A flatus tube, also known as a rectal tube, is a soft, flexible catheter inserted into the rectum to relieve abdominal distension caused by trapped gas. It’s a conservative, non-surgical method often used in cases like sigmoid volvulus, postoperative ileus, or severe constipation, especially in elderly or high-risk patients.
Definition
Introducing the tube into the rectum for expulsion of gas.
Purposes
- To remove flatulence from the lower bowel.
- To relieve abdominal distension.
Indications
- Relief of flatulence and gaseous distension of the lower bowel
- Colonic decompression in sigmoid volvulus or pseudo-obstruction
- Preoperative rectal clearing before enemas or surgery
- Management of fecal incontinence or impaction when enemas fail
Articles
Preparation of Equipment
- Screen.
- A clean tray containing:
- Rectal tube of correct size; adult: 22-26 Fr.
- Kidney tray with water.
- Water-soluble lubricant.
- Wet swab in a container.
- Mackintosh or underpad.
- Long artery forceps.
- Glass connector.
- Adhesive tape.
- Gloves.
Tube Sizes
| Patient Group | French Size (Fr) |
|---|---|
| Neonates and Infants | 12–14 Fr |
| Children | 14–18 Fr |
| Adults | 22–30 Fr |
| Elderly or Debilitated Adults | 20–24 Fr |
Select the smallest effective size to minimize mucosal trauma
Procedure
| Nursing actions | Rationale | |
| 1. | Explain the procedure to the patient. | Enhances cooperation and allays fear. |
| 2. | Assemble all the equipment near bedside. | To organize nursing activity. |
| 3. | Wash hands. | To prevent cross-infection. |
| 4. | Provide privacy. | Reduces embarrassment. |
| 5. | Roll the draw sheet to one side and spread the underpad. | To prevent soiling of the bed. |
| 6. | Position the patient in left lateral with right knee flexed. | To promote clear visualization of the rectum. |
| 7. | Cover the patient with bath blanket or top sheet exposing the rectum. | To reduce embarrassment. |
| 8. | Wear gloves. | To prevent contamination. |
| 9. | Clean the anal area using wet cotton swabs. | Prevents infection. |
| 10. | Lubricate the flatus tube about 15 cm and insert it about 12 cm into the anus. | Avoids friction and facilitates easy insertion. |
| 11. | Connect the free end of flatus tube to extra tubing by the glass connector and keep it under water in the kidney tray placed between the thighs. | Escape of bubbles in the water indicates passage of flatus. |
| 12. | Keep a big piece of cotton over the distal end of the tubing. | To act as a weight. |
| 13. | Watch for expulsion and remove it after 10-20 minutes. | Patient will feel uneasy if tubing is kept for longer time. |
| 14. | Clean the anus with the cotton swab. | To maintain cleanliness. |
| 15. | Reposition the patient comfortably. | To promote comfort. |
| 16. | Replace the articles. | For next use. |
| 17. | Wash hands. | To prevent cross-infection. |
| 18. | Document the procedure done. | Serves as a legal document. |
Aftercare
- Remove the tube gently and inspect for trauma or bleeding
- Clean the perianal area with wet swabs and re-position the patient comfortably
- Dispose of single-use materials per infection-control protocol
- Document date, time, tube size, duration, patient tolerance, volume of gas discharged, and any complications
Precautions & Complications
- Never force the tube against resistance—do not attempt if acute pain occurs
- Watch for rectal bleeding, mucosal tears, or signs of perforation (severe pain, crepitus)
- Limit duration to prevent pressure ulcers of the anal mucosa or sphincter injury
- Maintain aseptic technique to minimize infection risk
Do’s and Don’ts
Do
- Verify orders and patient consent
- Use gentle, rotatory insertion technique
- Secure the tube to prevent migration
- Monitor patient vitals and comfort throughout
- Record findings and any adverse events
Don’t
- Force insertion past resistance
- Leave the tube in situ longer than recommended
- Use oil-based lubricants that can irritate mucosa
- Neglect inspection for bleeding or signs of infection
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
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