The rectal trumpet: Use of a nasopharyngeal airway to contain fecal incontinence in critically ill patients

Abstract Objective: Our objective was to determine if a nasopharyngeal airway (rectal trumpet) could be used as a fecal containment device with less trauma than traditional devices, such as a fecal incontinence pouch or balloon rectal catheter. Design: A single-subject clinical series was used. Setting and Subjects: A nonrandom sample of critically ill adult and geriatric patients (n = 22) with ongoing fecal incontinence who were receiving care in an intensive care and intermediate care unit in a university teaching hospital was used. Instruments: Direct observation, medical record review, a questionnaire, and interviews were used. Methods: The bedside nurses identified patients as study candidates. Clinical findings were documented in the medical record. The nurses providing patient care completed questionnaires. Main Outcome Measures: Main outcome measures were parameters related to efficacy, practicality, and complications of use of the rectal trumpet: stool containment, skin and anal sphincter integrity, patient comfort, and ease of insertion. Results: All 22 patients (100%) had containment or improved containment of stool. Observable healing or restoration of skin integrity occurred in 90% of the patients with acquired skin injury (n = 20). None of the patients suffered any change in tone or damage to the anal sphincter. Although 41% of the patients experienced discomfort with insertion of the rectal trumpet, 86% had no discomfort while it was maintained in position. Insertion of the rectal trumpet was rated as easy by 84% of the responding nurses (n = 63). Conclusions: Use of a rectal trumpet was well tolerated by patients and practical for nurses. Incontinence was contained and no untoward effects were noted. Benefits to the patient included wound healing and improved comfort. (J WOCN 2002;29:193-201.)