Whole-Bowel Irrigation Technique

Updated: Mar 28, 2016
  • Author: Rittirak Othong, MD; Chief Editor: Vikram Kate, MBBS, MS, PhD, FACS, FACG, FRCS, FRCS(Edin), FRCS(Glasg), FIMSA, MAMS, MASCRS  more...
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Technique

Whole-Bowel Irrigation

A nasogastric (NG) tube should be placed, especially in children, to ensure that an adequate amount of polyethylene glycol electrolyte solution (PEG-ES) has been administered. [5]  (See Nasogastric Intubation.)

If resistance is encountered during insertion of the tube, do not force insertion. The following tips may help with insertion of the NG tube:

  • Warm water may help soften the tip of the NG tube and thereby make insertion easier
  • Tying a knot at the tip of the NG tube (for ~5 minutes) helps create a curve that may make insertion easier; make sure to untie the knot before inserting the tube
  • Curve the tip of the NG tube, and place it in a cup of ice for several minutes; insert the stiffened NG tube with the tip initially pointed down; once the tip enters the oropharynx, rotate the NG tube 180° so that the tip now points posteriorly toward the esophagus

Once placement of the NG tube is confirmed, the PEG-ES can be administered. The solution is administered at a rate of 500 mL/hr in children aged 9 months to 6 years, 1000 mL/hr in children aged 6-12 years, and 1500-2000 mL/hr in adolescents and adults. [27]

A commode should be positioned by the patient's bedside, and the patient should be seated on it.

The entire procedure usually takes 4-6 hours. Patients often experience nausea and may vomit, in which case it may be necessary to slow the infusion rate. Alternatively, an antiemetic may be administered. The procedure is stopped once clear rectal effluent is seen or all drug packets have emerged.

The efficacy of whole-bowel irrigation (WBI) was not shown to be enhanced by pretreatment with an antiemetic in a study that compared two groups, one of which received 10 mg of oral metoclopramide 30 minutes before WBI and the other received placebo. [28]

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Complications

Potential complications of WBI include the following:

  • Nausea/vomiting
  • Mallory-Weiss tear and esophageal perforation associated with vomiting after ingestion of PEG-ES [29]
  • Abdominal bloating/cramps
  • Acute respiratory distress syndrome (ARDS) from aspiration of PEG-ES or misplacement of the NG tube [30, 31]
  • Organ injuries during NG tube insertion
  • Angioedema of the lips [32]
  • Anaphylactoid reaction [33]
  • Death - This has been reported in an 86-year-old man who developed ARDS progressing to multiorgan failure after aspiration of PEG-ES [34]

The popular misconception notwithstanding, significant electrolyte abnormalities are not caused by WBI if PEG-ES is used as the solution.

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