Chapters Transcript DigniShield™ Stool Management System The BD Digna Shield stool Management System SMS with odor barrier properties also available with an infant option, is intended for fecal management by diverting and collecting liquid or semi-liquid stool to minimize skin contact in bed-ridden patients and to provide access for the administration of medication, adult use only. The BD DignaShield SMS device consists of a catheter tube assembly, a collection bag, tube clamp, a 50 mL syringe, a syringe of lubricating jelly, and Medi-Air biological odor eliminator. The drainage tube has 3 lumens, each with a separate access port. The green inflation port is used to inflate or deflate the cuff. The clear irrigation port is used to infuse water through slits at the end of the retention cuff and to provide access for the administration of medication. The purple flesh port is used to infuse water through the entire length of the drainage tube to assist drainage of fecal matter. The white port or the sampling port allows for the collection of stool samples through a slip tip syringe. To set up the system, verify the retention cuff has been completely deflated. This can be done by squeezing the cuff to ensure there is no residual air in. The device. If air remains within the cuff, attach the 50 mL syringe to the green inflation port and withdraw all remaining air from the cuff. After the cuff has been fully deflated, fill the syringe with 45 mL of water and set aside, using a permanent marker. Record the catheter insertion date on the label located on the piston valve connector. Attach the. to the piston valve connector on the catheter by pulling back on the green trigger switch and engaging the piston valve connector onto the collection bag hub socket. The green ring at the base of the collection bag hub socket should not be visible when connected. The preferred patient position for catheter insertion is on the left lateral side with their knees tucked to their chest. The patient's clinical The situation may dictate the use of an alternate position. The goal of the patient positioning is to maximize sphincter relaxation to ease catheter insertion. A rectal exam should be performed to evaluate for fecal implications. If a fecal implication is present, disinfection procedure and device insertion may occur at the discretion of the healthcare professional. To insert the catheter, unfold the link. Of the catheter to lay flat on the bed, extending the collection bag towards the foot of the bed. Attach the 50 mL syringe filled with 45 mL of water to the green inflation port, but do not inflate yet. To insert the inflation cuff, it must be the left point of the cuff between your thumb and index finger. Fold the top right point of the cuff down and to the left at a 45 degree angle. This will create a cone shape which will allow for an easy insertion. Generously coat the patient's anus with lubricating jelly. Gently insert the cuff in through the anal sphincter until the cuff is beyond the external orifice and well inside the rectal vault. Inflate the cuff with 45 mL of water by slowly depressing the syringe plunger. The green inflation port has an external pilot balloon used as a guide to determine proper inflation. As the cuff inflates, the pilot balloon also inflates. Ensure the inflation port remains parallel to the catheter to prevent kinking of the inflation looming and blockage of and gently pull on the drainage catheter to check that the cuff is securely in the rectum. And is positioned against the rectal floor. Position the length of the flexible drainage tube along the patient's leg, avoiding kinks obstruction and tension. Take note of the position of the indicator line and observe its relative position to the patient's anus. Observe changes in the location of the position indicator band to determine movement of the retention. In the patient's rectum, this may indicate the need for the cuff or drainage tube to be repositioned. Hang the bag using the built-in hanger at a convenient location on the bedside below the level of the patient's rectum. If the retention cuff area becomes obstructed with fecal matter, it may be irrigated by filling a syringe with tap water, attaching to the clear irrigation port. And depressing the plunger. If using an infant, make sure the irrigation port remains parallel to the catheter to prevent kinking in the tube and blockage of the injected water. Repeat the procedure as often as necessary to maintain proper functioning of the device. Ensure the water drains. Flushing the drainage tube. If the drainage tube becomes obstructed with feed port and depressing the plunger. Make sure the purple flush port remains parallel to the maintain an unobstructed flow of stool into the collection bag. Confirm the irrigation line is clear by attaching a lure lock syringe to the clear irrigation port and flush the system with water. If using an infant version of DignaShield, ensure you are attaching an infi compatible syringe to the irrigation. Port locate the tube clamp in place near the patient. Attach a lure lock syringe with the medication to be delivered to the clear irrigation port. If using an infi version of DignaShield, ensure you are attaching an infi compatible syringe to the irrigation port. Elevate the drainage tubing to facilitate medication into the rectum. Immediately flush the irrigation line with at least 10 mL of water or volume per physician's orders. Slide the tube clamp onto the drainage tube until the drainage tube contacts the hinge. Position the tube clamp as close to the patient's buttocks as possible without touching the patient's skin. Using two hands, placed thumb on thumb to snap the tube clamp shut. Ensure the patient does not lie on the tube clamp. If the clamp is difficult to close or excessive leakage of medication is observed, reposition the tube clamp on the drainage tube. Dispose of the syringe according to institutional policy. After the prescribed dwell time, remove the tube clamp and reattach it to the piston valve hanger string. Verify unobstructed flow from the patient into the collection bag. Uncap the white sample port. Gently kink the catheter segments between the piston valve connector and sample port. Tilt or milk the catheter to collect fecal matter around the sample port. Insert a slip tip syringe into the sample port valve and draw the appropriate sample of fecal matter into the syringe. Withdraw the syringe and secure the white cap back on to the sample port. To remove the collection bag, grab the piston valve connector, gently pull backward on the switch located on the side of the connector. Until the piston ejects from the collection bag, the piston valve and bag hub should close off automatically in this process. Once the bag is removed, insert the bag cap into the hub connector and dispose of the collection bag in accordance with institutional protocol for disposal of medical waste. Replace the collection bag by securely snapping a new bag to the connector. To remove the catheter from the rectum, the retention cuff must be deflated. Attach the 50 mL syringe to the green inflation port and slowly withdraw all water from the retention cuff. Make sure the inflation port remains parallel to the catheter to prevent kinking in the tubing and blockage of fluid. Once you have ensured the cuff is fully deflated. Disconnect the syringe and discard. To help with removal, you may add an appropriate amount of lubricant to the anal sphincter prior to pulling back on the catheter to remove the cuff. Grasp the catheter as close to the patient as possible and slowly slide the cuff out of the anus. Dispose of the device in accordance with institutional protocol for disposal of medical waste. By following the instructions of this video, hopefully you will be able to manage the device more effectively within the hospital system. We would like to thank you for taking the time to listen to this training demonstration of the Digna Shield stool Management system. Please consult the product's IFU for full instructions, contraindication. warnings, precautions, and potential adverse events. If you have any questions or require additional information, please contact your local area sales representative. For ordering information, please contact 1-8448 BDI or 1844823-5433. Created by
