Definition
Providing perineal care also known as peri-care is a fundamental nursing procedure that involves cleansing the genital and anal areas to maintain hygiene, prevent infection, and promote comfort, especially in patients who are immobile, incontinent, postpartum, or post-surgical.
Purposes
- To cleanse the perineal skin.
- To reduce chances of infection of episiotomy wound.
- To stimulate circulation.
- To reduce body odor and improve self-image.
- To promote the feeling of well-being.
Equipment’s
A clean tray containing:
- Sterile antiseptic lotion-2% dettol or savlon.
- Sterile normal saline in a bottle.
- Cheatle forceps.
- Antiseptic or antibiotic medication, if ordered.
- Sterile sanitary pad.
- Kidney tray.
- Sterile gloves.
- Mackintosh.
Sterile pack or tray containing:
- Artery forceps-1.
- Dissecting forceps-1.
- Cotton balls.
- Gauze pieces.
- Sterile towel to wipe hands after surgical scrub.
Additional items:
- Infrared light.
- Bedpan (if procedure is done at bedside).
- Jug with warm water.
- Receptacle for used perineal pad.
- Face mask.
Procedure
| Nursing Action | Rationale | |
| 1. | Before procedure Explain the procedure to patient, the purpose, and how she has to cooperate. | Gains confidence and cooperation of the patient. |
| 2. | Assemble articles at the bedside or in the treatment room. | Saves time and effort. |
| 3. | Ask the patient to empty her bowel and bladder and wash the perineal area before coming for perineal care. | Ensures cleanliness and reduces number of organisms in the perineal area. |
| 4. | Screen the bed or close the doors as appropriate. | Provides privacy and reduces embarrassment. |
| 5. | Assist the patient to assume dorsal recumbent position with knees bend and drape the area using diamond draping method.For patients confined to bed: Place patient on bed pan, remove the perineal pad, place in the receptacle, and pour warm water over the perineum. | Dorsal position facilitates better viewing of the perineum. |
| 6. | Open sterile tray, arrange articles with cheatle forceps, and pour antiseptic solution in the sterile gallipot in tray. | For orderly use of articles. |
| 7. | Adjust the position of the infrared light so that it shines on the perineum at a distance of 45-50 cm. | Promotes clear view of perineum. |
| 8. | During procedure Scrub hands and dry with the sterile towel. | Reduces microorganisms. |
| 9. | Put on sterile gloves. | To handle sterile articles without contamination. |
| 10. | Take the cotton swabs with artery forceps, dip in savlon and squeeze excess lotion with dissecting forceps into the kidney tray. | Maintains asepsis. |
| 11. | With the swab clean from urethra toward anus. Clean the area from midline outward in the following order until clean and discard the swab after each stroke. Strokes are to be in the following order: Separate the vestibule with nondominant hand and clean vestibule starting from clitoris to fourchette. Inside of labia minora downward, farther side first then nearer side. Take off the nondominant hand. Labia majora downward farthest side and then nearer side. Discard the used forceps (if a second one is available). Using the second forceps clean the episiotomy wound from center outward and outside of episiotomy both sides. | Cleaning from more cleaner area to least clean area prevents contamination. |
| 12. | Wipe all traces of antiseptic away with sterile normal saline swabs in the same manner as described above using thumb forceps. | Avoids skin irritation. |
| 13. | Dry the episiotomy with gauze pieces. Do not use cotton balls for this purpose. | Cotton fibers are likely to get caught while drying if cotton balls are used. |
| 14. | Provide perineal light/infrared light for 10 minutes, if indicated. | Provides soothing effect from heat. |
| 15. | Put prescribed medication on a gauze piece and apply to the episiotomy. | Prevents entry of pathogenic organisms. |
| 16. | Place sanitary pad from front to back. Do not shift position of the pad once it is applied. | Avoids chances of contamination. |
| 17. | After procedure Discard gloves and used items in the kidney tray, wash forceps and tray, and keep ready for sterilization. | Reduces chances of contamination. |
| 18. | Replace other articles in designated places. | Keeps articles ready for next use. |
| 19. | Make the patient comfortable and leave the unit clean. | Completes the procedure. |
| 20. | Record procedure in the patient’s chart including details regarding status of lochia and condition of episiotomy wound. | Documentation helps for communication between staff members and provides evidence of care given and observations made. |
Special considerations
- If a sitz bath is prescribed, give it before perineal care.
- If patient has urinary catheter, provide catheter care along with perineal care.
- Studies have shown that healing takes place effectively even when patients practice perineal hygiene by themselves.
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
- Annamma Jacob, Manual of Midwifery and Gynaecological Nursing, 4th Edition, 2023, Jaypee Publishers, ISBN: 978-9356961593
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