Why the rectal route?
In some circumstances, delivering medication orally becomes impractical or impossible (uncooperative patient, nausea, vomiting). The rectal route of medication administration allows for rapid and effective medication absorption due to the highly vascularized rectal mucosa. The route may also partially bypass the liver which may benefit those with impaired liver function.1
Lactulose for hepatic encephalopathy
This kind of therapy can be seen when administering Lactulose, as it is commonly given as a treatment for hepatic encephalopathy related to liver failure. Lactulose produces diarrhea by osmosis and leads to reduced absorption of ammonia. It does not cure liver disease, but it helps to slow the deterioration of the mental status caused by hepatic encephalopathy.2
Vancomycin for C. difficile
Another drug that is commonly administered with Flexi-Seal™ is vancomycin for C. difficile infections. Flexi-Seal™ can be used with patients suffering with C. difficile in the same way it is used on patients without it. This drug is instilled locally at the site of infection.
When used with Flexi-Seal™ PROTECT PLUS, it has the added ability to:
- Contain C.difficile spores via the self-closing catheter
- Minimize the spread of C. difficile spores via an active charcoal filter in the collection bag3
- Help reduce spillage and leakage of bag contents via ESENTA™ Diamonds™ gelling and odor control sachets
Instructions for Use
If you are interested in utilizing Flexi-Seal™ to administer medication rectally, please follow the steps outlined in the IFU and review the following tips:
- Lie patient on their left side with knees bent to have gravity assist in getting the medication from the rectum into the sigmoid colon.4
- Perform a rectal exam prior to administration to ensure there is not fecal impaction, which must be removed prior to delivering enema.
- Slowly instill the medication via the med/irrig port and clamp after each syringe delivery. It is important to use the black clamp that comes in each Flexi-Seal™ kit for this step. Without clamping, the medication effectively acts as an irrigation only.
- These medication enemas are typically large volumes of solution and should be delivered slowly to ensure maximum absorption via the mucous membranes.4
- Encourage the patient to lie in the left lateral position for prescribed amount of time to retain the medication.
A short walkthrough of the Flexi-Seal™ PROTECT PLUS medication port and the steps for rectal drug administration.
References:
1. Hua, Susan. (2019). Physiological and Pharmaceutical Considerations for Rectal Drug Formulations. Frontiers Research Foundation. Volume: 10 Pages: 1196
2. Madan, K., Sharma, P., Saraf, N., Choudhari, S., & Roy, D. S. (2017). Effectiveness and safety of lactulose retention enema in cirrhotic patients with grade 3 or grade 4 hepatic encephalopathy. International Journal of Basic & Clinical Pharmacology, 6(2), 365–372. https://doi.org/10.18203/2319-2003.ijbcp20170331
3. Minimizing the spread of C. difficile spores from the release of gas. February 19, 2013. Data on file, Convatec Inc.
4. https://www.nursingtimes.net/clinical-archive/neurology/rectal-drug-administration-in-adults-how-when-why-22-02-2016/
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