Author Wendy Ness is colorectal nurse specialist at Croydon University Hospital. Abstract



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Assessment and legal
considerations
DRF is an invasive procedure and should only be performed when necessary, after In this article...
Indications for digital removal of faeces
Risks associated with DRF and autonomic dysreflexia
Other bowel-emptying techniques
Although only a small number of patients require DRF, it is an essential part of their care and all NHS organisations must have a policy for manual bowel evacuation
Digital removal of faeces
Box 1.
CIRCumSTANCeS
NeCeSSITATINg DRF

When other methods of bowel emptying fail or are inappropriate

Faecal impaction or loading

Incomplete defecation

Inability to defecate

Neurogenic bowel dysfunction

Bowel management with specific patients following spinal cord injury
Source: Royal College of Nursing (individual assessment and taking religious and cultural beliefs into consideration
(RCN, 2012). Before initiating any bowel- emptying technique, health professionals must explain to their patients what the intervention involves, including expected outcomes, side-effects and complications
(Foxley, 2009). Valid consent must be obtained this reflects patients right to determine what happens to their own body and is a fundamental part of good practice. Health professionals who do not respect this principle maybe liable for legal action by the patient and by their professional body (Department of Health, 2009). When performing DRF as an acute intervention or part of a regular package of care it is important to carryout an individ- ualised risk assessment. The following should be checked:
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Blood pressure inpatients with an SCI who are at risk of autonomic dysreflexia AD, before and at the end of the procedure (Box 3) – a baseline blood pressure is advised for comparison. Inpatients for whom SCI is a routine intervention and tolerance is well established, the routine recording of blood pressure is not necessary;
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Signs of distress, pain, discomfort In association with


Who can carryout drf?
When drf is essential



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