A rectal tube is a soft, flexible catheter inserted into the rectum to manage various gastrointestinal issues. Its primary purpose is to relieve flatulence and abdominal discomfort, manage liquid stool, or administer medications or enemas. Because insertion is an invasive medical procedure, it requires a specific order from a licensed healthcare provider. It must be performed by personnel with appropriate training, necessitating an understanding of anatomy, sterile technique, and contraindications.
Licensed Nursing Staff as Primary Implementers
Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) are the healthcare professionals most frequently authorized to insert rectal tubes across various clinical environments. This responsibility is considered within the scope of practice for licensed nurses who have received educational preparation and demonstrated clinical competence. Their training typically includes this skill as part of the fundamental nursing curriculum, focusing on proper technique and patient safety.
Insertion of a rectal tube, particularly a modern fecal management system, requires specific education on device protocols. This includes understanding the correct inflation volume for the retention balloon and ongoing monitoring for complications. While RNs often perform the procedure independently, LPNs may operate under the direct or indirect supervision of an RN or physician, depending on the specific state’s Nurse Practice Act and the facility’s policy.
The nursing staff is responsible for the pre-procedure assessment, which involves checking for contraindications like recent rectal surgery, rectal bleeding, or severe hemorrhoids. They must perform a digital rectal examination prior to insertion to rule out fecal impaction, as inserting the tube into an impacted bowel can cause trauma. The nurse’s ongoing role involves monitoring the patient for adverse events, such as pressure injuries or lower gastrointestinal bleeding.
Advanced Practice Providers and Physician Oversight
Physicians (MDs/DOs), Physician Assistants (PAs), and Nurse Practitioners (NPs) are fully authorized to perform rectal tube insertion, though they less frequently carry out the hands-on procedure. Their primary role involves assessing the patient’s condition, determining the clinical need, and issuing the necessary medical order for the procedure. This group of practitioners is responsible for the overall treatment plan and for evaluating a patient’s suitability, especially when complex medical conditions exist.
In critical care or specialized settings, such as post-operative or intensive care units, these advanced practitioners may perform the insertion themselves. For example, in cases of complex abdominal distension, the provider may elect to insert the tube to ensure optimal placement and immediate management of the patient’s critical status. They are also responsible for assessing contraindications, such as compromised rectal wall integrity or systemic anticoagulation, which increase the risk of complications.
Boundaries of Practice and Required Training
Rectal tube insertion is consistently excluded from the scope of practice for Unlicensed Assistive Personnel (UAPs), which includes Certified Nursing Assistants (CNAs) and Medical Assistants (MAs). This exclusion exists because the procedure is invasive, carries inherent risks, and requires clinical judgment that is only developed through formal medical or nursing education. For instance, a CNA may assist a nurse by gathering supplies or providing patient support during the procedure, but they are not permitted to perform the actual insertion.
The insertion process demands a comprehensive understanding of contraindications, the ability to perform a digital rectal exam for impaction, and knowledge of sterile technique to prevent infection. These skills require formal medical licensure and specific, documented training beyond the scope of basic patient care. State boards of nursing and facility policies strictly define these boundaries to maintain patient safety and ensure accountability, making the procedure a licensed nursing or medical function.