What is whole-bowel irrigation?
Whole-bowel irrigation is the rarely used technique that cleans the entire intestine to remove unwanted or toxic substances from the gastrointestinal tract. The technique is done by inserting a tube from the nose to the intestine (nasogastric tube).
Usually, a large volume of nonabsorbable solution called polyethylene glycol-electrolyte is administered through the tube to clean the intestines. The technique is usually performed to prepare patients for an intestine surgery or in patients who have an overdose of certain substances or drugs.
When is whole-bowel irrigation necessary?
Whole-bowel irrigation is uncommonly performed because it carries significant risks in patients. This procedure is performed for the below conditions:
- Prior to an intestinal surgery
- Ingestion or overdose of a significant or life-threatening amount of sustained-release medications or drugs (sustained-release potassium chloride)
- Ingestion of a significant or life-threatening amount of medications that are not adsorbed by activated charcoal (AC), or a situation in which no other intestine cleaning methods are appropriate (e.g., iron supplements, lead or lithium overdose foreign body)
- Ingestion of illicit drugs
- Ingestion of whole skin patches (e.g., fentanyl patch or clonidine patch)
- Ingestion of multiple water beads or gel beads with no signs of bowel obstruction
When whole-bowel irrigation technique shouldn’t be done?
Whole-bowel irrigation technique shouldn’t be done in patients:
- Who are uncooperative
- In whom a nose tube cannot be placed
- With uncontrolled vomiting
- Who have a decreased conscious state or risk assessment, suggesting the potential for a decreased conscious state or seizure in the subsequent four hours
- With intestinal obstruction
- Who are intubated and ventilated (this is a relative contraindication because large volumes of fluid may fill the tract and flow past the tube cuff, leading to aspiration)
- With unstable vital signs
What happens during whole-bowel irrigation?
Whole-bowel irrigation may take up to six hours.
- A nurse or healthcare provider should be able to monitor the patient and their vitals throughout the procedure.
- A sufficient supply of polyethylene glycol-electrolyte is usually kept ready before the procedure.
- A nasogastric tube is inserted from the nose to the stomach.
- The patient is given intravenous metoclopramide to minimize vomiting and enhance gastric emptying.
- Activated charcoal (AC) is sent through the nasogastric tube (for the nonmetallic ingestions).
- Next, a polyethylene glycol-electrolyte solution is sent through the nasogastric tube at 2 L per hour (children 25 mL/kg/hour).
- The patient should sit on a commode because they may have diarrhea.
- The technique should continue until six hours or until the fecal discharge is clear.
- The procedure may need to be stopped if the patient has abdominal distension or loss of intestinal sounds.
- In some patients, abdominal X-ray may be done to assess the effectiveness of decontamination of radio-opaque substances such as iron and potassium salts.
- Once the technique is completed, the tube is removed, and the patient might need sufficient rest and monitoring.
What are the complications of whole-bowel irrigation?
Whole-bowel irrigation is a risky technique that may have the below complications:
- Nausea, vomiting, and abdominal bloating
- Severe diarrhea
- Anal irritation
- Fluid or unwanted substances in the breathing tract leading to breathing issues
- Injury to the digestive tract or organs due to the tube
- Swelling of lips
- Allergic reactions
In rare cases, if sufficient care is not taken, death is also a possibility during whole-bowel irrigations.
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