A roundtable for New Nurses, Student Nurses, Veteran Nurses, and everyone in between.
(A sister site to The All Nighter)
(Or: “How To Make your Shift Less Shitty”)
Ahh, the smell of fresh clostridium difficile in the morning. Contact precautions with no hand gel allowed, needing a new chux every five minutes, and being elbow deep in poop… I think the only thing worse than having a patient with c.diff is probably being a patient with c.diff. Before Fecal Management Systems (FMS) like the Flexi-Seal rectal tube, having c.diff or any other form of incontinent liquid stool more than likely meant that you’d be sitting in it for most of the day. As a nursing student, I didn’t really find that an FMS could make much of a difference. In fact, the other day was the first time I actually saw a FMS that was not constantly leaking all over the place. After taking report on a patient whose diarrhea had been unmanageable throughout the previous shift despite his Flexi-Seal and the nurse’s best efforts, I was speaking to one of my mentors on the staff and expressed my opinion of FMS’s as a big waste of time, money, and hope. She brought me to the patient’s bedside, taught me the following, and changed my views on Flexi-Seals forever. Using her advice, I was able to keep the patient and his bed clean and dry for the entirety of my shift! Though these are anything but secrets, and are in fact the manufacturer’s recommendations, not many nurses know about or do them. Maybe next time you hear a fellow nurse complaining about FMS’s as I did, you can teach them a thing or two and do The Night Nurse proud.
The patient requiring a FMS is the same patient at extremely high risk for skin breakdown. Good old fashioned turning and positioning from left to right should be done constantly throughout your shift—the key and the challenge to incorporating a FMS into this regimen is that in order for the device to work, it must be unobstructed from where it exits the body to where it enters the collection bag. The easiest way to do this is to place support pillows at the patient’s side and between his legs to provide a clear path for the tube, and hang the collection bag on the side of the bed that the patient is facing.
Milk the rectal tube frequently to prevent backup—at minimum, this should be done every time the patient is repositioned. If the tube is obstructed by dried or thick stool, it can be irrigated as per the manufacturer’s instructions.
If these steps have been taken with no success, there is a good chance that the balloon is improperly inflated. The Flexi-Seal balloon is intended for inflation with 45cc of WATER. If it is filled with air, it may deflate over time. If it is underinflated, liquid stool may leak around it. Filling the balloon to its maximum may not be appropriate for patients of all sizes. Think about it—too large an object in the rectum would send anyone’s bowels into hypermotile-mode. To find out if an improperly inflated balloon is the source of your FMS woes, take a large syringe and aspirate its contents. If it is filled with air, fill it with water. If it is filled with less than 45cc, try filling it to capacity. If it filled with 45cc, try removing 5cc and reevaluating for leaks.