Neurogenic Bowel Management, Spina Bifida — Troubleshooting the Cecostomy — Clinical Pathway: Outpatient Specialty Care

Neurogenic Bowel Management, Spina Bifida Clinical Pathway — Outpatient Specialty Care

Troubleshooting the Cecostomy

Cecostomy implants a percutaneous device that is used for delivering antegrade irrigations to the colon to evacuate the colon of stool. Because additives are used with this irrigation, the tubing and attachment device can become clogged. Consistency in timing is key to a good bowel-management program. Consider possible impaction when there is poor response to therapy. The device can become dislodged and there can be leakage around the insertion site.

Troubleshooting the CECOSTOMY
Problem Intervention
Leakage immediately after irrigation
  • Assess for impacted stool.
  • Clear: increase sit time, adjust volume of irrigant.
  • Liquid (feculent): increase sit time, adjust volume of irrigant, increase additives.
  • Consider non-latex catheter (22-24 Fr.) per rectum to allow for drainage.
Hard daytime accidents
  • Assess diet: fiber, water, trigger foods.
  • Consider adjusting volume of irrigant.
  • Consider additives: glycerin, PEG, Castile soap.
Loose daytime accidents
  • Assess diet: fiber, water intake, trigger foods.
  • Adjust oral laxative.
  • Adjust additives: glycerin, PEG, Castile soap.
Monthly accidents coinciding with menstruation
  • Decrease oral laxatives prior to menstruation.
  • Consider flushing every 12 hours (morning and evening) at time of menstruation.
Abdominal pain/vomiting
  • Prime tubing prior to administration to eliminate air.
  • Check temperature of irrigant (warm, not cold or hot).
  • Adjust volume of irrigant.
  • Adjust rate of administration (slow down or stop, rest and try again).
  • Ensure proper timing of last oral intake (> 30 minutes after meals is best).
  • Adjust additives: glycerin, PEG, Castile soap.
Slow flow or stoppage of flow
  • Check for clogging of Chait Access Adapter due to additives (flush device with hot water when NOT connected to the cecostomy device).
  • May have increased stool burden at the site of cecostomy tube; push 60 mls of warm water via catheter tip syringe through Chait Access Adapter rather than relying on gravity to clear.
Poor clean-out
  • Repeat irrigation.
  • Consider abdominal X-ray.
Leakage around cecostomy tube
  • Refer to surgical provider.
Cecostomy tube displaced
  • Refer to emergency department for immediate evaluation.
Severe abdominal or back pain, rectal bleeding
  • Refer to emergency department for immediate evaluation.