Definition
Colonic lavage, also known as colonic irrigation/bowel wash is a procedure that uses water to cleanse the colon or large intestine.
Purposes
- To prepare colon for specific surgical or diagnostic procedures.
- To dilute and remove toxic agents that may be present in large intestine, e.g., reduction of ammonia absorption from GI tract in patients with hepatic encephalopathy.
- To reduce temperature in hyperpyrexia and heat stroke.
- To supply fluid and electrolytes those are absorbed from intestines.
- To stimulate peristalsis.
- To relieve inflammation.
- To keep the individual clean in case of fecal incontinence.
Contraindications
- Chronic diarrhea.
- Rectal surgeries and infection.
- Intestinal obstruction.
- Rectal polyps.
- Massive colon carcinoma.
- Loose anal sphincter.
- Debilitation.
- Anal fistula.
- Intestinal diverticulum.
- Painful skin lesions around anus.
- Bleeding hemorrhoids.
Solutions Used
- Plain water.
- Cold water.
- Normal saline.
- Sodium carbonate solution 1-2%.
- Antiseptic solution such as silver nitrate (1:5,000).
- Potassium permanganate (1:5,000).
- Thymol (1:100).
- Alum (1:100).
- Boric solution (1-2%).
- Tannic acid (1:100).
Number of solutions used: 2-3 Lor till the return flow is clear.
Temperature of the Solution
- For cleansing purpose 104°F.
- For reducing temperature 80-90°F.
Articles
A tray containing:
- Colonic lavage set with tubing and glass connection
- Rectal tube:
- Adult: 22-30 Fr.
- Children: 12-18 Fr.
- Vaseline.
- Rag pieces/tissue papers.
- Mackintosh.
- Jugs with hot and cold water.
- Kidney tray.
- Bucket.
- Solutions.
- Lotion thermometer.
- Bedpan with lid.
- Duster.
- Perineal toilet tray.
- Clean disposable gloves.
- Plastic apron.
Procedure
| Nursing Actions | Rationale | |
| 1. | Before procedure Check the patient’s chart for physician’s order and any specific instructions. | |
| 2. | Explain to the patient about the procedure and how he has to cooperate. | Encourages cooperation of patient and reduces anxiety. |
| 3. | During procedure Wash hands and don gloves. | Prevents cross infection. |
| 4. | Prepare solution at the required temperature. Test the temperature on the inner aspect of the wrist. | Ensures that it will not cause discomfort to the patient. |
| 5. | Attach the tubing and the rectal tube with the funnel. Pour the solution in it and check for leakage. | Ensures that the articles to be used are in good working condition. |
| 6. | Lubricate the tip of rectal tube about 4 inches. | For easy insertion of the tube and to prevent friction. |
| 7. | Fill the funnel with the solution and expel air from the tubing by allowing a small amount of fluid to run into the kidney tray. Pinch the tube or close it with a clamp. | Expelling air from the funnel and tubing prevents air from entering into the colon. |
| 8. | Maintain left lateral position and bring the patient close to the edge of the bed. Separate the patient’s buttocks to visualize the anus clearly and insert the tip of tube about 4 inches while the patient exhales a deep breath. | The rectum is relaxed when the patient breathes out and makes the insertion of the tube easier. |
| 9. | Lower the funnel below the level of the rectum. | Allows flatus, if any, to escape from the rectum. It will be seen bubbling through the fluid in the funnel. |
| 10. | Raise the funnel and allow the fluid to run in and continue to pour more fluid into funnel before the funnel is empty. | Pouring the solution before the funnel is empty prevents entry of air into rectum. |
| 11. | When 200-300 mL of fluid has gone inside, pinch the tube before the funnel is completely empty and invert it into the bucket and siphon off the fluid. | The fluid which has gone in should be drained out before introducing more fluid. |
| 12. | When the return flow ceases, turn the funnel upright and pour more Ca solution, lower the funnel until air from the tube has been expelled. Then raise the funnel and repeat the procedure. | Care is taken to expel air from the tubing as well as from the rectum. |
| 13. | Temporarily stop the procedure if the patient develops any discomfort. | Entry of fluid into the rectum stimulates peristalsis, stopping the procedure for few moments will relax the bowels as the peristaltic movement is passed off. |
| 14. | Continue the procedure until all the fluid ordered has been given or until the return flow is clear. | It helps to know if the entire bowel is cleansed well. |
| 15. | After procedure Gently remove the rectal tube by pulling it through 3-4 layers of rag pieces/tissue papers. | Pulling through the rag pieces removes the feces on the tube. |
| 16. | Discard the tissue papers in the paper bag. Place the funnel with tubing in the kidney tray. | Avoids contamination of the articles and environment with the soiled articles. |
| 17. | Assist patient to the toilet, commode or bedpan. | Drains out any fluid left in the rectum. |
| 18. | Bring the toilet tray and assist for the perineal care if required. | Maintains hygiene of the perineum. |
| 19. | Change the bed linen if soiled and assist the patient to lie down in comfortable position. | Promotes neat appearance of the bed and comfort of the patient. |
| 20. | Take all the articles to utility room. Disinfect the funnel, tubing, catheter, and bucket. Clean dry and replace them in their proper place. | Helps in preparing for next use. |
| 21. | Remove gloves and wash hands. | Prevents cross infection. |
| 22. | Record the type of procedure and the result with date and time in nurse’s record. | Gives information about patient’s response to the procedure. |
Special Consideration
Colonic irrigation may be given using a Y – connector and rectal tube.
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/
Stories are the threads that bind us; through them, we understand each other, grow, and heal.
JOHN NOORD
Connect with “Nurses Lab Editorial Team”
I hope you found this information helpful. Do you have any questions or comments? Kindly write in comments section. Subscribe the Blog with your email so you can stay updated on upcoming events and the latest articles.
