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Methods of Bowel Management in Critical Care: A Randomized Controlled Trial

Pittman, Joyce; Beeson, Terrie; Terry, Colin; Kessler, William; Kirk, Lisa

Journal of Wound, Ostomy and Continence Nursing: November/December 2012 - Volume 39 - Issue 6 - p 633–639
doi: 10.1097/WON.0b013e31826a4b9c
Continence Care

PURPOSE: The purpose of this study was to compare 3 methods of bowel management to control fecal incontinence in adult critical care patients and their effect on incontinence-associated dermatitis, pressure ulcer prevalence, and clinician satisfaction.

SUBJECTS AND SETTING: Fifty-nine adult patients in critical care with liquid fecal incontinence were recruited from 6 critical care units in a large Midwest healthcare system.

METHODS: Subjects were randomly assigned to 1 of 3 groups: bowel management system catheter, rectal/nasopharyngeal trumpet, or usual care. Subjects were assessed daily for incontinence-associated dermatitis, pressure ulcer prevalence, and other clinical data. Direct care nurse satisfaction with each method was evaluated by self-administered survey.

RESULTS: Incontinence-associated dermatitis severity and pressure ulcer prevalence did not differ across groups at baseline. Over time, the change in incontinence-associated dermatitis severity score was significantly different across groups (P < .001). There were no significant differences in proportion of patients experiencing pressure ulcers during the study among groups. Clinicians reported significantly greater satisfaction with the bowel management system (P = .007) and rectal trumpet (P = .001) as compared to usual care. In addition, economic and safety benefits were identified with use of internal fecal devices. Specifically, an economic savings of $3100 to $3400 per 29 days of care was identified. Subjects experienced no adverse side effects when internal devices were used.

CONCLUSION: Results of this randomized controlled trial provide new information for the care of patients with fecal incontinence in the critical care setting. Incontinence-associated dermatitis severity scores differed across groups over time, pressure ulcer prevalence did not differ across groups over time, use of an internal device or bowel management system improved clinician satisfaction, and the use of internal fecal methods was more cost-effective than usual care.

Joyce Pittman, PhD, RN, FNP-BC, CWOCN, Nurse Practitioner, Adjunct Assistant Professor, Indiana University Health–Methodist Hospital, Indianapolis.

Terrie Beeson, MSN, RN, CCRN, ACNS-BC, Clinical Nurse Specialist, Indiana University Health–University Hospital, Indianapolis.

Colin Terry, MS, Biostatistician, Indiana University Health, Indianapolis.

William Kessler, MD, Gastroenterology; Associate Professor, Indiana University Health, Indianapolis, IN.

Lisa Kirk, MSN, CWOCN, Wound, Ostomy, Continence Nurse, Indiana University Health–Riley Hospital, Indianapolis

Correspondence: Joyce Pittman, PhD, FNP-BC, CWOCN, Indiana University Health–Methodist Hospital, 1701 Senate Blvd, Rm B149, Indianapolis, IN 46206 (

The authors declare no conflicts of interest.

Copyright © 2012 by the Wound, Ostomy and Continence Nurses Society