NursePROTIPS: LEAK-FREE FLEXI SEAL (RECTAL TUBE)
Don’t you hate it when you go to reposition your total care patient and you discover that the rectal tube has done nothing but leak since the last clean-up? It happens from time to time, and sometimes can’t be helped. You just can’t will someone to have improved rectal tone. But you can eliminate most of your leak-related issues with a few common-sense steps.
If the inflatable ring isn’t up against the rectal wall, then stool can leak around it. This is why we give a very gentle tug after insertion.
Check the donut. Ensure the proper amount of water is inflating the retention balloon that holds the tube in place. Refer to the manufacturer's instructions and hospital policy. Seems simple, but is often overlooked.
Check the seal. Give a GENTLE, OH-SO-GENTLE tug to the Flexi to ensure the retention balloon is against the inside of the rectum, minimizing stool that is able to leak around it. Always communicate with your patient before tugging things attached to their body, for the record.
Be attentive. Periodically ensure that there are no twists, turns, or kinks in the tubing from patient to bag. The more your patient squirms around, the more often you should check the line. You want it to be like a waterslide, with a smooth, unobstructed path, as much as possible.
Avoid obstructions. Don’t position your patient flat on their back. Keep them slightly lateral lying so as not to have gravity and their body weight crush the tubing, kinking off the flow. Left lateral is best, to follow the path of the colon, but as long as they’re on their side, the stool can pass without too much resistance in the tubing.
5. Position properly. When you help them lay laterally, place pillows behind your patient, leaving pillowless space near the patient’s sacrum, using it as a channel off the side of the bed, behind the patient. The tubing should take the path of a tail, not crossing over the patient’s legs/feet, pillows, etc. When the bag is on the same side of the bed as the patient is facing, there is no clear path except under and over legs, causing an upward climb for the stool. This can also cause backflow - which is bad news. Use gravity to your advantage wherever possible.
6. Hang it right. Don’t allow the tubing to be pulled taut or piled up. Hang it on the bed frame hooks so that it has slack, but does not fold over on itself or coil up. If the bed frame has no spot to hang the bag, place the bag in a plastic basin or another receptacle, per your institution’s policy. Just keep it from lying directly on the floor.
7. Strip it, strip it good. Strip the tubing periodically. If the stool is thick or pasty, stripping the tubing between gloved fingers keeps things moving forward and prevents back-up in the tubing.
8. Use a barrier. A moisture-barrier cream (per your facility’s policy) will help protect your patient’s peri-anal area from breakdown related to stool leakage. Be sure you know how to use the cream properly, as some creams are not meant to be perfectly cleaned off each time.
These all seem like common sense in the nursing community, but I’m always amazed when I walk into a patient’s room and I see that the rectal tubing looks like a corkscrew while the nurse or CNA complains about all the leaks in the bed. Basics, folks. Don’t overlook the basics. Paying attention to the details throughout your shift can save you some big, time-consuming bed changes and impromptu bed baths from leaky fecal collection tubes.
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