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

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

Troubleshooting the Peristeen/Navina

Peristeen/Navina is a closed irrigation system that delivers water by pumping fluid to give a retrograde transanal irrigation. It does not use gravity. If there is an issue with the system, the patient, family or provider should reach out to a Peristeen/Navina specialist. Consistency in timing is key to a good bowel-management program. Consider possible impaction when there is poor response to therapy or expulsion of balloon during the irrigation.

Troubleshooting the PERISTEEN/NAVINA
Problem Intervention
Meeting Resistance
  • Check for impaction
  • Check placement of catheter
Impaction
  • Consider digital disimpaction
  • Check temperature of water (warm, not cold or hot)
  • Adjust volume of irrigant (refer to Urology/SB Specialist)
  • Consider cleanout with oral medication (from above)
  • Consider mineral-oil enema followed by Peristeen/Navina irrigation
  • Administer in small aliquots
Leakage During Administration
  • Ensure no impaction
  • Check catheter placement
  • Check balloon, add more air
  • May need to move up in catheter size
  • Change position of patient on toilet (rear-facing)
  • Check connection of tubing
Expulsion of Balloon Catheter
  • Deflate balloon, reinsert catheter, add more air to the balloon and begin irrigation again.
  • May need to move up in catheter size
Leakage Immediately After Peristeen/Navina
  • Clear leakage: increase sit time, decrease volume of irrigant
  • Feculent leakage: increase sit time, adjust volume of irrigant
  • Non-latex catheter (22-24 Fr.) per rectum to allow for drainage
Hard Daytime Accidents
  • Assess diet: fiber, water intake, trigger foods
  • Consider adjusting volume of irrigant
  • Adjust oral laxative
Loose Daytime Accidents
  • Assess diet: fiber, water intake, trigger foods
  • Decrease oral laxative
Monthly Accidents Coinciding with Menstruation
  • Decrease oral laxatives prior to menstruation
  • Consider irrigation every 12 hours (morning and evening) at time of menstruation
Abdominal Pain/Vomiting
  • Prime tubing prior to administration to eliminate air
  • Check temperature of fluid (warm, not cold or hot)
  • Adjust volume of irrigant
  • Adjust rate of administration (slow down or stop and rest then try again)
  • Ensure proper timing of last oral intake (> 30 minutes after meals is best)
Slow Flow or Stoppage
of Flow
  • Check for impaction
  • Check for clogging of tubing
Poor Clean-out
  • Repeat irrigation
  • Consider abdominal X-ray
Peristeen/Navina Catheter, Tubing or Bag Problems
Rectal Bleeding, Severe Abdominal or Back Pain
  • Refer to Emergency Department