Bedbound patients with incontinence of loose stools have the potential to develop impairment of skin integrity and/or alteration in comfort. Assessment of the underlying cause for this incontinence is important. As medical evaluation and treatment modalities are being pursued for this problem, the nurse is presented with the challenge of protecting the patient's perineal/buttock skin surfaces.
Currently, products used for fecal incontinence include protective ointments, diapers/protective pants, perineal pouches, rectal tubes/Foley and Mushroom-tipped catheters. Another intervention that has been effective for stool containment is the use of a nasopharyngeal airway.
Over the last 5 years, this technique has been used with hundreds of patients at Yale New Haven Hospital, averaging 30 per day. The literature reports that leaving tubes in place for longer than 20 minutes decreases the rectal sphincters' responsiveness; however, in our experience no ill effects have been noted after the removal of the airway.
The protocol used is as follows: equipment/supplies used include: nasopharyngeal airway, urinary drainage collection system, water-soluble lubricant, unsterile gloves, underpad, and barrier system.
The procedure is outlined as follows:
1. If possible, explain to patient reasons for tube insertion and sensation to be experienced with tube insertion.
2. Position patient on side;
3. Lubricate trumpet portion of the airway with a water soluble lubricant;
4. Insert airway into rectum, pass external and internal sphincters;
5. Connect airway tubing to straight drainage system;
6. Stabilize drainage tubing on bed surface with bed-bound patient;
7. For patients able to get out of bed, a disposable brief can help maintain airway position; create an opening for tubing in brief's perineal section;
8. Airway is to be changed every 2 days; wait approximately 1 hour before reinsertion;
9. Barrier system should be used to protect skin.
The system should not be used in the following clinical situations: leukopenic precautions, perirectal abscess, and gastrointestinal bleeding. It is a short-term method.
Barbara Watterworth, BSN, RN, CETN
Jayne Ryzeuski, MSN, RN
New Haven, CT
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