Urinary and bowel elimination

1. By: Desalegn T. (BscN, Msc in AH)
Urinary and bowel elimination
for second year nursing students 2022
1 By: Desalegn T.

2. Objectives
2
At the end of this session you will be able
to:-
Define elimination
Define and classify enema care
Demonstrate properly enema care
Perform proper colostomy care
Demonstrate proper catheterization
By: Desalegn T.

3. Elimination
3
 Urinary and GI systems together provide for the elimination of body
wastes.
 Urinary system filters and excretes urine from the body, there by
maintaining fluid, electrolyte, and acid-base balance.
 Normal bowel function provides for the regular elimination of solid
wastes.
 During periods of stress and illness, clients experience alterations in
elimination patterns.
 Assess for changes, identify problems, and intervene to assist clients
with maintaining proper elimination patterns
By: Desalegn T.

4. Fecal Elimination
4
Defecation:- is the expulsion of feces from the anus and rectum.
It is normally initiated by two defecation reflexes.
1. As the peristaltic waves approach the anus, the internal anal
sphincter becomes inhibited from closing and if the external
sphincter is relaxed defecation occurs this is called the
intrinsic defecation reflex.
2. Second reflex called parasympathetic defecation reflex
When the nerve fibers in the rectum are stimulated ; signals are
transmitted to the spinal cord and then back to the descending and
sigmoid colon and the rectum
By: Desalegn T.

5. Cont’d
5
Normal defecation is facilitated by
Thigh flexion which increases the pressure within the abdomen.
Sitting position which increases the downward pressure on the
rectum.
 An adult usually forms 7 to 10 liters of flatus (gas) in the large
intestine every 24hours.
 Gases include carbon dioxide, methane, oxygen and nitrogen
some are swallowed with foods and fluids taken by mouth;
others are formed through the action of bacteria on the chime in
the large intestine and other gas diffuses from the blood into
the GIT.
By: Desalegn T.

6. Factors that affect defecation
6
 Age and development
Some control of defecation starts at 1½ to 2 years of age; nervous
and muscular systems are well developed to permit bowel control.
 Diet
Certain foods are difficult for some people to digest
Gas producing foods such as cabbage, onion, banana and apple.
Laxative producing foods such as chocolate and alcohol
Constipation producing food such as cheese, pasta, egg and lean
meat.
By: Desalegn T.

7. Cont’d
7
 Fluid: - healthy fecal elimination requires a daily fluid intake of 200
to 300ml.
 Activity:- stimulate peristaltic thus facilitating the movement of
chime along the colon.
 Psychological factors:- some people who are anxious experiences
increased peristaltic activity and subsequent diarrhea.
 Life style: - early bowl training may establish the habit of defecating
at regular time.
 Medication:- Repeated administration of morphine and codeine
cause constipation.
By: Desalegn T.

8. Cont’d
8
 Diagnostic procedure: - barium (used in radiological exam) presents
a further problem. It hardens if allowed remaining in the colon
producing constipation and sometimes an impaction.
 Anesthesia and surgery: - surgery that involves direct handling of
the intestine can cause temporary cessation of the movement.
 This condition is called paralytic ileus.
 Pathological condition:-spinal cord injuries and head injuries can
decrease the sensory stimulation for defecation.
 Irritants: - Spicy food, bacterial toxins and poisons can irritate the
intestinal tract and produce diarrhea and large amounts of flatus.
 Pain
By: Desalegn T.

9. 10
Enema
Introduction of fluid into rectum and sigmoid colon for
cleansing, therapeutic or diagnostic purposes.
Purpose:
 For emptying-Soap solution enema
 For diagnostic purpose- (Barium enema)
 For introducing drug/substance - (retention enema)
Solution used
 Normal saline
 Soap solution - soap 1gm in 20ml of H2O
 Epsom salt 15gm-120gm in 1000ml of H2O
By: Desalegn T.

10. Cont’d
11
Mechanisms of some solutions used in enema
Tap water:
Increase peristalsis by causing mechanical distension of the
colon
Soap solution:
Increases peristalsis due to irritating effect of soap to the
luminal mucosa of colon.
Epsom salt:
Causes flow of ECF(extra cellular fluid) to the lumen causing
mechanical distension resulting peristalsis
By: Desalegn T.

11. Cont’d
12
Classified into
- Cleansing(evacuation) - Return flow enema
- Carminative/relieving discomfort of gas/ - Retention
Cleansing enema
Kinds:
1. High enema
Is given to clean as much of the colon as possible
2. Low enema
Is administered to clean the rectum and sigmoid colon only
By: Desalegn T.

12. 13
Purpose of cleansing enema
 To stimulate peristalsis and remove feces or flatus
 To soften feces and lubricate the rectum and colon
 To clean the rectum and colon in preparation for an
examination. e.g. colonoscopy
 To remove feces prior to surgical procedure
 For incontinent patients to keep the colon empty
 For diagnostic test. E.g. before certain x-ray exam- barium
enema
 Before giving stool specimen for certain parasites
By: Desalegn T.

13. Cont’d
14
Guidelines
Enema for adults are usually given at 40-43OC and
children at 37 OC
Hot-cause injury to the bowel mucous
Cold- may trigger a spasm of the sphincter muscles
The amount of solution to be administered depends on:
Kind of enema
The age of the person and
The personal ability to retain the solution
By: Desalegn T.

14. Cont’d
15
Age Amount
 18months 50-200ml
 18mont-5yrs 200-300ml
 5-12 yrs 300-500ml
 12yrs and older 500-1000ml
 The rectal tube should be appropriate: is measured in French scale
Age Size
 Infants/small child------------10 -12fr
 Toddler --------------14 -16fr
 Scholl age child----------------16 -18fr
 Adult’s -------------------22-30fr
By: Desalegn T.

15. 16
Procedure
 Inform the patient about the procedure.
 Put bed side screen for privacy.
 Attach rubber tube with enema cane with nozzle and stop cock or
clamp.
 Place the patient in the lateral position with the right leg flexed
for adequate exposure of the anus (facilitate the flow of solution
by gravity in to the sigmoid and descending colon which are on
the side).
 Fill the enema can which 1000cc of solution for adults.
By: Desalegn T.

16. Cont’d
17
 Lubricate about 5cm of the rectal tube facilitate insertion
through the sphincter and minimize trauma.
 Hung the can at least 45cm from bed or 30cm from patient
on the stand.
 Place a piece of mackintosh under the bed
 Make the tube air free by releasing the clamp and allowing
the fluid to run down little to the bed pan and clamp open
prevents unnecessary distention.
 Lift the upper buttock to visualize the anus.
By: Desalegn T.

17. Cont’d
18
 Insert the tube
7-10cm in adult smoothly and slowly.
5-7.5 cm in the child.
2.5-3.75cm in an infant.
 Raise the solution container and open the clamp to allow
fluid to flow
 Administer the fluid solely, if client complains of fullness
or pain stop the flow for 30 second and restart the flow at
a slower rate
By: Desalegn T.

18. Cont’d
19
 Do not allow all the fluid to go as there is a possibility of air
entering the rectum or when the client cannot hold any
more and wants to defecate
 Remove bed pan clean the rectal tube.
 Document the procedure.
Note
 If resistance is encountered at internal sphincter, ask the
clients to take a deep breath then run a small amount of
solution (relaxes the internal anus sphincter)
By: Desalegn T.

19. 20
Retention enema
 Administration of solution to be retained in rectum for short
or long period
 Fluid usually medicine is retained in rectum for short or long
period- for local or general effects
E.g. oil retention enema, antispasmodic enema
Principles:
Is given slowly by means of a rectal tube
Amount of fluid is usually 150-200cc
Cleansing enema is given after the retention time is over
Temperature of enema fluid is 37.4 c or body temp
By: Desalegn T.

20. Cont’d
21
Purpose
To supply the body with fluid
To give medication E.g. stimulants(paraldehyde) or
antispasmodic
To soften impacted fecal matter.
Other equipment is similar except the tube for retention
enema is smaller in width.
Procedure
 Similar with the cleansing enema but the enema should be
administered very solely and always be preceded by
passing a flatus tube
By: Desalegn T.

21. Cont’d
22
Note
Most medicated retention enema must be preceded
by a cleansing enema/flatus tube
Elevate foot bed to help patient retain enema.
Kinds of solution used are pure water, normal saline,
glucose 5% , soda bicarbonate 2-5%.
Olive oil 100-200cc to be retained for 6-8hours is
given for sever constipation.
By: Desalegn T.

22. Rectal washout (siphoning enema)
23
 Colon irrigation or colonic flush
 Also called enterolysis
 Is the process of introducing large amount of fluid in to large
bowel for flush and allow return or wash out fluid
Purpose
To prepare the patient for x-ray exam and sigmoidoscopy
To prepare the patient for rectum surgery and allow return or
wash out fluid
By: Desalegn T.

23. Cont’d
24
Solution used
Normal saline
Soda-bi-carbonate solution(to remove excess mucus)
Tap water
KMNO4 sol. 1:6000 for dysentery or weak tannic acid
Tr. Asafetida in 1:1000 to relieve distention
By: Desalegn T.

24. 25
Procedure
Insert the tube like the cleansing enema.
Client lies on the bed with hips close to the side of the
bed (client assumes a right side lying position for
siphoning).
Open the clamp and allow running about 1000cc of
fluid in the bowel then siphon back into the bucket.
Carry on the procedure until the fluid return is clear.
By: Desalegn T.

25. Cont’d
26
Note
The procedure should not take>2hours.
Should be finished 1hour before exam or x-ray to give
time for the large intestine to absorb the rest of the fluid.
Give cleansing enema ½ hour before the rectal wash out
Allow the fluid to pass slowly
Amount of solution 5-6 liters until the wash out rectum
fluid becomes clear.
By: Desalegn T.

26. Cont’d
27
Insertion of flatus tube
 Sigmoid volvulus presents with abdominal pain,
distension and constipation.
 It is particularly common in elderly persons.
 Sub acute volvulus is an obstruction to the passage of
flatus, usually without damage to a patient’s gut or its
blood supply.
 This can be relieved by decompression either by flatus
tube or flexible sigmoidoscopy.
By: Desalegn T.

27. Cont’d
28
 Decompression can be successful in 50-90% of
cases.
 If strangulation is suspected (severe pain, toxic or
peritonitis signs, or discoloured mucosa at
sigmoidoscopy or flatus tube yields blood stained
fluid) – immediate laparotomy is needed.
 These patients should be carefully observed for
bowel ischemia (persistent abdominal pain and
blood-stained stools), as it indicates the need for
surgical intervention.
By: Desalegn T.

28. Cont’d
29
Role of surgery:
Surgery is indicated, if decompression fails to
alleviate the symptoms or if signs of ischemia
develop.
However, volvulus tends to recur in about 60% of
patients after conservative management with
decompression.
Surgery will be needed in recurrent cases.
By: Desalegn T.

29. Cont’d
By: Desalegn T.
30
PURPOSE
1. To remove flatulence from the lower bowel.
2. To relieve abdominal distension.
3. Used before giving a retention enema.

30. Cont’d
31
Use of flatus tube and procedure of insertion
 Long, soft flatus tube is inserted, patient in the left lateral
position.
 Obstruction is usually at 15 cms.
 Flatus tube is inserted with the help of a rigid/flexible
sigmoidoscope.
 Sigmoidoscope is held at the twist, flatus tube is passed
along it.
 With a gentle rotatory movement, the tube is eased pass
By: Desalegn T.

31. Cont’d
By: Desalegn T.
32
 Sigmoidoscope is withdrawn, taking care to avoid displacing the
tube.
 Flatus tube should be taped to the buttock to prevent its
proximal migration.
 Flatus tube is connected to a collection bag.
 Flatus tube allows for rapid decompression of the distended
colon, with the immediate relief of symptoms.
 Tube may be left in situ for 48 hours to allow for complete
emptying of the loop and for the resolution of mural edema.
 Tube should not be left for more than 72 hours as it may cause
pressure necrosis.

32. 33
Bowel diversion /ostomy
 An ostomy is an opening on the abdominal wall for
elimination of feces or urine.
 Purpose of ostomy is to divert and drain fecal or urinary
material.
There are many types of ostomy
Ileostomy:- is an opening into the ileum (small bowel).
Colostomy:- is an opening into the colon (large bowel).
Ureterostomy:- is an opening into the ureter.
By: Desalegn T.

33. Cont’d
34
Colostomy can be either temporary or permanent.
Temporary colostomy:- performed for traumatic
injuries or inflammatory condition.
Permanent colostomy:- performed to provide a
means of elimination when the rectum or anus is non
functional as result birth defect or cancer of bowel.
Colostomy produces a malodorous mushy drainage
By: Desalegn T.

34. Cont’d
35
Anatomic location:- The location of the ostomy influences the
character and management of the fecal drainage
 An Ileostomy produces liquid fecal drainage. it contains
some digestive enzyme which damage the skin.
 Ascending colostomy odor is a problem requiring control
(e.g. a deodorant inside the appliance)
 A transverse colostomy some has been reabsorbed.
 A descending colostomy produces increasingly solid fecal
drainage.
By: Desalegn T.

35. Cont’d
36
Stoma and skin care
 The fecal material from a colostomy or Ileostomy is
irritating to the periosteal skin.
 A barrier such as Karaya is applied over the skin around
the stoma to prevent contact with any execration.
 Odor control is essential to client’s self esteem
 They need to be changed whenever the effluent leaks on to
the periostomal skin
By: Desalegn T.

36. 37
Colostomy irrigation
 Is a form of stoma management used only for clients who have a
sigmoid or descending colostomy.
 It is not done for Ileostomy because the feces are usually liquid.
 A relatively small amount of fluid 300 to 500ml stimulates
evacuation b/se a colostomy has no sphincter and the fluid tends to
return
This problem is reduced by the use of a cone on the irrigating
catheter.
The cone helps to hold the fluid within the bowel during the
irrigation.
By: Desalegn T.

37. Urinary Elimination
38
Micturition, voiding and urination all refers to the process
of emptying the urinary bladder.
 Urine collects in the bladder until pressures stimulate special
sensory nerve ending in the bladder wall called stretch
receptor.
 This occurs when the adult bladder contains between 250 and
450ml of urine. In children 50 to 200ml stimulates the
nerves.
 Urinary retention: - when a person unable to void even
though the bladder contains an excessive amount of urine.
By: Desalegn T.

38. Factors affecting voiding
39
Factors affecting volume of urine formed and process of voiding
are:
Growth and development: Changes throughout the life cycle
Psychosocial factors: Helps stimulate the micturition reflexes
include privacy , normal position, sufficient time
Fluid and food intake
 Some foods and fluids change color of urine e.g. Carrot
 Certain fluids such as alcohol increases fluid out put
Medication e.g. chlorothiazide, furosemide increases urine
formation.
By: Desalegn T.

39. Cont’d
40
Muscle tone and activity: exercising regularly will have good muscle
tone, increased body metabolism and a good urine production.
The presence of an indwelling catheter can lead to poor bladder
muscle tone.
Pathological conditions: - affects the formation and /or excretion of
urine.
 Febrile condition can interfere with urine formation b/s the body
losses excessive fluid through perspiration.
 Hypertrophy of prostate gland can interfere with the ability to empty
the bladder
Surgical and diagnostic procedure
Spinal anesthesia affect the passage of urine b/s they decrease the
client’s awareness of the need to void.
By: Desalegn T.

40. Urinary Catheterization
41
 Urinary catheterization is introduction of a tube
(catheter) through the urethra into the urinary bladder.
 Is performed only when absolutely necessary for fear of
infection and trauma.
Note:- Strictly a sterile procedure i.e. the health care
giver should always follow aseptic technique
By: Desalegn T.

41. 42
Cont’d
Types of catheter
Based on size, materials, and types.
1. Straight (plain or Robinson)
2. Retention (Foley, indwelling)
Based on the number of lumens they have
1. Straight catheter -has single lumen
2. Double lumen catheter- has two lumens
3. Triple lumen catheter – has three lumens.
By: Desalegn T.

42. Cont’d
43
 In double lumen catheter, one lumen is used to inflate
balloon at the end of the catheter and the other lumen
is to drain urine.
 The triple lumen catheter provides an additional
lumen for the instillation of irrigating solutions.
By: Desalegn T.

43. Cont’d
44
 Indwelling catheter
Remain in place for continuous drainage of urine and it is also called
retention or Foley catheter.
Are used for gradual decompression of an over distended
bladder, for intermittent bladder drainage and for continuous
bladder drainage and it has a balloon
 Intermittent or straight catheter
Is used to drain the bladder for shorter period of time (5-10min).
Clients can be taught to insert and remove intermittent catheter
themselves.
By: Desalegn T.

44. Indications of urinary catheterization
45
 To relieve urinary retention or incontinence
 To obtain sterile urine specimen
 To measure the amount of post void residual urine for
monitoring
 To empty the bladder before, during and after surgery.
 In case of bladder obstruction
 For a patient with neurologic disorders (unconscious
patients)
 For bladder irrigation or decompression
By: Desalegn T.

45. Contraindications
46
Urethral trauma
Pelvic fracture
Scrotal hematoma
Complications of catheterization
Urethral trauma from friction during insertion
Infections(renal inflammation, pyelonephritis,
cystitis, etc) from ascending infection following the
catheter
By: Desalegn T.

46. Alternatives for internal urethral catheterization
47
There are two alternatives
1. Suprapubic catheterization:-it is occasionally used for
continuous drainage.
It is inserted through a small incision above the pubic area
directly into the urinary bladder.
2. Condom catheter: - when voluntary control of urination is not
possible for male clients (if there is urinary incontinence)
 Soft, pliable device made of plastic or rubber material is
applied externally to the penis.
By: Desalegn T.

47. 48
Equipments necessary for catheterization
- Catheter with appropriate size - Syringe (10cc)
-Sterile gloves -Lubricant (ky-
jelly)
- Sterile drape -Collecting bag
& tubing
-Cleansing solution eg. savlon -Plaster
-Cotton swab -Screen
-Forceps -Sterile water
By: Desalegn T.

48. Procedure
49
 Gather the necessary equipment & explain the procedure to
the client
 Position the client in supine position with legs spread and feet
together
 Open catheterization kit
 Prepare sterile field, done sterile gloves
 Check balloon for patency
 Apply lubricant to 2-5cm of the distal part of the catheter
 Apply sterile drape & bed protection materials (rubber sheet).
By: Desalegn T.

49. Cont’d
50
 In female separate the labia & in male hold the penis
straight with non-dominant hand.
 Cleanse peri-urethral mucosa with cleansing solution
 Pick the catheter identify the urethral meatus and gently
insert until 2-5 cm beyond where the urine started
flowing
 Inflate balloon with 10cc of sterile liquid/ water.
 Gently pull the catheter until inflation balloon snug
against the bladder neck
By: Desalegn T.

50. Cont’d
51
 Connect the catheter to the drainage system & secure
it to thigh or abdomen
 Place drainage bag below level of the bladder
 Evaluate catheter function & amount, color, odor,
quality of urine
 Remove gloves & wash your hands.
 Document what you have done
By: Desalegn T.

51. 52
Cont’d
1. Selecting an appropriate catheter
May be made of
Plastic_ for one week
Latex_ 2-3weeks (rubber)
Silicon_ for 2-3 month
 Select the type of material in accordance with the
estimated length of the catheterization period.
By: Desalegn T.

52. Cont’d
53
2. Determine appropriate catheter size
Are determined by diameter of lumen.
Graded on French scale or number
Catheter size depends on the size of the urethral canal
• #8-10fr_ children
• #14-16fr_ female adults
• #18fr_ adult male
3. Determine appropriate catheter length by the client
gender
 For adult male _ 40cm catheter (18fr)
 For adult female_ 22cm catheter (14-16fr)
By: Desalegn T.

53. Cont’d
54
4. Select appropriate balloon size
5-10ml _for adults
3-ml_ for children
Catheterization using intermittent/ a straight catheter
Purpose
 To relieve discomfort due to bladder distention
 To assess the residual urine
 To obtain a urine specimen
 To empty the bladder prior to surgery
By: Desalegn T.

54. 55
Note
 If resistance is encountered during insertion do not force.
Ask the client to take deep breath, relax the external sphincter
(slight resistance is normal)
 Dorsal recumbent:
Female for a better view the urinary meatus and reduce the risk
of catheter contaminates.
Male_ allows greater relaxation of the abdominal and perennial
muscles and permits easier insertion of the tube.
 Straight catheter: - is a single lumen tube with a small eye or
opening about (1.25cm) from the insertion tip.
By: Desalegn T.

55. 56
Inserting a Retention (Indwelling) Catheter
 Contains a second smaller tube throughout its length on the
inside, this tube is connected to a balloon near the insertion tip.
Purpose
 To manage incontinence
 To provide for intermittent or continuous bladder drainage and
irrigation.
 To prevent infection.
 To measure urine output needs to be monitored hourly.
By: Desalegn T.

56. Procedure
57
• Explain the procedure to the patient
 Prepare the equipment
 After catheter insertion the balloon is inflated to hold the catheter in
place within the bladder.
 The outside end of the catheter is bifurcated i.e. it has two opening
one to drain the urine the other to inflate the balloon.
 The balloon are sized by the volume of fluid or air used to inflate
them 5ml-30ml(15 commonly) indicated with the catheter size 18fr
-5ml.
By: Desalegn T.

57. Cont’d
58
 Test the catheter balloon.
 Follow steps as insertion straight catheter.
 Insert the catheter an additional 2.5-5cm beyond the point at
which urine began to flow.
 This ensures that the balloon is inflated inside the bladder and not the
urethra (cause trauma).
 Inflate the balloon with the pre filled syringe
 Apply slight tension on the catheter until you feel resistance
that the catheter is well anchored in the bladder.
 Release the resistance.
By: Desalegn T.

58. Cont’d
59
 Tape the catheter with tape to the inside of female’s thigh or to the thigh
or a body of a male client.
 Restrict the movement of the catheter and irritation in the urethra when
the client moves.
 Establish effective drainage.
 The bag should be off the floor _ the emptying spout does not become
grossly contaminated.
 Document pertinent data.
Removal
 Withdraw the solution or air from the balloon using a syringe and
remove gently.
By: Desalegn T.

59. 12.8. Gastric lavage
 Gastric lavage is the introduction of solution into the
stomach and removing gastric contents through
nasogastric tube for washing out the stomach.
Purpose
 To remove inserted poison, other than corrosive
substances like ammonia and mineral substances.
 To introduce ice water or normal saline solution in
tackling bleeding.
 To cleanse the stomach before operation.
 For diagnostic purposes.
 To relief congestion, nausea and vomiting .
60 By: Desalegn T.

60. Indication
 Pyloric stenosis
 Poisoning
 Preoperative care
Equipments
1. Equipments for NG tube insertion
2. Measuring jug
3. 2-3 litters prescribed solution.
4. IV stand
5. Tap water or ice if ordered
6. 50ml syringe
7. Funnel
8. Gloves
9. Rubber and cotton sheet
10. Towel
11. Litmus paper
61 By: Desalegn T.

61. Cont’d…
12. Suction machine (optional)
13. Labelled specimen container
14. Laboratory request form
15. Charcoal tablets ( universal antidote)
16. Emesis basin
17. Tissue paper
18. Drainage container
19. Vital sign instruments
20. Chart
62 By: Desalegn T.

62. Procedure
1. Explain the procedure to the patient
2. Wash your hand
3. Assemble the necessary equipments.
4. Keep patient privacy and position the patient
· Position in left lateral position for conscious patient but
if unconscious, place in prone position with head
over the edge of the bed or head lower than the body
(semi prone position)
5. Protect client and bed linen with towel and rubber
sheet
6. Done single use examination glove
63 By: Desalegn T.

63. Cont…
7. Select the appropriate distances mark on the tube
by measuring the distance on the tube from the
client’s bridge of the nose to ear lobe plus the
distance form ear lobe the to the bottom of the
xiphistemu(xyphoid process).
8. Lubricate the tube.
9. Gently insert and pass the tube, the tongue, the
mouth forward the posterior pharynx (If the client is
unconscious, mouth gag may be used)
 If air bubbles, cough and cyanosis are noticed
withdraw the tube and recommence the procedure.
64 By: Desalegn T.

64. Cont…
10. Advance the tube slowly to prevent injury until the
pre measured mark,
11. Assess the correct placement by aspirating
stomach contents, or by listening gosh of air while
the client exhales.
12. After the NG tube is in place, allow the stomach
contents to empty in to the drainage container before
instilling any irrigating solutions. This confirms proper
placement of the tube and decreases the risk of over
filling of the stomach and inducing of vomiting.
65 By: Desalegn T.

65. Cont’d…
13. Once you confirm proper placement of the tube,
begin gastric lavage by instilling about 250ml of
irrigating solution to assess the patient’s tolerance
and prevent vomiting.
 If you are using simple rubber tube for the
lavage
a. Fill the small jug with water/ solution, measure and
pour gently until the funnel is empty, then invent over
the pail (the funnel is connected with the funnel end
of the oesophageal tube)
b. Take specimen, if required, and continue the
process until the returned fluid becomes clear and
the prescribed solution had been used.
66 By: Desalegn T.

66. Cont’d…
 If you are using a tube with a bulb
a) Clamp the tube below the bulb,
b) With right hand, squeeze the bulb thus forcing the air out
through the funnel.
c) With left hand, pinch tubing above the bulb/proximal to
you/ and at the same time
with right hand, release the clamp. This creates a suction
which will draw the stomach contents into the bulb.
d) Lower funnel and allow excess gastric contents to drain
into the pail.
e) Pour 200-300 cc of solution/water into funnel. Before
funnel is empty allow solution to drain.
f) Before a solution stops running. Turn up funnel and add
another quantity of
solution
g) Repeat this procedure until returns are clean.
67 By: Desalegn T.

67. Cont’d…
14. Instruct the client to take deep breath and hold it to
close epiglottis
15. Monitor patient’s vital signs, urine output, and level of
consciousness every 15 minutes and notify the
physician for any changes.
16. Give mouth wash
17. If ordered, gently remove the tube, feel the client’s
tube, and watch the respiration
18. Remove glove, hand wash, Clean or discard used
equipments.
19. Comfort the patient
20. Record the procedure, including the time, date, type
of irrigating solution and the amount of gastric contents
drained.
68 By: Desalegn T.

68. 69
THE END !!
By: Desalegn T.