Whole-Bowel Irrigation Periprocedural Care

Updated: Apr 07, 2020
  • Author: Rittirak Othong, MD, FACMT, FTCEP; Chief Editor: Vikram Kate, FRCS, MS, MBBS, PhD, FACS, FACG, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS, FFST(Ed)  more...
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Periprocedural Care

Equipment

The materials required for whole-bowel irrigation (WBI) include the following:

  • 10% lidocaine solution (see the first image below)
  • 2% lidocaine jelly or KY jelly for lubrication (see the second image below)
  • Nasogastric (NG) tube of appropriate size (see the third image below)
  • Reservoir bag to hold irrigation polyethylene glycol electrolyte solution (PEG-ES; see the fourth image below)
  • PEG-ES (eg, GoLYTELY; see the fifth image below)
  • Intravenous (IV) pole on which to hang the bag of irrigation solution
  • Bedside commode (see the sixth image below)
10% lidocaine solution 10% lidocaine solution
2% Xylocaine jelly or KY jelly for lubrication 2% Xylocaine jelly or KY jelly for lubrication
Nasogastric tube. Nasogastric tube.
Nasogastric feeding bag (reservoir bag for the irr Nasogastric feeding bag (reservoir bag for the irrigation solution).
Polyethylene glycol electrolyte solution. Polyethylene glycol electrolyte solution.
Bedside commode. Bedside commode.
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Patient Preparation

Anesthesia

Two studies, one involving 60 patients [28] and the other 206 patients, [29] demonstrated that the use of both lidocaine spray and lubricating jelly for the insertion of NG tubes was superior to the use of lubricating jelly alone. First, 1 mL of 10% lidocaine solution was sprayed into each nostril, in conjunction with 2 mL of 10% lidocaine solution sprayed into the back of the oropharynx. An NG tube was then lubricated with either lidocaine jelly or KY jelly.

These two simple steps significantly reduced patient pain, discomfort, and related adverse events (cough, epistaxis, chest pain, vomiting, shortness of breath, dizziness, and epigastric pain). [29] Moreover, the application of lidocaine spray before NG tube insertion increased both physicians' and nurses’ satisfaction during the procedures. [28, 29]

Positioning

A plain abdominal film should be obtained to confirm NG tube placement before the irrigation solution is administered. The patient should be comfortably seated on the bedside commode.

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