Medication Administration: Rectal

CLINICAL GUIDELINES

Rectal medications are administered by a registered nurse (RN), licensed practical nurse (LPN), physician, or family who is knowledgeable about the medication and techniques of administering rectal medication to a child.
A healthcare prescriber orders medications.
Principles of pharmacologic management (see Chapter 6) are followed.
The rectal route is not the preferred route because of potential emotional trauma to the child and unpredictable absorption from the colon. Absorption can be further affected by the presence of stool in the colon and rectum. The rectal route may be the best choice for a child who cannot tolerate oral medication and in whom a parenteral route is not available.
Medications are administered within 1 hour of prescribed time.

CHILD AND FAMILY ASSESSMENT AND PREPARATION

Assess the child’s previous experiences with receiving rectal medications.
Assess the child’s and the family’s understanding of need for rectal medication that will be administered.
Prepare the child, as appropriate to cognitive level, and family for medication administration.
Use therapeutic play to allow the child to work through his or her fears and master control of the situation.
Assess for drug allergies; if present, notify healthcare prescriber. Label the child’s record and apply identification band indicating allergies.
Ask the child if he or she is able to defecate (using terms the child is familiar with) before administration of the suppository. Stool in the colon can affect absorption of medication.

PROCEDURE
Administering Rectal Medication

Steps	Rationale/Points of Emphasis
1 Verify the order with the child’s medical record and check for allergy to drug; if present, do not administer drug and notify prescriber. Rectal medication administration is contraindicated in children who are immunosuppressed or thrombocytopenic because of the risk of infection or bleeding.	Verifies correct drug, dose, route, time, and patient. Allergic reactions to medications may be life threatening.
2 Perform hand hygiene.	Reduces transmission of microorganisms.
3 Obtain medication and read the label to verify with the order. Check for expiration date; if expired, do not administer.	To decrease chance of medication error, patient, route, dose, frequency, and time to be administered must be verified each time a medication is administered.
4 Check medication form dispensed to ensure that it is appropriate for the child.	Suppositories are the most frequent form of rectal administration, although occasionally medication may be administered in an enema form (see Chapter 37 ). Children are very susceptible to fluid and electrolyte imbalances.
5 Prepare medication for administration. Avoid cutting if possible. If the suppository must be cut to obtain the ordered dose, then it must be cut lengthwise.	Cutting a suppository lengthwise helps absorption at the required rate. The drug may not be dispersed evenly within the suppository.
6 Verify the medication with the electronic record or take medication record and medication to the child to administer. Verify the child’s identity by comparing name on medication (if verified electronically) or on medication record with the child’s identification band and any other patient identifier required by the institution.	Ensures proper identification of the child.
7 Don gloves.	Protects the administrator from fecal material, thus reducing transmission of microorganisms.
8 Position the child in a left lateral position with the right leg flexed or in the knee-chest position.	Either of these positions exposes the anus and helps relax the external sphincter for ease of insertion.
9 Remove the suppository packaging and lubricate the suppository with a water-soluble lubricating jelly.	Reduces friction against mucosal surfaces.
10 Gently insert the apex (pointed end) of the suppository past the internal anal sphincter, placing the medication against the rectal wall. In an infant or toddler, insert the suppository with the little finger. The index finger can be used for older children.	The suppository must be past the internal sphincter to prevent expulsion. KidKare Instruct the child to pant like a puppy. This provides distraction and relaxes the anal sphincter.
11 Hold the child’s buttocks together until the child relaxes or loses the urge to push. If the child has a stool within 30 minutes, examine the stool for the presence of the suppository.	Prevents expulsion of medication. KidKare Distraction of the child with games or other activities can help avoid expulsion.
12 Remove gloves. Dispose of gloves in appropriate receptacle. Perform hand hygiene.	Reduces transmission of microorganisms. Standard precautions.