From the Guidelines
Rectal tubes should be used with caution due to the significant risks of rectal tissue damage, infection, and sphincter damage, which can outweigh their benefits in managing fecal incontinence and relieving gas distention. The main risks associated with rectal tubes include rectal tissue damage, mucosal ulceration, necrosis, and perforation due to pressure from the tube against the rectal wall 1. Prolonged use can lead to sphincter damage and worsened incontinence. Infection is another concern, as bacteria can travel along the tube into the rectum.
The benefits of rectal tubes include effective management of liquid stool in bedridden patients, prevention of skin breakdown from fecal contamination, relief of abdominal distention by facilitating gas passage, and improved patient comfort and dignity. However, these benefits must be carefully weighed against the potential risks. When using rectal tubes, they should be limited to short-term use (typically less than 29 consecutive days), secured properly without excessive tension, and removed for 1-2 hours every 8 hours to reduce pressure injury 1.
Some key considerations for the use of rectal tubes include:
- Limiting use to short-term periods
- Securing the tube properly without excessive tension
- Removing the tube for 1-2 hours every 8 hours to reduce pressure injury
- Regularly assessing the rectal mucosa for signs of tissue damage
- Considering alternative methods like fecal management systems or scheduled bowel programs for longer-term management.
It is essential to note that the evidence for the use of rectal tubes is limited, and more research is needed to fully understand their risks and benefits 1. However, based on the available evidence, it is clear that rectal tubes should be used with caution and careful consideration of the potential risks and benefits.
From the Research
Risks Associated with Rectal Tubes
- The use of rectal tubes can lead to major adverse events, including lower gastrointestinal bleeding, which may require blood transfusion, endoscopy, or surgical intervention 2
- Excessive administration of rectal diazepam can cause chronic and excessive sedation, cyclic reappearance of seizures, and fluctuating plasma levels, leading to toxic, withdrawal, and epileptic symptoms 3
- Rectal tubes can also cause discomfort, pain, and anxiety in patients, particularly if inserted incorrectly or left in place for an extended period
- The risk of rectal tube-related complications may be higher in critically ill patients, who may have underlying medical conditions that increase their susceptibility to adverse events 2
Benefits of Rectal Tubes
- Rectal tubes can be an effective way to administer medication, such as diazepam, to patients with seizures or epilepsy, particularly in emergency situations where intravenous access is not available 4, 5, 6
- Rectal diazepam can provide rapid cessation of seizures, with onset of effect noted approximately 10 minutes after administration 5, 6
- The use of rectal tubes can also help to prevent the development of status epilepticus in patients with serial seizures 6
- In addition, rectal tubes can be used to manage excessive bowel motions in critically ill patients, which can help to prevent skin breakdown and promote patient comfort 2