Don’t you hate it when you go to reposition your total care patient and you discover that the rectal tube has done nothing but leak since the last clean-up? It happens from time to time, and sometimes can’t be helped. You just can’t will someone to have better rectal tone. But you can eliminate most of your leak-related issues with a few common sense steps.
- Ensure the proper amount of water is inflating the retention balloon that holds the tube in place. Refer to the manufacturer’s instructions and hospital policy. Seems simple, but is often overlooked.
- Give a GENTLE, OH-SO-GENTLE tug to the flexi to ensure the retention balloon is against the inside of the rectum, minimizing stool that is able to leak around it. Always communicate with your patient before tugging things attached to their body, for the record.
- Periodically ensure that there are no twists, turns or kinks in the tubing from patient to bag. The more your patient squirms around, the more often you should check the line. You want it to be like a waterslide, with a smooth, unobstructed path, as much as possible.
- Don’t position your patient flat on their back. Keep them slightly lateral lying so as not to have gravity and their body weight crush the tubing, kinking off the flow. Left lateral is best, to follow the path of the colon, but as long as they’re on their side, the stool can pass without too much resistance in the tubing.
- When you help them lay laterally, place pillows behind your patient, leaving pillowless space near the patient’s sacrum, using it as a channel off the side of the bed, behind the patient. The tubing should take the path of a tail, not crossing over the patient’s legs/feet, pillows, etc. When bag is on the same side of the bed as the patient is facing, there is no clear path except under and over legs, causing an upward climb for the stool. This can also cause back flow – which is bad news. Use gravity to your advantage wherever possible.
- Don’t allow the tubing to be pulled taut or piled up. Hang it on the bed frame hooks so that it has slack, but does not fold over on itself or coil up. If the bed frame has no spot to hang the bag, place the bag in a plastic basin or other receptacle, per your institution’s policy. Just keep it from lying directly on the floor.
- Strip the tubing periodically. If the stool is thick or pasty, stripping the tubing between gloved fingers keeps thing moving forward and prevents back-up in the tubing.
These all seem like common sense in the nursing community, but I’m always amazed when I walk into a patient’s room and i see that the rectal tubing looks like a corkscrew while the nurse or CNA complains about all the leaks in the bed. Basics, folks. Don’t overlook the basics. Paying attention to the details throughout your shift can save you some big, time-consuming bed changes and impromptu bed baths from leaky fecal collection tubes.