Pre‐procedure

ActionRationale

1. 1.Show
   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [178], C).
2. 2.Show
   Position the patient lying on their left side (if the patient is unable to tolerate this, position the patient so that access to the rectum is possible). Maintain privacy and dignity throughout.
   This position offers the easiest access to the rectum. E
3. 3.Show
   Undertake a digital examination.
   To evaluate suitability for the insertion of the device (ConvaTec [53], C). The rectum should be empty.
4. 4.Show
   Remove any residual air from the balloon by attaching the syringe to the inflation port and withdrawing the plunger.
   To ensure the balloon is fully deflated prior to insertion. E
5. 5.Show
   Fill the empty syringe with sterile water or saline. Do not overfill. Follow the manufacturer's guidelines.
   To prepare to fill the balloon. E

Procedure

1. 6.Show
   Unfold the length of the flexiseal tubing (catheter) and lay it flat on the bed, extending the collection bag towards the foot of the bed.
   This is the correct positioning of the tubing and bag to optimize drainage. E
2. 7.Show
   Insert a lubricated gloved index finger into the retention balloon cuff finger pocket and coat the balloon end of the catheter with lubricant.
   To minimize patient discomfort and aid insertion (ConvaTec [53], C).
3. 8.Show
   Gently insert the balloon through the anal sphincter until it is well beyond the external orifice and well inside the rectal vault.
   This is the correct position for the device (ConvaTec [53], C).
4. 9.Show
   Inflate the balloon to the correct volume according to the manufacturer's instructions. Never inflate the balloon with more water than instructed.
   Inflating the balloon too much may cause damage to the integrity of the device or damage to the surrounding tissues (ConvaTec [53], C).
5. 10.Show
   Remove the syringe from the inflation port and gently pull back on the catheter.
   To check the catheter is securely positioned within the rectum. E
6. 11.Show
   Take note of the position indicator line relative to the patient's anus.
   Observing changes in the location of the indicator line can determine movement of the retention balloon in the patient's rectum. This may indicate the need for the balloon or the device to be repositioned (ConvaTec [53], C).
7. 12.Show
   Position the length of the catheter along the patient's leg. Make sure to avoid pressure, kinks and obstructions.
   To optimize drainage. E
8. 13.Show
   Hang the collection bag by the strap on the bedside, positioning the bag at a lower level than the patient.
   To ensure unobstructed flow. E

Post‐procedure

1. 14.Show
   Observe the device for obstruction from kinks, solid faecal particles or external pressure. Repeat regularly according to local policy.
   To ensure appropriate use of the device and unobstructed flow. E
2. 15.Show
   Observe the anus for signs of leakage or pressure‐related damage.
   To ensure the flexiseal is working correctly and that it is not causing any pressure damage. E