A rectal tube is a temporary medical device inserted into the rectum, primarily used to decompress the lower gastrointestinal tract by facilitating the removal of gas and liquid stool. This device may also be used to administer certain medications or perform a rectal washout, which is a common procedure for managing specific bowel conditions. To ensure the tube functions correctly and remains open, a maintenance procedure known as flushing is performed regularly. Flushing involves introducing a small volume of fluid into the tube to clear any potential blockages from thick stool or sediment, which maintains the tube’s patency for effective drainage.
Defining the Need and Gathering Equipment
Before initiating the procedure, a healthcare provider determines the necessity for flushing, often based on a physician’s specific order or clinical indicators. A lack of expected drainage from the tube, patient complaints of increasing abdominal discomfort, or distension often suggest that the tube is occluded and requires attention. The goal of this preparatory stage is to ensure both patient safety and the readiness of all required sterile supplies.
Proper preparation involves assembling the necessary equipment, which generally includes a sterile flushing solution, typically 0.9% sodium chloride, and an appropriately sized catheter-tip syringe, such as a 60-milliliter syringe. You will also need clean gloves, a water-soluble lubricant, an absorbent waterproof pad, and a designated receptacle for collecting waste and drainage.
The procedure begins with explaining the process to the patient to gain cooperation and reduce anxiety, ensuring privacy throughout the entire process. Positioning the patient is an important initial step; a left side-lying position with the knees slightly bent, known as the Sim’s position, is generally preferred because it utilizes gravity for easier access.
Step-by-Step Flushing Technique
The actual flushing procedure begins with meticulous attention to aseptic technique, which involves hand hygiene and donning clean gloves. Next, confirm the connection of the rectal tube and ensure that the distal end is positioned over the waste receptacle or connected to the drainage bag. This setup confirms that any material flushed from the colon will be captured for assessment.
Using the syringe, gently draw up the prescribed amount of the sterile flushing solution, usually a small volume between 10 to 30 milliliters per flush, depending on the clinical protocol. Connect the filled syringe to the proximal end of the rectal tube, taking care to avoid introducing air into the colon. Slowly and steadily inject the saline solution into the tube, applying only minimal pressure during the instillation.
It is necessary to monitor for any resistance during the injection of the fluid. If resistance is met, immediately stop the instillation and do not attempt to force the fluid. Forcing the flush can cause injury to the delicate rectal or intestinal lining. After the solution is instilled, allow a brief dwell time of a few seconds, which permits the saline to loosen any thick or impacted material within the tube or the lower colon.
Following the dwell time, allow the fluid to drain back into the collection receptacle, often facilitated by gravity. If the return flow is slow or absent, try gently repositioning the tube a few centimeters or gently massaging the lower abdomen to encourage drainage. Repeat the process of instilling a small volume of saline and allowing it to drain until the return fluid is clear of stool or debris, indicating a successful clearance of the tube.
Post-Procedure Assessment and Documentation
After the flushing technique is complete, a thorough assessment of the patient is immediately performed to ensure comfort and safety. This assessment includes observing the patient for any signs of distress, such as sudden, severe abdominal pain or cramping, which could indicate a complication. The abdomen should be palpated to confirm that distension has decreased and that the abdomen feels softer than it did prior to the flush.
Successful flushing is confirmed by observing a clear or near-clear return of the saline solution through the tube, often accompanied by improved drainage or the passage of gas and stool. Conversely, any persistent patient discomfort, the appearance of frank rectal bleeding, or a failure to retrieve a volume of fluid roughly equal to or greater than the volume instilled are warning signs that require immediate medical notification. These symptoms may suggest mucosal trauma or a persistent obstruction.
The final step involves meticulous documentation of the entire procedure in the patient’s medical record. This record must include the date and time the flush was performed, the precise type and total amount of fluid instilled, and the amount and characteristics of the fluid that returned. It is also important to document the patient’s tolerance of the procedure, noting any complaints of pain or changes in their abdominal assessment.