Clinical protocol

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4.1 The Registered Nurses should consider the following points prior to performing bowel care, especially if the patient is not known to them. The following is not a comprehensive list a) Check for allergies specifically latex and lignocaine. The allergy must be recorded. Use non latex gloves and do not use lignocaine if there is a known allergy.

Kent Community Health NHS Foundation Trust Protocol for manual removal of faeces (acute) In adults over the age of 18 years V Page of July 2016 b) Some patients may have had experience of physical/sexual abuse and this area of nursing care maybe inappropriate or extremely difficult.
4.1.1 Absolute contraindications (rectal intervention should not be performed) a) Severe/acute inflammatory bowel disease. c) Rectal or colonic surgical anastomosis in the last 6 months. (Unless written agreement by consultant. d) Severe cognitive impairment (unless carer available to supervise/administer). Follow Mental Capacity Act Policy.
4.1.2 Additional Supervision and monitoring. Some patients may require additional supervision or monitoring when rectal intervention is being performed. To ensure the intervention is not causing any unwanted side effects and that it is acceptable to the patient. a) Spinal cord injury at Tor above, monitor for autonomic dysreflexia. Stop any procedure in spinal cord patients who are having an autonomic dysreflexic attack flushing, high blood pressure, flushing above the level of spinal lesion. Administer their prescribed medication and they may improve if they sit upright. Seek medical attention if required. (See appendix) b) Anorectal conditions that could cause pain or bleeding during the procedure (e.g. third degree haemorrhoids, anal fissure.
4.1.3 Relative contraindications. (Only use after careful discussion with relevant medical practitioner. a) Anal fissure. b) Large haemorrhoids that bleed easily. c) Past pelvic radiotherapy. d) Anal surgery within the last 6 months.

Clinical protocol
Executive summary
Governance arrangements
Related policies/procedures
Document tracking sheet
Contents page
Ethnicity and diversity
Roles and responsibilities
Training and awareness
Monitoring compliance and effectiveness of this policy
Monitoring matrix:
Equality analysis
Glossary and abbreviations
Appendix 2 bristol stool form scale
Knowledge and
Performance criteria
Appendix 3 care and management of autonomic dysreflexia
Common causes of autonomic dysreflexia.
Signs and symptoms
Specialist advice

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