RECTAL WASH OUT

Erick Corputty
 Introduction
• Rectal washouts are performed to decompress
the lower intestine and deflate the abdomen
by removing gas and stool using small
amounts of Sodium Chloride 0.9% (normal
saline).
 Indication
• Performed in babies and children to relieve low intestinal
obstruction, e.g. suspected Hirschsprung disease (HD),
meconium plug disease, meconium ileus or intestinal
dysmotility.
• Used as a mode of temporary management in proven cases
of Hirschsprungs Disease until definitive surgery is
performed (for 4-12 weeks depending on each case).
• Used in the management of patients admitted with
enterocolitis.
• Used preoperatively in patients undergoing closure of
stoma procedures.
• May be used in the management of constipation in children
 Equipment

• Nelaton catheter
– Orders should include specific size, and length of
catheter to be inserted
Weight Size Length to be inserted
Weight <2kg Size 8FG Nelaton 2-3cm
Weight 2-6kg Size 10FG Nelaton 5cm
Weight >6kg Size 12FG Nelaton 5cm

Rectal tube (Nelaton catheters 16Fg, 18Fg, 22Fg, 25Fg) for rectal washout as
per medication chart.
• 60mL catheter tip syringe
• Sodium Chloride 0.9% sachets
– Ensure Sodium Chloride 0.9% sachets are warmed prior to
use (warm to touch- Do Not use the
microwave). Neonates, especially premature neonates
may cool quite rapidly if the solution is cold. The volume
of saline to be used is determined by the surgeons and
should be written as an order.
• Lubricant
– Use only water based lubricant.
• Gloves/incontinence sheets
– Use incontinence sheets to protect soiling of the bed.
 Procedure
• Position neonate, usually on his/her back with legs in the
frog position
• Position older child on their left side
• Swaddling of arms, comfort and play therapy techniques
can be used
• Select appropriately sized catheter for use
• Warm 0.9% Sodium Chloride sachets (in a jug of warm tap
water) and prime catheter with solution
• Lubricate tip of catheter and gently insert into the rectum
• Length to be determined by surgical instructions
• Instil 0.9% Sodium Chloride solution in 10 - 20 ml aliquots
(by pushing in with syringe plunger) over 1-2 minutes
(there should be no resistance when injecting the normal
saline)
• Remove syringe and let fluid run into nappy/kidney dish. Procedure
may be repeated twice if return is not clear
• If there is 0.9% Sodium Chloride retention or return is not clear
contact surgeon
• Remove catheter from the rectum and leave the patient clean and
dry
• Note and record results of rectal washout accurately on fluid
balance chart and in progress notes
• Sucrose may be administered prior to and throughout the
procedure as required
• Do not use excessive force if resistance is felt. Contact medical staff
if unsure
• Do not pull back on syringe to aspirate, allow the saline to run out
naturally. Sometimes manipulating the catheter in and out a few
centimetres gently and massaging the abdomen may encourage
fluid returns to be expelled
Do not exceed maximum of 20ml/kg or total of 250mL, Use only
Sodium Chloride 0.9% solution
 Documentation
• Observe and document
– Note any reduction in abdominal distension
– Amount of decompression
• Washout result
– Volume, colour, consistency and type of
substance; e.g. stool/meconium/instilled fluid
 Complication
• There is a risk of reabsorption of saline, especially
if most of the solution is not expelled. In the case
of retention of instilled solution
– contact the surgical/neonatal team
– record volume of saline retained
– consider taking blood to check electrolytes, if clinical
situation is appropriate
• Bowel perforation
• Nausea and vomiting
• Abdominal discomfort
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