PROBLEM: Bowel access and fecal control are often essential adjuncts to patient care. Access is important diagnostically, for contrast radiographic studies, and therapeutically, for the administration of medications and bowel irrigation to prepare patients for surgery, remove fecal impactions and stimulate defecation. Control of fecal evacuation may assist in perineal and sacral wound healing and has safety implications for medical personnel. In our critical care setting, we have also noted an increasing need for the administration & retention of multiple classes of medications rectally for treatment of patients with illnesses such as liver failure, renal failure and gastrointestinal hemorrhage.

PURPOSE: Delineate the therapeutic uses of an indwelling bowel access system for inpatients in intensive care settings.

METHOD: The product* was used in the care of 288 patients between September 2004 and November 2005; we retrospectively reviewed the charts of 111 consecutive patients in whom this device was utilized.

RESULTS: The mean dwell time was 10.9 days, with a range of 1 - 58 days. Indications for use: control of diarrhea (n=66), wound protection (n=29), and medication administration (n=25). Medications included: Kayexalate, lactulose, neomycin, and vancomycin. There was only one adverse event: An ulceration of the rectal vault which was later determined to be the result of over-inflation of the retention cuff.

CONCLUSION: The product provided a safe and effective means of medication delivery, control of fecal drainage and the protection of wound and skin in a variety of complex patients. This particular bowel access device* provides the unique additional benefit of medication administration and retention, which was an important adjunct to care in the ICU setting.

*Zassi Bowel Management System, Hollister Incorporated, Libertyville, IL.

The support of Hollister Incorporated for this presentation is gratefully acknowledged.