Procedure for rectal washout

Paediatric guidelines (in development)
NHS Lothian

Items required for the procedure

  • Normal saline 0.9% (stored at room temperature)
  • 50ml syringe
  • Rectal tube: size 10 or 12 (may require bigger size later)
  • Bowl
  • Lubricating jelly
  • Procedure Pad
  • Non-sterile gloves and apron
  • Changing mat
  • Nappy and wipes

The procedure

A clean procedure in the community setting

The bowel washout should be performed in a warm environment. The baby and the individual performing the washout should be comfortable as the procedure can take some time to complete adequately. A changing table is the ideal height. The baby should not be left unattended.

  1. Ensure everything you need has been collected and near to hand.
  2. Wash and dry hands thoroughly.
  3. Apply non-sterile gloves and apron (healthcare professionals only/as required)
  4. Prepare the normal saline as directed by a health care professional. This may be available in different size sachets or bottles and the cap should be removed ready for use.
  5. Remove the baby's nappy and lower clothing and place the baby on the changing mat and procedure pad.
  6. Observe the abdomen for signs of swelling (this should reduce after washout).
  7. Remove the plunger from the 50ml syringe and attach the rectal tube to the syringe tip.
  8. Apply lubricating jelly to the end of the rectal tube.
  9. Hold both the syringe and the rectal tube tip upwards with your non-dominant hand. This is to prevent the fluid from running through.
  10. Fill the barrel of the syringe with approximately 30ml of normal saline.
  11. Lower the rectal tube to remove air and allow fluid to run to the end of the rectal tube.
  12. Raise the end of the rectal tube again to stop the flow.
  13. Hold the rectal tube near the end with your dominant hand and the syringe in your other hand. With the hand holding the syringe, kink the rectal tube to prevent fluid running out as you lower it towards the baby.
  14. Insert the rectal tube through the anus into the rectum (a few cms initially)
  15. Release the kink in the rectal tube to allow the fluid to run in, whilst gradually advancing the rectal tube. NB Do not use FORCE when passing the rectal tube. If the rectal tube becomes BLOCKED at any time, remove it and unblock using the 50ml syringe plunger and small saline flush.
  16. When all the fluid has emptied from the syringe barrel, lower the syringe below the level of the baby's bottom and place over the bowl. Allow fluid and stool to flow into the bowl by gravity. You may need to rotate the tube backwards and forwards using thumb and index finger to allow the fluid to empty from the bowel.
  17. Repeat this process by refilling the syringe in aliquots of 30mls advancing the tube slightly further until fluid runs clear. Where possible ensure the tube stays in the rectum during the procedure to minimise discomfort of removing and reinserting. If tube has been taken out to unblock or if it falls out, remember to lubricate with jelly when re-inserting.
  18. Once the fluid runs clear slowly remove the rectal tube to ensure that all the remaining fluid has drained. The amount of fluid should be approximately the amount you started with.
  19. Cleanse the baby's bottom and reapply the nappy, checking that the abdomen is soft.
  20. Dispose of all equipment as directed by a healthcare professional.
  21. Remove gloves and apron (if worn). Wash and dry hands thoroughly.