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Bowel care Part 6 – Administration of a suppository

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A suppository is a medicated solid formulation prepared for insertion into the rectum. Once inserted the temperature of the body will dissolve the suppository from its solid form to a liquid.

Higgins, D. (2007) Bowel care Part 6 – Administration of a suppository. Nursing Times; 103: 47:, 26-27.

Keywords: Gastrointestinal, Suppository

Author
Dan Higgins, RGN, ENB 100, ENB 998
, is senior charge nurse in critical care, University Hospital Birmingham.

The administration of a suppository requires skill and competence on the part of the practitioner, as well as their compliance with the NMC guidelines on the administration of medicines (2007) and local drug administration policy.

Indications for administration

Suppositories may be a useful tool in the management of chronic constipation, particularly when combined with other interventions such as oral agents and preventative measures. They may also be used to empty the rectum in preparation for investigation and for other procedures such as colonoscopy.

Suppositories may be used as a route of drug administration for local effect (haemorrhoid medication) or to be absorbed for systemic effect by the vascular network surrounding the rectum (analgesia, antibiotics). The rectal route of drug administration is particularly useful for patients who are fasting or nil-by-mouth before or after surgery.

Precautions/considerations

Care should be taken in the administration of suppositories to patients who have undergone rectal or lower colonic surgery, or who have experienced an obstruction, as the risk of perforation may be increased. This risk may also be increased in patients who have undergone gynaecological surgery or radiotherapy.

Any pathology of the perianal region should be considered and risks assessed.

Digital rectal examination (see NT Clinical, 13 November, p28), according to organisational policy, should be performed prior to administration to assess faecal loading and any abnormalities.

The risks associated with suppository administration are considered to be low but suppositories can be detrimental and at worst fatal to the patient if administered in the wrong circumstances. Expert advice should be sought from specialist practitioners in any of the circumstances mentioned above.

Suppositories are occasionally prescribed to be administered via a stoma. Again, it is important that expert advice should be sought in such situations.

There has been some controversy over the correct insertion technique with regard to which end of the suppository to insert first – the apex (narrower end) or base (blunt end). In a small sample study Abd-el-Maeboud et al (1991) suggested that if suppositories are inserted apex first the circular base distends the anus and the sphincter may not close completely. However, there is as yet insufficient research evidence to be conclusive about which end of a suppository should be inserted first.

Equipment required

  • Gloves.
  • Disposable apron.
  • Plastic-backed absorbent sheet.
  • Lubricating solution.
  • Bedpan or commode.
  • Prepared solution.

The procedure

  • Explain the procedure and reasons for it, reassure the patient and obtain informed consent (NMC, 2004) (Fig 1).
  • Identify any allergies or contraindications.
  • Assess patient privacy and dignity and take steps to ensure this is as well provided for as possible.
  • Check the prescription details as required.
  • Wash hands and don plastic apron and gloves (Fig 2).
  • Check the suppository is within its expiry date and ensure it is intact.
  • Position the patient lying on the left side with her or his knees drawn up to the abdomen (Fig 3). This eases the passage of the suppository into the rectum (Dougherty and Lister, 2004). Gravity and the anatomical structure of the sigmoid colon also indicate that inserting the suppository with the patient in this position will aid retention.
  • Position a plastic-backed absorbent sheet underneath the patient.
  • Assess the area and perform a digital rectal examination, if this has not already been done.
  • Break the suppository seal.
  • Lubricate the end of the suppository with lubricating gel (Fig 4).
  • Gently separate the buttocks, identifying the anus.
  • Slowly insert the lubricated suppository into the rectum (Fig 5).
  • Repeat the procedure if more than one suppository is required.
  • Attend to perianal hygiene.
  • Ask the patient to retain the suppository as suggested in the manufacturer’s recommendations.
  • Provide a bedpan, commode or nurse call system as indicated.
  • Dispose of any waste.
  • Remove apron and wash your hands.
  • Document the procedure accurately, completing the drug record if required (Fig 6).
  • Ensure the effect of the suppository is noted and documented accurately.

 

Professional responsibilities

This procedure should be undertaken only after approved training, supervised practice and competency assessment, and carried out in accordance with local policies and protocols.

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