Colonic irrigation in pediatrics—also known as rectal irrigation—is a therapeutic procedure used to cleanse the colon by introducing fluid through the rectum. It’s most commonly indicated in children with Hirschsprung disease, chronic constipation, or enterocolitis, especially when there’s a risk of stool stasis and bacterial overgrowth.
Indications/Purposes
- To remove toxins and parasites
- Before colonoscopy
- Prior to a surgical procedure
- Enterocolitis
- To prevent stasis of stool in the colon
Complications
- Rectal perforations
- Transmission of communicable diseases if tube is not sterilized properly
- Dehydration and electrolyte imbalance
Equipment Needed
A clean tray containing:
- Silicone catheter: 16 Fr for children <1 year, and 24 Fr for children >1 year
- 60 mL catheter tipped syringe
- Petroleum-based lubricant
- Gauze pieces in a small bowl to apply lubricant
- Plastic apron, pair of gloves Mackintosh and towel
- Gown for the patient
- Tissue paper/towels to wipe the anal region after the procedure
- Kidney tray
- Container to discard the return solution
- NS/prescribed solution
Preparation
- Explain the procedure to parents and child as appropriate.
- Review the order for colonic irrigation.
- Assemble the required articles near the working area.
- Provide privacy.
- Remove the clothing below the waist.
- Place the child on the procedure table.
- Provide left lateral position.
- Spread the mackintosh and towel under the waist.
Procedure
- Perform hand hygiene.
- Wear apron and gloves.
- Pour NS solution into the basin or kidney tray.
- Using 60 mL catheter tip syringe, draw 20 mL NS.
- Gently insert the appropriate-size lubricated catheter into the rectum approximately 6 inches.
- Place the catheter tip syringe into the end of the silicone catheter and inject 20 mL NS into the rectum.
- Disconnect syringe from the catheter, allow NS to drip into the container.
- Observe for the return content.
- Continue the procedure till the return fluid is clear or the prescribed amount of solution is completed.
Post procedure Care
- Remove the catheter gently from the rectum and discard it in the kidney tray.
- Wipe the area. Assist the child in wearing clothes.
- Document the procedure in nurse’s record with date, time, type and amount of solution used. Observation made during the procedure.
General Instructions
- The temperature of the solution should be ideal to body temperature (94-100°F).
- Inject 10-20 mL of solution at a time.
- Massage the lower abdomen during the procedure.
- Encourage the child to relax during the procedure.
- Ensure that same amount of fluid is returned, which is injected into the colon.
- Ensure that the size of the catheter should be larger enough to allow passing of stool through the catheter.
- Observe the content of return fluid:
- Undigested foods indicate improper chewing.
- Strings indicate tapeworm.
- Yellow color: toxins.
- White color: Candida albicans.
Special Considerations
- Avoid in cases of rectal perforation, active bleeding, or severe dehydration.
- Monitor for fluid retention, cramping, or electrolyte imbalance.
- Ensure equal return volume to what was instilled.
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 Kluwer’s, ISBN-13:978-9388313285
- Marcia London, Ruth Bindler, Principles of Paediatric Nursing: Caring for Children, 8th Edition, 2023, Pearson Publications, ISBN-13: 9780136859840
- 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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