A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings

The primary purpose of this procedure is to provide an easy and rapid route for medication and fluid administration in non-critical situations when IV access is difficult, delayed or unnecessary. This method can solve a large problem in the Emergency Department by facilitating immediate treatment protocols in palliation of symptoms in non-critical situations when IV access is difficult or delayed. The main advantage of this technique is to be able to provide quick and effective delivery for medication and fluids, decreasing IV sticks and length of stay.

This technique is beneficial for retention enema administration such as Lactulose, Kayexalate and treatment for constipation, the balloon makes it easier and more comfortable to retain the enema. Being a painless alternative to intravenous delivery it could be of great benefits in the pediatric setting, both for fluid and medication delivery as well as for treating pediatric constipation. First, assess the rectum for stool using a standard digital exam.

It is best if the rectum is empty, however, formed stool is not contraindication for use. Prior to insertion, assess the rectal opening for contraindications which include:lesions, tumors, abscesses, rectal bleeding, diarrhea or bowel surgery within the last six weeks. If the device can be used, then first lubricate the catheter from the tip to the blue marker line with a water soluble lubricant.

Then, insert the catheter into the rectum to the blue marker line between the two blue arrows. Next, inflate the balloon using a luer syringe by injecting 15 milliliters of water or saline. Now, gently tug on the catheter to assure that the balloon is positioned against the rectal sphincter.

Then, position the catheter between the patient's legs and secure it to the anterior aspect of the patient's thigh using a catheter securing device. Alternatively, the catheter can also be secured to the lower abdomen. If not already in liquid form, pulverize any solid forms of medication that must be administered.

Do not pulverize time release formulations. Then, add 10 millileters to 20 milliliters of water to the pulverized medication and mix it into a micro-enema suspension. Before administering the medicine, prepare a three milliliter enteral syringe with water.

Now, pull the liquified or suspended medication into an enteral syringe. And inject the bolus into the catheter port over three to five seconds. Then, in one second, flush the medication administration port with three millileters of water.

To hydrate the patient, only administer hypo-tonic solutions such as water, 0.2 or 05%normal saline, using a 45 or 60 milliliter enteral syringe. Administer the fluid at a rate of two to four milliliters per second. Alternatively, hydrate using a gravity-fed feeding bag with an infusion pump via the catheter.

The catheter is FDA cleared to remain in the rectum for up to 28 days. As noted before, do not use a catheter for patients with rectal lesions, tumors or active rectal bleeding, or recent bowel surgery. Also, do not use the catheter if the rectal mucosa is compromised, such as due to ulcers or ischemic proctitis.

And do not use it with patients that have diarrhea. Always be sure to remove the catheter before defecations, which will easily expel the catheter. To remove the catheter, attach a 20 milliliter luer syringe to the balloon inflation valve and gently withdraw the 15 milliliters of water from the balloon.

Then, gently remove the catheter from the rectum. An 80-year-old male with multiple medical comorbidities presented to the ED via ambulance with fever, decreased mental status and cough, attempts at IV access were unsuccessful. The described protocol provided 50 ml of fluids and medications.

About 90 minutes later, the patient was afebrile, alert and oriented. A 41-year-old female presented by ambulance in alcohol withdrawal. Attempts at obtaining IV access for administration of fluids and benzodiazepines were unsuccessful, and the patient was deemed too disoriented and agitated to safely tolerate oral administration.

Using the described technique, two milligrams of lorazepam was delivered, resulting in immediate improvement of the patient's agitation, orientation and tachycardia. A 25-year-old female presented via ambulance with acute confusion, agitation and tachycardia resulting from substance abuse. She also had an underlying, untreated hyperthyroidism.

IV access was established, but the patient would not tolerate oral ingestion of methimazole, which was instead delivered using the described methods. The catheter was used for subsequent administrations until the patient improved sufficiently to tolerate oral intake. After watching this video you should have a good understanding of how to administer medications and fluids via the macy catheter in situations where IV access is delayed or unnecessary, and or a retention enema is needed.

Once mastered, this technique can be done in two minutes or less. While attempting this procedure, it's important to remember that unlike a foley catheter, this a non-sterile technique.