Definition
Proctoscopy is a medical procedure used to examine the rectum and anus. It involves the use of a proctoscope, a hollow tube with a light and lens, which allows doctors to inspect the lower part of the gastrointestinal tract. This procedure helps diagnose conditions such as hemorrhoids, rectal polyps, and sources of rectal bleeding.
Proctoscopy is also known as rigid sigmoidoscopy and differs from flexible sigmoidoscopy, which examines a larger portion of the colon. It is commonly performed in outpatient settings and does not usually require anesthesia.
Purposes for proctoscopy
To assess and evaluate for the following:
- Rectal bleeding.
- Hemorrhoids.
- Polyps, cysts.
- Blood or mucus in the stool.
- Unexplained anemia.
- Chronic constipation.
- Rectal/anal ulceration.
- Condition of anus/rectum before surgery.
Contraindications for proctoscopy
- Severe necrotizing enterocolitis.
- Toxic megacolon.
- Painful anal lesions.
- Severe cardiac dysrhythmias.
Articles for proctoscopy
- Proctoscope with an obturator.
- Drapes and clean gloves.
- 1-2% lidocaine (Xylocaine) gel.
- Specimen container with 10% formalin, if biopsy is to be performed.
- Cytology slides and jar with 95% ethyl alcohol (ethanol).
- Sterile swabs with culture tubes if cultures are to be obtained.
- Lubricant and cotton swabs.
- Emesis basin and toilet tissue.
- Biopsy forceps.
- Receptacle for waste.
Preparation of the Patient for proctoscopy
Preparing a patient and assisting with a proctoscopy procedure involves several important steps to ensure safety and effectiveness.
- Dietary Restrictions:
- Patients may be advised to follow a clear liquid diet before the procedure.
- Avoid solid foods and dairy products if instructed by the healthcare provider.
- Bowel Preparation:
- A laxative or enema may be prescribed to cleanse the rectum for better visualization.
- Patients should follow the bowel preparation instructions carefully.
- Medication Adjustments:
- Inform the healthcare provider about any medications being taken, especially blood thinners, as adjustments may be necessary.
- Clothing and Accessories:
- Wear loose, comfortable clothing and remove any jewelry or metallic items.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions, and obtain informed consent.
Procedure
| Nursing action | Rationale | |
| Before procedure | ||
| 1. | Explain to the patient the test purpose, procedure, benefits, and risks. | Helps improve patient’s understanding of the procedure. |
| 2. | Obtain a signed, witnessed informed consent if required. | Consent is required for biopsy and cytology studies. |
| 3. | Inform the patient that there is no need to fast; however, a restricted diet, such as clear liquids in the evening before the test may be prescribed. | Helps minimize fecal content in lower GI tract. |
| 4. | Remind the patient that laxatives and enemas may be given the night before examination. Enemas and/or rectal laxative suppository may be administered in the morning of the procedure. | Cleanses lower bowel and rectum off fecal matter. |
| During procedure | ||
| 5. | Wash hands. | Prevents transmission of infection. |
| 6. | Assemble articles. | Ensures all articles are ready for use. |
| 7. | Explain to the patient what will be done and how he may cooperate. | Decreases client’s anxiety related to the procedure. |
| 8. | Instruct patient to undress and don hospital gown. Drape using a bed sheet. | Prepares patient physically for the procedure. |
| 9. | Screen the bed or close the room-door as appropriate. | Provides privacy. |
| 10. | Position the client in knee chest position. If client is aged, weak or ill, Sims’ position is advised. | Allows sigmoid colon to be straightened. |
| 11. | Assist or secure assistance in helping client maintain position. | Allows procedure to be done without interruption. |
| 12. | Don gloves. | |
| 13. | Continue to give explanation to client as the procedure progresses. | Provides information to client and helps him relax. |
| 14. | Apply lubricant to gloved finger. | Protects fragile mucosa from injury. |
| 15. | Insert lubricated finger in rectum to check for possible obstruction prior to insertion of proctoscope. | Prevents possible injury to bowel mucosa from blind entry. |
| 16. | Lubricate end of proctoscope (physician gently inserts endoscope into anal canal as required. If cramping occurs, client may require more medication or temporary pause in the forward movement of scope). | Facilitates entry of proctoscope into anal canal. Facilitates slow access to colon and allows visualization of mucosa. |
| 17. | Advice patient to breathe through mouth when scope is inserted. | Reduces discomfort during insertion of scope. |
| 18. | Slowly remove endoscope at completion of examination. | Prevents injury to mucosa. |
| After procedure | ||
| 19. | Place endoscope in appropriate container with cleansing solution. | Aids in disinfection of instrument. |
| 20. | Remove soiled gloves and place in appropriate receptacle. | Practices infection control standard. |
| 21. | Wash hands. | Prevents spread of microorganisms. |
| 22. | Send specimen to laboratory immediately. | |
| 23. | Ask client to lie flat for 10-15 minutes. | Allows for observation as the patient recovers. |
| 24. | Monitor for signs of fatigue, abdominal pain or distention, fever, hypertension, or rectal bleeding. | Bloody stools are normal for 1-2 days following rectal biopsy. |
Complication
- Rectal perforation.
- Persistent abdominal discomfort.
- Rectal bleeding.
- Fever.
Special considerations
- If biopsy specimens are taken, the site may be anesthetized first with 1-2% lidocaine.
- No enema or barium studies should be performed for 1 week following rectal biopsy as there is increased risk of perforation.
- Confirm the patient has followed pre-procedure instructions, such as bowel preparation.
- Address any anxiety by explaining the procedure clearly and reassuring the patient.
- Observe the patient for signs of discomfort or complications, such as bleeding or pain.
- Ensure the patient remains in the correct position for optimal visualization.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure the proctoscope and accessories are properly prepared and functioning.
- Monitor the patient for delayed complications, such as rectal discomfort or bleeding.
- Provide clear instructions for recovery, including dietary recommendations and follow-up care.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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