Manual removal of faeces by nursing staff for adult patients who have an established bowel management plan Musgrove Park Hospital is part of Taunton and Somerset NHS Foundation Trust Page 2 of 10 1.2 Nursing staff need to be aware that some people with established spinal cord lesions are dependent on manual evacuation as their routine method of bowel care. Evidence shows that failing to support such individuals can place them at risk of developing autonomic dysreflexia (Appendix C. This syndrome usually occurs in people with a spinal cord lesion above the level of the sixth thoracic vertebra. If left unresolved autonomic dysreflexia could have damaging outcomes such as cerebral haemorrhage, seizures and cardiac arrest (RCN 2006, 2008, NPSA 2004). 1.3 Nursing staff have felt uncomfortable undertaking this procedure fearing that the patient maybe at risk of physical harm and that they themselves could be accused of abuse. 1.4 These guidelines outline the indications for this procedure, who should undertake it and how training and competence should be assessed and recorded. It is compiled inline with RCN guidance (April 2008).