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52bravo
06-06-2004, 15:34
Rektal infusion is a big topic in a danish forum i am in, do you use in when you have no IV IO ect? the question are most for Long range reccon paloon, pj and other spec.obs.


Frank Hansen

look mother my first post

NousDefionsDoc
06-06-2004, 18:08
I'm not sure what you are talking about.

Razor
06-06-2004, 18:32
It sounds like the ol' IV up the poop chute technique.

NousDefionsDoc
06-06-2004, 18:35
If you have fluids, why would you not infuse the normal way? I am unfamiliar with this technique.

Eagle5US
06-06-2004, 18:51
You can infuse Normal Saline rectally...this technique was widely utilized by the british in the Falklands.

The british military was significantly short qualified medical personnel trained in IV fluid therapy...
The tubing SANS NEEDLE can be placed into the COLON (this means past the rectal vault) through the anus. The "trick" is getting it up there far enough for the fluid to act as more than an enema.
The patient should already be significantly hypovolemic and unconscious, the tubing is wrapped around a finger and slid up into the rectum to the third knuckle as if doing a rectal exam...with the finger still in place and being used as a guide and barrier keeping the anus open, the tubing is slid forward to approximately where the first "Y" port junction is, or 12 inches...whichever comes first.
Digit removed, IV turned on full...

WHY THE HELL would they do something like this???

The function of the large intestine / colon is to absorb water from the slurry that is your fecal sludge...this way you can make little pellets and logs to marvel at and make funny faces when they come out.
If you are dehydrated / hypovolemic, it is thought that these microvilli in the colon will absorb at least SOME of the fluids and assist in your rehydration.

I am not aware of any scientific studies to support their practice...but in theory it makes sense. This WILL make your patient shit his pants though...just like an enema will because it will stimulate the evacuation response.

PA

NousDefionsDoc
06-06-2004, 18:58
I understand the reasoning behind it. So they used it as a compensation method for lack of adequate training.

We don't have that problem. We can teach someone how to do an IV in much less time than it takes to sale from England to Argentina. LOL

ccrn
06-06-2004, 22:00
Originally posted by 52bravo
Rektal infusion = rectal infusion

Interesting twist of spelling....


I would like to see evidence that supports this method. Ive administered a few different types of fluid rectaly and never were they retained to the extent that they could support the vascular compartment that I'm aware of. Now medications might be another story ie lactulose enema for a pt with end stage liver disease suffering exacerbation of metabolic encephalopathy (usually from noncompliance).

On the other hand I could take a jr highschooler and teach him or her to do IV starts within a few hours...

ccrn

DoctorDoom
06-07-2004, 05:53
x

52bravo
06-07-2004, 08:19
I my selv find, not the best way as menny of the posts says, I my selv use IV or IO, but unit (recon of the home defences) use this rectal( in danish and latin/greak rektal so sorry)infusion.
thay dont have IV or IO equipment(dont get my started on that, i find i stupid and not up to 2004 standart)

i my selv is not from a recon unit, and find the rectal infusion not the best way to go on shock terpi. and i glad that to se that i am not the only one.
and i think that oral infusion, will be the best for them, but thay still go on that that the retal infusion is best.

and yes i am from odense denmark

Frank Hansen

ccrn
06-07-2004, 08:43
Originally posted by DoctorDoom
Lactulose is a bulk binder and would by definition result in a diarrhea

Binds with ammonia in the colon. I know what lactulose is Ive had the lovely experience of administering it personaly many times.

And I know what the intent of the original poster was but nice summary I suppose...

Ive never seen fluid resuscitation via colonic route either and for a good reason...it wouldnt work I'm sure. But like I said I would like to see research to support it. Desperate or not if it doesnt work it doesnt work and time could be better spent doing something else-

52bravo
06-07-2004, 08:47
med-line turnd up 0

52bravo
06-07-2004, 09:01
Originally posted by Eagle5US
You can infuse Normal Saline rectally...this technique was widely utilized by the british in the Falklands.

The british military was significantly short qualified medical personnel trained in IV fluid therapy...
The tubing SANS NEEDLE can be placed into the COLON (this means past the rectal vault) through the anus. The "trick" is getting it up there far enough for the fluid to act as more than an enema.
The patient should already be significantly hypovolemic and unconscious, the tubing is wrapped around a finger and slid up into the rectum to the third knuckle as if doing a rectal exam...with the finger still in place and being used as a guide and barrier keeping the anus open, the tubing is slid forward to approximately where the first "Y" port junction is, or 12 inches...whichever comes first.
Digit removed, IV turned on full...

WHY THE HELL would they do something like this???

The function of the large intestine / colon is to absorb water from the slurry that is your fecal sludge...this way you can make little pellets and logs to marvel at and make funny faces when they come out.
If you are dehydrated / hypovolemic, it is thought that these microvilli in the colon will absorb at least SOME of the fluids and assist in your rehydration.

I am not aware of any scientific studies to support their practice...but in theory it makes sense. This WILL make your patient shit his pants though...just like an enema will because it will stimulate the evacuation response.

PA

eagle5US: do you have a link, articel ect ti the UK army's rectal fun?

DoctorDoom
06-07-2004, 17:01
x

Doc T
06-07-2004, 19:57
Originally posted by DoctorDoom


One of the questions being debated by medical ethicists is if a person is DNR and when terminal has directed that they not receive IV hydration or paraenteral nutrition, whether the practice of pararectal hydration is ethical. It has been used in terminally ill patients so I don't see why it wouldn't work in other patients.



Are you serious that people are questioning whether rectal infusion is ethical if a person has already stated refusal of IV fluids??? that seems ridiculous. That is like saying if you refuse oral intubation the nasal route would be acceptable...

cannot believe this even gets debated.

doc t.

Eagle5US
06-07-2004, 20:15
Originally posted by Doc T
Are you serious that people are questioning whether rectal infusion is ethical if a person has already stated refusal of IV fluids??? that seems ridiculous. That is like saying if you refuse oral intubation the nasal route would be acceptable...

cannot believe this even gets debated.

doc t.
Uhhhh..Hi Doc T :D

Eagle

Roguish Lawyer
06-07-2004, 20:17
What a shitty thread.



















Sorry. Couldn't resist. :D

ccrn
06-07-2004, 23:33
QUOTE]Originally posted by DoctorDoom
.... it would appear from your first post[/QUOTE]

I was referirng to not only a binder ie lactulose but tap H2o enema etc also. I would challenge anyone to retain a liter of saline or any other type of water rectaly for more than a few moments or minutes let alone enough fliud for resuscitation ie vascular collapse assuming a pt had enough rectal tone to do so.

I'd also like to add that rectal route is not exactly expediant or conveniant in emergent situations ie TNCC.

Considering someone prehospital will not get the many units of PRBC, colloids/hespan etc ,alot more than one liter will be given...

Stand back I say....

Based on my experience in the ICU and ER, and stories Ive heard of in the OR I think it would not work.

If 91W carries IV equipment into the field with leg units I cannot imagine how a highspeed unit, if even a foreign one , would not have the capability if not more. Of course there is the scenario of mass casualty etc but triage sorts that out however unfortunate.

I cant imagine either a terminal DNR/DNI pt accepting rectal fluids if not recieving other routes. Of course DNR does not mean "Do Not Treat" and we will often still treat them aggressively for better or worse. Ive been in this situation many times, (and hospice and palliative) in a few different regions of the country and have never even seen or heard of it mentioned let alone done. More sound to advance NGT or feeding tube instead-

ccrn

DoctorDoom
06-08-2004, 07:29
x

DoctorDoom
06-08-2004, 07:48
x

ccrn
06-08-2004, 09:08
Originally posted by DoctorDoom
...may be construed as a pissing match. That is certainly not my intent; I have enjoyed and learned from this discussion.

Not taken that way at all.

Interesting articles but not research however, not to mention 6 and 7 years old respectively.

Also they conflicted each other regarding the use of normal saline.

Are you aware of any independently duplicated research that is current to support the use of "proctoclysis" fluid administration either in the palliative/hospice or trauma pt?

ccrn

52bravo
06-08-2004, 09:11
and the bowle perfusion in shock is not same as it is in cancer, i think the perfusion is the big one here

DoctorDoom
06-15-2004, 15:42
x

DanUCSB
06-15-2004, 16:06
The more I hear/read about it, the more it seems to fall into urban myth status. That is, I've always heard of it being done, and everyone seems to have a "friend of a friend" who it was performed upon, but I have yet to run into some that's actually either performed it, or have had it performed on themselves.

That's not to say that it's not a valid procedure, or something else to have in your bag of tricks... either way, it's beyond my current expertise (which tops out at the SuperCLS/CPR level). It just seems to be a procedure that is far more talked-about than actually implemented.

Kyobanim
06-15-2004, 16:07
I'm just glad there weren't any pictures to accompany this thread.

DoctorDoom
06-15-2004, 16:44
x

DanUCSB
06-15-2004, 17:00
Now I feel dirty.

I had to go back and make sure that that wasn't what I had actually typed, otherwise I'd feel -really- dirty. ;)