1. Douches are given only on the doctor’s orders.
2. Douche is not given during menstruation, pregnancy and puerperium for fear of infection carried to the uterus.
3. Thorough hand washing should be done before and after the procedure to prevent cross infection carried to and from the patient especially if the patient is suffering from venereal diseases.
4. Use gloves whenever possible to prevent cross infection.
5. Carefully remove and destroy the pads used by the patients.
6. Clean the perineum thoroughly before the douches are given. Clean the perineum from above downwards towards the rectum to prevent colon bacilli entering the urethral meatus.
7. Usually a ‘clean technique’ is enough for all patients. However, ‘sterile technique’ is used in all cases when indicated, e.g., vaginal operations.
8. Use solution of correct strength to prevent chemical irritation.
9. Adjust the height of the reservoir to regulate the pressure of the solution flowing into the vagina. Too much pressure in a vaginal irrigation may force infections into the cervical canal. Therefore, the height of the irrigating can should be not more than 24 inches from the level of the patient’s hips. Remember the pressure of an aqueous solution in a container has been established as ½ pound for every one foot of elevation. The pressure of the irrigating fluid used for vaginal irrigation should not exceed one pound.
10. The douche nozzle should be kept wet and lubricated to prevent friction and tissue trauma.
11. Regulate the temperature of the solution according to the purpose of irrigation. For most of the irrigation, a temperature of 40.5 degree celcius is tolerated by the patient. To relieve inflammation and to check bleeding, a higher temperature is used.
12. Gravity will aid to the inflow of solution, if the hips are elevated and the head is low. Gravity also aids the outflow of solution if the patient is raised to the sitting position on the completion of the treatment.
13. The douche nozzle should be directed downward and backward along the curve of the vaginal wall. It should be rotated to ensure flushing of the anterior, posterior and lateral fornices.
14. The treatment should not be done hastily if the therapeutic effects are to be achieved. It should take atleast 20 to 30 minutes to give two pints of solution.
15. If a glass nozzle is used, it must be carefully examined for cracks before and after the insertion to prevent injury to the vaginal wall.
16. Apply medications immediately after the douche, if ordered.
17. Do the procedure in an adequate light.
NURSE’S RESPONSBILITY IN ADMINISTERING A VAGINAL IRRIGATION
1. Check the name, bed number, and other identification of the patient.
2. Check the diagnosis and the purpose of vaginal irrigation.
3. Check the doctor’s orders for the type of the solution to be used for the irrigation, any medication to be applied after the irrigation etc.
4. Check whether the vaginal douche is contra-indicated in the patient, e.g., menstruation, pregnancy, post partum period etc.
5. Check the patient’s abilities and limitations to maintain a desired position.
6. Check the patient’s previous experience with vaginal instrumentation and the understanding of the procedure.
7. Check whether the patient needs a clean technique or a sterile technique.
8. Check the condition of the perineum for any lesions.
9. Check the articles available in the patient’s unit.
PREPARATION OF THE ARTICLES
1. Irrigating can with tubing and a clamp; can filled with the irrigating solution.
Purpose: To use as reservoir for the irrigation.
2. Douche nozzle.
Purpose: To direct the fluid into the vaginal canal.
3. Gloves 1 pair.
Purpose: To maintain asepsis and to protect the nurse’s hands.
4. Jug with extra fluid for irrigation
Bedpan or douche pan.
Purpose: To receive the return flow.
5. I.V. Pole.
Purpose: to adjust the height of the irrigating can.
Purpose: to protect the nurse’s dress.
7. Sponge holding forceps and wet cotton swabs in a container.
Purpose: to clean the perineum.
8. Dry cotton balls in a container.
Purpose: to dry the perineum.
9. Cotton applicators.
Purpose: to apply the medication, if ordered.
10. Mackintosh and towel.
Purpose: to protect the bedding and the garments.
11. Vaginal speculum.
Purpose: to examine the vagina and to apply the medication.
12. Kidney tray and paper bag.
Purpose: to receive the wastes.
13. Extra sheets and garments.
Purpose: to change after the procedure.
Preparation of the Patient and the Environment:
1. Explain the procedure to the patient. Explain her the sequence of the procedure and tell how she can co-operate in the procedure.
2. Provide privacy with screens. Close the doors and windows as needed.
3. Ask the patient to void. This will reduce the discomfort of a full bladder.
4. Remove the back rest and extra pillow if any.
5. Bring the patient to the edge of the bed to avoid over reaching. Adjust the height of the bed to the comfortable working of the nurse.
Place the mackintosh and towel under the patient to protect the mattress and bed clothes.
6. Cover the patient with a bath blanket or a sheet and fanfold the top covers to the foot end of the bed. Drape the patient as for any gynaecological examinations and expose only the perineum. Remove the bottom garments or raise it above the waist level.
7. Keep all the articles arranged at the bedside locker conveniently for the nurse.
8. Assist the patient to a dorsal recumbent position on the bed pan. The hips should be higher than the shoulders to aid in the gravity flow. A pillow under the back will make the patient more comfortable.
Steps of Procedure:
1. Wash hands
Reason: to prevent cross infection.
2. Pour the solution into the can and allow little solution to run through the tubing. Tighten the clamp. Hang the can on the I.V. pole not more than 24 inches from the level of the patient’s hip.
Reason: height of can determines the force of fluid.
3. To put on gloves.
Reason: to protect the nurse’s hands.
4. Clean the perineum with wet swabs using the sponge holding forceps.
Reason: this prevents the infection carried to the vaginal canal.
5. Examine the douche nozzle for any cracks and connect it to the tubing attached to the can.
Reason: cracks in the douche nozzle may cause injury of the vaginal wall.
6. Allow small amount of solution to flow over the vulva. Regulate the flow of fluid by adjusting the screw clamp.
Reason: pouring solution over the vulva removes any gross discharge. Also determines the tolerance of the patient to the temperature of the solution.
7. Separate the labia with the thumb and forefinger of the left hand and gently insert the nozzle into the vagina about 2 to 3 inches. Direct the nozzle downward and upward along the curve of the vaginal canal.
Reason: following the anatomical curve will prevent injury to the vaginal mucosa.
8. Allow the fluid to run in a steady stream. Note the character of the return flow. Rotate the nozzle.
Reason: rotating the nozzle ensures thorough cleansing of the vaginal walls including the fornices (pouches).
9. When a required amount of fluid is used, pinch the tubing and remove the nozzle from the vaginal canal. Clamp the tubing.
Disconnect the douche nozzle and place it in the kidney tray.
Reason: The douche nozzle is infected and prevents the infection carried to the irrigating can which is considered to be clean.
After Care of the Patient and the Articles:
1. Help the patient to a sitting position on the bedpan to drain the solution from the vaginal canal.
2. Remove the bedpan, turn the patient to one side and dry the perineum and buttocks.
3. If any medication is to be applied, insert the speculum into the vagina to visualize the cervix and apply the medications using the cotton applicators. Apply a perineal pad to prevent staining of the garments by the medications.
4. Remove the mackintosh and towel and re-arrange the bed. Change the garments and bed linen as necessary.
5. Adjust the position of the patient in bed and make her comfortable.
6. Take all the articles to the utility room. Note the character of the fluid in the bedpan. If any cotton balls or cotton pads have fallen into the bedpan, remove it. 7. Empty the bedpan and clean it as usual. Rinse the douche nozzle in cold running water first and then with warm soapy water. Rinse it thoroughly under the running water again and put it for boiling, or disinfect it in an appropriate disinfectant. Clean all the articles and dry them and store them in their proper place.
7. Wash hands.
8. Record the procedure on the nurse’s record with date and time. Record the type and the amount of solution used, amount and type of vaginal discharge present (if any) and the patient’s reaction to the douche.
AUTHOR: RC JONGTE
VAGINAL IRRIGATION OR VAGINAL DOUCHE – A SIMPLE NURSING CARE.
The term ‘douche’ is applied to a stream of fluid directed to a body cavity to flush that cavity. A vaginal irrigation is the washing of the vagina by a liquid at low pressure. It is similar to the irrigation of external auditory canal, in which the fluid immediately returns after being installed in.
1. To cleanse the vaginal canal, removing an offensive or irritating discharge.
2. To relieve inflammation and congestion of the genital tract.
3. To apply an antiseptic solution that discourages the growth of micro-organisms as in preparation of surgery.
4. To arrest haemorrhage.
5. To stimulate circulation of pelvic organs and promote absorption of exudates.
1. Sterile water
2. Normal saline
3. Sodium bicarbonate 2 percent
4. Vinegar (acetic acid) 1 percent
5. Savlon 1 in 1000
6. Potassium permanganate 1 in 4000
7. Boric acid 2 percent
8. Acriflavine 1 in 4000
9. Dettol 2 percent
10. Bichloride of mercury 1 in 4000
The temperature of the solution is adjusted according to the purpose of the douche. For cleansing purpose, use the solution at body temperature, but prepare the solution at 40.5 degree celcius and allow it to cool. To apply warmth, the douche can be given as hot as the patient can tolerate, usually temperature of 43.3 degree celcius.