply barrier cream.
  15. Measure the fluid in the bowl to ensure the fluid has been excreted.
  16. The aim is to irrigate the large bowel with 50mL/kg and gain 50mL/kg with stool by the end of the procedure.
  17. See Appendix 2 for trouble shooting guidance should fluid not return.
  18. Dispose of the soiled fluid in appropriate sluice/designated sink.

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Distal Loop Washout (DLWO)

Equipment

Warm sterile sodium chloride 0.9%
Lubricating gel - alcohol free
Bowl
Measuring jug
Size 6 and 8 ng tubes or size 10 rectal tubes
20mL bladder syringe
Apron
Gloves
Large towel/disposable pad
Changing mat
Baby wipes
Disposable bag

Procedure

NB: Liaise with the Consultant Paediatric Surgeon prior to the procedure regarding potential problems. Some infants may have a fistula between the bowel and genitourinary tract and potentially may develop a urinary tract infection.

  1. Prepare equipment and ensure a warm environment.
  2. Wash hands and apply apron and gloves.
  3. Place infant on a changing mat, in a comfortable position.
  4. Wrap a towel around the upper half of the body and expose the mucous fistula.
  5. Observe and feel the abdomen before and after procedure.
  6. Remove the plunger from the syringe; connect the empty syringe to ng/rectal tube tube.
  7. Run 10mL of warmed sodium chloride 0.9% through the syringe barrel and tube, kink the tubing to prevent the flow.
  8. Lubricate the tip of the tube with lubricating gel.
  9. Gently insert the catheter into the mucous fistula allowing sodium chloride 0.9% to run in whilst advancing the tubing until resistance is felt. Allow the sodium chloride 0.9% to drain out into a bowl.
  10. Holding the catheter in position with one hand, fill the syringe barrel to 10- 20mL and allow the fluid to run in. Lower the syringe and allow the fluid to flow out again holding the syringe in a way that you can measure the output, pour into the large collecting bowl. There may be a delay in drainage. If so, remove the tube and run through with 5mL of sodium chloride 0.9% to clear the tube. The mucous within the fistula is often thick and blocks the small tube.
  11. Insert the tube again and allow the sodium chloride 0.9% to drain out of the fistula.
  12. Turn baby from side to side a couple of times to allow mucous to be dislodged and mixed with sodium chloride 0.9%.
  13. Observe the colour, consistency and smell of the effluent.
  14. Wash and dry the area, advise the family that there might be some natural drainage later.
  15. Measure the drainage in comparison to what was started with, if possible.
  16. Dispose of the soiled fluid in appropriate sluice or designated sink
  17. Discard all consumables. Repeat the process monthly or as directed by the Consultant Paediatric Surgeon.
  18. See Appendix 2 for trouble shooting guidance should fluid not return.

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Cloaca

NB: Liaise with the Consultant Paediatric Surgeon prior to the procedure regarding potential problems. Some infants may have a fistula between the bowel and genitourinary tract and potentially may develop a urinary tract infection. There is also a risk of bacterial translocation through the gut wall, leading to a bacteraemia.

Prophylactic antibiotics may be indicated.
*** An additional person is required to assist, this enables the procedure to be as clean as possible.

Equipment
Warm sodium chloride 0.9% (100mL bag) or 20mL/kg
Pair of scissors
Lubricating gel - alcohol free
Bowl
Measuring jug
Size 6 and 8 Ng tubes- sterile
Size 10 rectal tube-sterile
20mL bladder syringe-sterile
Apron
Large towel/disposable pad
Changing mat
Baby wipes
Disposable bag
Sterile dressing pack and sterile gloves (powder free)

Procedure:

  1. Prepare equipment and ensure a warm environment.
  2. Wash hands and apply apron and gloves.
  3. Place on a changing mat in a comfortable position.
  4. Wrap a towel around the upper half of the baby and expose the mucous fistula.
  5. Observe and feel the abdomen before and after procedure.
  6. Remove the plunger from the syringe; connect feel the
  7. the empty syringe to ng tube.
  8. Run 10mL of warmed sodium chloride 0.9% through the syringe barrel and ng tube, kink the tubing to prevent the flow.
  9. Lubricate the tip of the tube with aquagel.
  10. Gently insert the catheter into the mucous fistula tubing allowing sodium chloride 0.9% to run in whilst advancing the tubing until resistance is felt.
  11. Holding the catheter in position with one hand, fill the syringe barrel to 20mL and allow the fluid to run in. Lower the syringe and allow the fluid to flow out again holding the syringe in a way that you can measure the output, pour into the large collecting bowl. There may be a delay in drainage, if so, remove the tube and run through with 5mL of sodium chloride 0.9% to clear the tube. The mucous within the fistula is often thick and blocks the small tube.
  12. Insert the tube again and allow the sodium chloride 0.9% to drain out of the fistula.
  13. Turn from side to side a couple of times to allow mucous to be dislodged and mixed with sodium chloride 0.9%.
  14. Observe the colour, consistency and smell of the effluent.
  15. Wash and dry the area, advise the family that there might be some natural drainage later.
  16. Measure the drainage in comparison to what was started with.
  17. See Appendix 2 for trouble shooting guidance should fluid not return
  18. Dispose of the soiled fluid. Discard all consumables. Repeat the process monthly or as directed by the Consultant Paediatric Surgeon.
  19. Advise parent of potential pyrexia post procedure and what action to take. Ensure contact telephone numbers of professional advice is available.

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Prior to discharge home

It is essential to document the following information for the parent/carers and nurses prior to discharge into primary care with all competencies completed and signed by an expert in undertaking all the documented procedures in this guideline.

The practitioner will:

  • Document the reason why the baby is having rectal washouts
  • The size and type of catheter to be used
  • How far to insert the catheter
  • The volume of fluid
  • The type of fluid
  • Explain and demonstrate the correct temperature of the fluid to be used
  • Explain the principles of effective hand washing
  • Demonstrate effective hand washing and drying
  • Explain the consequences of ineffective hand washing
  • Explain the importance of environment preparation before and after performing the rectal washout
  • State how often the rectal washouts need to be performed
  • Competently demonstrate the correct procedure
  • Explain how the procedure may affect the infant
  • Explain the potential problems which may occur
  • Explain the use of flatus tubes and when this is necessary to use,
  • Explain the strategies to overcome the problems

Abbreviations used:

1 RWO - Rectal washout
HD - Hirschsprungs Disease
HE - Hirschsprungs Enterocolitis

2 MI - Meconium Ileus

3 DLWO - Distal Loop Washout

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Appendix 1 - Teaching Programme for undertaking Rectal Washouts

Teaching and learning to care for a child requiring rectal washouts is a joint commitment between the hospital and the carers. It is individual and some people will need more opportunity to practice than others.

This teaching programme aims:

  • To give you information about rectal washouts
  • To teach you to undertake rectal washouts safely
  • To teach you about the potential problems that may arise and how to deal with them

This teaching programme will cover the following subjects:

  • The reason for rectal washouts
  • Preparation
  • How to perform the procedure
  • What to look out for
  • Problem solving
  • Written instructions and contact numbers

What is a Rectal/Bowel Washout?

A Rectal washout is a means of emptying and cleaning the lower bowel with the use of a rectal catheter and saline solution.

Why is it Necessary for your baby to have Rectal/Bowel Washouts?

At present your baby is unable to empty their bowel adequately without help. Babies with bowel motility problems are more prone to bowel infections and rectal washouts will help to prevent these problems. Cleaning the bowel also keeps your baby comfortable enabling them to feed and grow.

Rectal washouts can be a positive experience if performed at a time that is comfortable and convenient for you and your baby.

Babies do not always like to lie still with no nappy on and may appear upset. Your voice, soothing music or a comforter may help to settle them. A recently fed baby will be relaxed which means the washout will be more successful.

If your baby remains unduly distressed and appears to be in pain the washout should be discontinued and professional advice sought.

Preparation

With careful preparation the procedure should be uneventful.
Decide on the best place to perform the washout. The environment must be warm and free from draughts and disturbances.
The washouts can be performed either on a changing table or a changing mat placed on a table or chest of drawers. Your baby should be supervised at all times.

Collect and assemble the following equipment:
Warm Normal Saline 0.9%
Lubricating Gel
Bowl and Jug
Rectal Tube
50mL Bladder Syringe
Apron and Gloves (Optional at home)
Disposable Pad or Towel
Plastic Sheet to protect surrounding area
Towel
Changing Mat and Wipes
Disposal Bag
Dummy/Comforter.

ENSURE BABY IS SAFE AND CAN NOT ROLL OFF

How much Saline do I use?

Warm Sterile Saline: 100-150mL per Kilogram of body weight. (E.g. If your baby weighs 3kgs 300-400mL of saline may be required).
Some babies will need more fluid others may use less.

Warm the saline by standing the bottle of saline in hot water. Older children may tolerate fluids at room temperature.
NB. Water must not be used for this procedure as it is easily absorbed by the bowel and may make your baby unwell.

PROCEDURE

Following preparation of equipment and environment;

  • Wash hands and put on apron and gloves (parents/carers optional)
  • Undress your baby leaving vest or t-shirt on
  • Wrap your baby in an old towel leaving buttocks exposed
  • Lay your baby on the chosen surface i.e. changing mat, chest of drawers etc.

Whilst your baby is undressed, look and gently feel your baby’s tummy.

You can often see that your baby’s tummy is swollen before the washout is performed. This swelling should go down with the release of the bowel contents and air. If after performing the washout, your baby’s tummy remains swollen, please seek advice from your surgical outreach nurse or ward staff.

  • Remove plunger from syringe
  • Connect the syringe to the end of the catheter
  • Lay your baby on their back (Laying your baby on their left side may aid the flow of saline into the rectum)

To make the rectal tube easier to insert, smear the end of the tube and the anus, with lubricating gel. Put more gel on the tube each time it needs reinserting to prevent soreness.
soreness.

  • Gently insert tube into the rectum
  • The tubing should be inserted until it no longer advances easily. You can vary the position of the tube to suit your babys needs in order to get the best results.

Never force the tube as this could damage the lining of the bowel



Holding the tube in place with one hand, fill the syringe barrel with 20mL of saline with the other. This can be difficult at first if
doing this on your own.

If there are 2 people, one can hold the syringe & the other can comfort your baby.

Holding the syringe up allows the saline to flow into the bowel, and as it flows, the catheter can then be advanced further.

  • When the saline has flowed into the bowel lower the syringe & allow the saline and stool to drain back into the syringe.
  • Empty returned fluid from the syringe into the bowl. The syringe should be lower than the baby’s bottom to aid drainage.
  • Refill the syringe with another 20mL and hold up to begin the washout procedure again.


Check the fluid draining out is equal to the volume that went in.
Description: Pic 4

If possible ensure the tube stays in the rectum during the procedure, to minimize discomfort and protect the baby’s anus from soreness.

  • This procedure should be repeated until all the saline in the jug is used or the backflow of saline is running clear.

Stop sooner if your baby is unduly distressed, cool or seems unwell.

  • Gently and slowly withdraw the catheter from your baby’s rectum, with the syringe upside down over a bowl whilst gently massaging the tummy as you withdraw the catheter.

This will help the process of emptying the bowel and allow any fluid or wind left in the rectum to drain out.

NB> Observe the colour, consistency and smell of the stool. :

Signs of infection can include changes in stool consistency different from usual:-

Offensive smell
Unusual colour
Looser consistency
Blood in stool

If your baby appears unwell or has any of these symptoms please ring for advice. (See back of booklet for appropriate phone numbers).

  • When the procedure is complete, your baby should be cleaned dried and dressed appropriately to keep warm.
  • Empty and measure the fluid in the bowl. The amount should be approximately the same as you started with, allowing for any spillages.
  • Fluid should be disposed of down the toilet. All equipment should be washed in the bathroom with hot soapy water and stored ready for use again.

If after performing the rectal washout the fluid draining from the bowel remains dirty, it may be necessary to repeat the procedure later in the day. In between this time, take notice of your baby’s abdomen and nappies, it may be that your baby as his/her bowels open themselves, in which case,
additional washouts may not be required.

Wind can cause more discomfort than stool and is more difficult to pass. If you had a good result from the washout but later in the
day your baby seems uncomfortable and their tummy feels full, try passing a flatus tube to release excess wind. (See problem section)

Some babies will continue to pass stools bowel on their own – Please still continue with washouts as planned

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Appendix 2

Daily rectal washouts will need to continue until your baby has surgery or you are advised to stop or decrease the frequency

PROBLEM

ACTION

CONTACT

Tube does not go in the babies bottom the suggested length

  • Do not use force to push the tube in. Try changing the position of the baby, laying on side or back.
  • Leave the washout for 30 minutes and try again.
  • Rotate the tube gently whilst putting it in.
  • Use smaller amounts of fluid (10mL) to release wind.

If you are unable to get the tube in after trying recommended action seek medical advice.

Solution does not run in with gravity.

  • Hold the tubing up higher.
  • You may have to use the plunger to gently start off the flow.
  • The tube may be blocked with stools. Remove the tube and examine the end for blockage.
  • Use smaller amounts of fluid (10mL) to release wind.
  • Gently plunge fluid in (but do not pull fluid out).

If the problems persist seek medical advice.

Solution does not drain out after the washout.

  • The tube may be blocked.
  • Gently rotate the tube whilst withdrawing it from the baby’s bottom.
  • Change the position of the babe (side to back, or side to tummy).
  • Observe the nappy after the washout to see if the solution is passed out of the bottom.

If problem persists seek medical advice.

Washout is non-productive of stools.

  • You may have to repeat the washout in a few hours.
  • The baby may have passed stools unaided.

If the baby’s abdomen remains distended or is vomiting you must seek immediate medical advice.

Bleeding from the bottom.

  • Passing the tube may have caused irritation to the lining of the bottom.
  • If it is only a small amount of blood no action is needed.

If the bleeding continues seek medical advice.

Wind

  • Pass an empty lubricated tube into the rectum.
  • As well as releasing wind it can start flow of poo.
  • It is not necessary to do ‘kinking’ procedure (page 6) if flow of poo started.
 

Baby passes stools unaided

  • It is difficult to tell if the baby has passed an adequate amount of stool.

Do not miss out a washout with out seeking medical advice.

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What is a flatus tube (Appendix 3)

A Flatus tube is a rectal tube used to aid the passage of wind.
The tube is the same tube that is used to perform the daily washouts.
There is no need to insert any saline.
Pass the tube into the rectum, with syringe attached.
Holding the syringe down allow the wind to be released.
Clean equipment as per usual

Provenance

Record: 2858
Objective:
  • To provide details of the procedures and equipment used.
  • To identify potential problems
  • To provide the evidence collated
  • To provide an abdominal assessment tool for guidance
  • To prevent potentially hazardous bowel infections
Clinical condition:

Hirschsprungs Disease / Meconium Ileus

Target patient group: Less than one year old
Target professional group(s): Secondary Care Doctors
Secondary Care Nurses
Adapted from:

Evidence base

References

Bradnock T and Walker G (2008). The current management of Hirschsprung’s Disease in the UK: A National Summary of Practice.

Carman M (2005). Management Medical Treatment Bowel Irrigation with Sodium chloride 0.9% Solution? Colon and Rectal Surgery. Oxford

Chattopadhyay, Anindya, Prakash, Bhanu, Vepakomma, Deepti, Nagendhar, Yoga, Vijsyskumsr (2004). A prospective comparison of two regimes of bowel preparation for paediatric colorectal procedures: sodium chloride 0.9% with added potassium vs. polyethylene glycol. Paediatric Surgery International. Vol 20, No. 2, p127 - 129 (3)

Clinical Guidelines (Hospital). Neonatal Bowel Washout.http://www.rch.org.au/rchcpg/index.cfm?doc_id=9220

Gabra H, Stewart R, Nour S (2007). Mid-gut malrotation and associated Hirschsprung’s Disease: a diagnostic dilemma. Pediatric Surgery International. 23 : 703 - 705

Hosseini S, Foroutan H, Zeraation S, Sabet B (2008). Botulinium toxins, as bridge to transanal pull through in neonate with Hirschsprung’s Disease. Journal of Indian Association of Paediatric Surgeons. Vol 13, Iss 2, p69 - 71

Junj K, Masahiro N, Norihiro N, Shuichi Y, Yoshihirok, Akiko K (2003). Preoperative Colonic Decompression and Irrigation Through a Transanal Tube to Perform the One-Stage Pull-Through procedure for Hirschsprung’s Disease. Journal of the Japanese Society of Paediatric Surgeons. Vol 39, No 1, p73 - 78

Kessman J (2006). Hirschsprung’s Disease: Diagnosis and Management. American Family Physician. 74: 1319 - 1322/1327 - 1328. http://www.aafp.org/afp/AFPprimter/20061015/1319/html

Lee S, Puapong D, Dubois J (2006). Hirschsprung’s Disease. eMedicine - http://www.emedicine.com/med/TPOIC1016.HTM

Molenaar J and Meijers C (1998). Hirschsprung’s Disease in Paediatric Surgery (Chapter 23).
In: Paediatric Surgery London. Ed Arnold Publishers

Parithan P, Chiengkriwate P, Chow Chuvech V, Patrapinyoleuls, Sangkhathat S (2007). Bowel prescription for pull-through operation in Hirschsprung’s Disease. Sangkla Medical Journal. 25 (5): 401 - 406

Robb A and Lander A (2008). Hirschsprung’s Disease. Surgery (Oxford). Vol 26, Iss 7, P288 - 290

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Abbreviations used:

1 RWO - Rectal washout
  HD - Hirschsprungs Disease
  HE - Hirschsprungs Enterocolitis
2 MI - Meconium Ileus
3 DLWO - Distal Loop Washout

Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.