Fecal Impaction Removal

  Because of the potential to stimulate the sacral branch

   1. of the vagus nerve, patients with a history of dysrhythmia or heart disease have a greater risk of changes in heart rhythm. Be sure to monitor the patient's pulse before and during the procedure. This procedure may be contraindicated in patients with cardiac disease; if in doubt, verify with the physician.
   2. Assess patient's bowel history, vital signs, bowel sounds, and abdominal distention.
   3. Determine whether physician's order to remove stool manually exists.
   4. Perform hand hygiene, and apply gloves.
   5. Help patient change position, if needed. Raise bed horizontally to working height.
   6. With far side rail raised, assist patient to left side-lying position with knees flexed.
   7. Provide privacy. With near side rail lowered, drape patient's trunk and lower extremities with bath blanket. Place a waterproof pad under patient's buttocks. Place bedpan next to patient.
   8. Don disposable gloves. Lubricate gloved index and middle fingers of dominant hand with anesthetic lubricant.
   9. Have patient take slow deep breaths. Slowly and gently insert index finger (feel anus relax), insert middle finger, and then advance fingers along rectal wall toward umbilicus.
  10. Move fingers in scissors motion to fragment fecal mass. Work fingers into hardened mass. Work stool toward end of rectum. Remove sections of feces; discard into bedpan.
  11. Periodically assess heart rate, and observe patient for signs of fatigue.
  12. Continue to clear rectum of feces, and allow patient to rest at intervals.
  13. After impaction removal, offer patient washcloth and towel for cleansing buttocks and anal area.
  14. Remove bedpan, and inspect feces for color and consistency. Dispose of feces. Remove gloves by turning inside out, and discard them in proper receptacle.
  15. Help patient to toilet or clean bedpan. (Administer enema or cathartic, if ordered.)
  16. Perform hand hygiene.
  17. Continue to monitor patient's vital signs for 1 hour to detect bradycardia.
  18. Assess bowel sounds. Palpate abdomen to determine whether it is soft and nontender.