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PROCEDURE FOR
Fecal Management System
PURPOSE: To provide for safe & effective fecal management for patients with little or no
bowel control and liquid stool
EQUIPMENT:
-
FMS Kit (contains catheter,
60 ml luer-lock syringe & 3 collection bags)
-
Gloves
-
Lubricant
-
45 ml of water or saline
NURSING ACTION:
PROCEDURE STEPS:
1.
Fill the syringe with 45 ml tap water or saline.
2.
Attach syringe to the inflation port.
3.
Securely snap the collection bag to the connector at the end of the
catheter.
4.
Position the patient to gain access to the rectum.
5.
Perform a digital exam to evaluate for fecal impaction.
KeyPoint:
The FMS is not indicated for solid or soft-formed stool; it will obstruct the
opening.
6.
Lubricate a gloved index finger and the retention balloon.
7.
Insert a gloved index finger into the retention balloon cuff finger
pocket.
8.
Gently insert the balloon end through the anal sphincter until the
balloon is beyond the external orifice and well inside the rectal vault.
9.
Inflate the balloon with 45ml of water or saline. The oval inflation
indication chamber on the inflation port will expand as fluid is injected.
KEYPOINT:
If the inflation indication chamber remains excessively expanded after the
plunger stops, the balloon is not properly inflating which is likely the result
of improper balloon positioning in the rectal vault. Use the syringe to
withdraw the fluid, reposition the balloon in the rectal vault and reinflate the
balloon.
10.
Remove the syringe from the inflation port, and gently pull on the soft
silicone catheter to check that the balloon is positioned against the rectal
floor. (You should be able to visualize the black indicator line.)
11.
Apply a tape label with the date of insertion and your initials.
12.
Position the length of the catheter to avoid kinks and obstruction.
13.
Hang the bag by the strap at a height lower than the patient.
14.
Change the collection bag only when full by snapping the cap onto each
used bag and dispose of per appropriate infection control standards.
15.
Small amounts of moisture or seepage around the catheter is anticipated.
KeyPoint:
To avoid skin irritation, keep the skin clean, dry and protected with a
moisture barrier ointment.
16.
Irrigation of the device:
a.
Fill syringe with tape water
b.
Attach syringe to irrigation port.
c.
Depress plunger.
d.
Repeat procedure if necessary.
REMOVAL of DEVICE:
KeyPoint:
If the patient’s bowel control, consistency and frequency of stool
begins to return to normal, discontinue the device. The FMS must be removed
prior to discharging patient from the facility.
1.
Attach the syringe to the inflation port
(45 ml).
2.
Slowly withdraw all water from the retention balloon. (Do not cut
catheter to remove).
3.
Grasp the catheter as close to the patient
as possible and slowly slide it out of the anus.
4.
Dispose of the device according to proper infection control standards.
5.
Notify a physician if any of the following occurs:
·
Persistent rectal pain
·
Rectal bleeding
·
Abdominal distention
Contraindications:
1.
Do not use on patients with history of:
·
Lower large bowel, rectal or anal
surgery within the past year.
·
Any rectal or anal injury
·
Severe rectal/anal stricture or
stenosis
·
Severe hemorrhoids
·
Confirmed rectal/anal tumor
·
Fecal Impaction
·
Inflammatory bowel disease
2.
Do not use on pediatric patients.
3.
Do not use more than 29 days.
REFERENCES:
Flexi-Seal Fecal Management
System: Directions For Use, Convatec, E.R. Squibb & Sons, L.L.C.
RESOURCE PERSON(S):
Dee Doctor, RN, MNSc, CWOCN
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