CONSTIPATION RELIEF REGIMEN
1) Obtain abdominal x-ray* to rule out ileus or other.
2) Reduce narcotics*
#
to minimum effective dose.
3) Discontinue ICU Bowel Protocol*.
4) Complete rectal check; manually disimpact as required
#
.
5) Give 500 – 1000 mL soap suds enema*
#
PR AND 150 mL
magnesium citrate*
#
per NG Q12h; repeat x 4 (max) as indicated.
6) DO NOT insert Flexi-Seal
®
rectal tube.
7) Confirm resolution of constipation as indicated.
STEP 1) Give docusate (200 mg per NG once daily).
STEP 2) Give docusate (200 mg per NG once daily),
Milk of Magnesia® (30 mL per NG once daily),
AND cascara (15 mL per NG once daily).
ICU GUIDELINE: BOWEL PROTOCOL
NO
NO
STEP 3) Repeat Step 2. Complete rectal check;
disimpact if +ve. Give mineral oil enema PR; if no
response repeat enema in 4 - 6 hrs (once only).
YES NO
YES
DEFINITIONS
QUALITY BM: A moderate to large, semi-formed/formed BM.
DIARRHEA
: >3 moderate to large loose/liquid BMs (or 300 mL)
within a 12 hr time frame.
CONSTIPATION
: Absence of a QUALITY BM over a continuous
48 - 72 hr time frame and/or passage of hard stool and/or presence
of hard stool in rectum.
QUALITY BM within past 24h?
QUALITY BM within past 24h?
QUALITY BM within past 24h?
NO
YES
DEVELOPED BY: J Greenwood, RD and members of the ICU Bowel Care Working Group. Approved by Dr V. Dhingra, ICU Medical Director (20/5/2011).
YES
QUALITY BM within past 24h? PROTOCOL INITIATION:
● Day 1 of enteral feeding*
#
PROTOCOL TERMINATION:
● Presence of DIARRHEA.
● Repeated exaggerated response to Bowel Protocol.
● Initiation of “Constipation Relief Regime”
PROTOCOL RESUMPTION:
● Absent QUALITY BM >48 hrs.
PROTOCOL MODIFICATION
:
● ↑ dose of cathartics
*#
if repeated failed response to Bowel Protocol.
* MD order required # Unless contraindicated
GOAL: To prevent constipation and achieve a QUALITY BOWEL
MOVEMENT (BM) every 48 – 72 hrs.
START
