• Suspected or confirmed Hirschsprung’s disease 
• Suspected meconium plugs 

• Bowel decompression 
• Establishment of feeding 
• Weight gain 
• Reduced risk of colitis 

• Rectal biopsies taken in preceding 24 hr 
• Rectal bleeding (relative contraindication) 
• Severe anal stenosis 
• Anus not clearly identified 
• Known surgical patient (without discussion with surgical team)

• Bleeding from anus or rectum 
• Perforation of bowel (this is very rare) 
• Electrolyte imbalance if inappropriate fluid used or retained 
• Vomiting 
• Hypothermia 
• Distress to baby and parent 

Consent

•  Explain procedure to parents/carer and obtain verbal consent 

Equipment

• Tube size 6–10 Fr
• Lubricating gel (if catheter not lubricated) 
• Bladder tip syringe no smaller than 60 mL 
• Rectal washout solution (sodium chloride 0.9%) warmed to room temperature 
• Plastic apron 
• Gloves 
• Protective sheet 
• Receptacle to collect effluent 
• Container for clean rectal washout solution 
• Blanket to wrap baby 

Preparation

• Place all equipment at cot side 
• Sedation is not necessary 
• Second person to comfort baby using dummy and breast milk/sucrose [see Non-nutritive sucking (NNS) guideline]
• Wash hands, put on gloves and apron 
• Position baby supine with legs raised 
• Keep baby warm 

•  Inspect and palpate abdomen – note distension or presence of lumps 
• Draw up sodium chloride 0.9% 60 mL into syringe and keep on one side 
• Insert lubricated catheter into rectum [up to approximately 10 cm (in a term baby) or until resistance felt] noting any flatus or faecal fluid drained 
• Massage abdomen in a clockwise direction to release flatus 
• Attach syringe containing sodium chloride to tube in rectum and gently instil fluid: 

• Disconnect syringe from tube and drain effluent into receptacle 
• Repeat procedure until drained solution becomes clearer, up to a maximum of 3 times 
• If solution does not drain out, manipulate tube in and out and massage abdomen 
• If no faeces are passed or all the solution is retained, seek medical help 
• Re-examine abdomen and note any differences 
• Wash, dress and comfort baby 

Preparation for discharge

• For discharge, baby should require ≤2 rectal washouts a day 
• Order equipment via paediatric community nurse 
• Ward will supply 5 days’ equipment 
• Discharge letter for GP detailing equipment required 
• Arrange home visit with clinical nurse specialist in stoma care if available locally 
• Ensure parents competent to perform rectal washout and can describe signs of colitis 
  
  • complete rectal washout parent competency sheet if available locally