Suppository administration

The purpose of this guideline is to provide guidance about the administration of suppositories at Great Ormond Street Hospital.

Suppositories can be used as an administration route for medication, or as a route to administer a laxative to evacuate the rectum. For many children or young people, using the rectal route can be a very distressing experience. The National Institute for Health and Care Excellence (NICE) states that the rectal route should only be used in the treatment of constipation if oral laxatives don't work, and then only if the child/young person and family consent (NICE, 2014).

Preparation 

  • Give full explanation of the procedure to the child/young person and parent/carer(s) (Rationale 1).

  • Ensure that the environment where the procedure is to take place is private.

  • If the suppository is prescribed as a laxative, ensure a toilet, commode or bedpan is available (Rationale 2).

  • If the suppository is a means of administering medication, ask the child/young person to try and go to the toilet to open their bowels first (Rationale 3).

  • Gather equipment together (Rationale 4):

    • suppository and prescription chart

    • lubricating jelly

    • disposable gloves (Rationale 5)

    • wipes

Administration of suppository 

  • Remove the child’s nappy or underwear or ask the young person to do this themselves.

  • Ask the child/young person to lie on their left side with knees bent up to their abdomen (Rationale 6).

  • Infants can lie on their back with feet and legs held up (Rationale 7).

  • Some children/young people can be taught how to insert suppositories into their own rectum and would find this easier to do in a squatting position.

  • Perform a clinical hand wash (Rationale 5).

  • Put on disposable gloves (Rationale 5).

  • Open the suppository and lubricate the end. Holding the suppository between index finger and thumb, locate the anus and gently insert the suppository with the index finger. The suppository should be fully inserted into the rectum against the wall of the rectum (Rationale 8 and 9).

  • Suppositories are usually placed rounded end first. In some cases the suppository is expelled before medication is absorbed. If this is the case it has been suggested that placing the suppository blunt end first prevents the suppository from being expelled from the rectum (Abd-El Maeboud et al, 1991; Bradshaw and Price, 2007).

  • Ask the child to retain the suppository as long as possible (Rationale 10).

  • If the suppository is used to evacuate the rectum, sit the child on the toilet, commode or bedpan to empty the bowel. If the child/young person is unable to sit on the toilet/bedpan either a nappy can be put on or an incontinence sheet placed under the child (Rationale 11).

  • If the suppository is for medication purposes eg analgesia; wipe excess lubricating jelly off the perineum and replace the child’s nappy or underwear or ask the young person to do this themselves if able (Rationale 12).

  • Dispose of packaging and equipment in the appropriate waste disposal bag, in line with hospital waste disposal policy.

  • Document administration on the appropriate medicine chart (Rationale 13).

  • Document the outcome of the suppository if used as a laxative. Document the effectiveness of the suppository if used as a medicine (Rationale 13).

Issues to consider regarding suppository administration 

  • Using the rectal route in children/young people can be distressing. Due consideration should be taken and full explanation should be given to the parents and child.

  • If a child has had surgery on the rectum, nothing should be placed into the rectum without the express permission of medical staff (Rationale 14).

  • The rectal route for medication should not be used for children with oncological conditions or who are otherwise immunocompromised (Rationale 15).

  • Rectal medication for children with inflammatory bowel disease should be confined to local treatments for that disease eg steroid preparation (Rationale 16).

  • Consider the effect that rectal administration might have on the child psychologically (Rationale 17) (Royal College of Nursing (RCN), 2003).

Rationale

Rationale 1: Explanation of the procedure should alleviate anxiety.
Rationale 2: The suppository should evacuate the rectum of stool within 20 minutes.
Rationale 3: If the rectum is empty there is a better chance that the medication will be fully absorbed.
Rationale 4: To allow the procedure to be carried out promptly without interruption.
Rationale 5: To adhere to standard infection control precautions.
Rationale 6: This position offers the easiest access to the rectum.
Rationale 7: This position is easiest to maintain with an infant.
Rationale 8: Lubrication of the suppository will make insertion easier.
Rationale 9: Fully inserting the suppository against the wall of the rectum will allow it to be retained longer and therefore be more effective.
Rationale 10: The longer the suppository is retained the better the result, and the more medication is absorbed.
Rationale 11: Sitting on the toilet or commode allows the most effective position to empty the rectum.
Rationale 12: Absorption rates of medication in suppository form are variable and can take anything up to one hour.
Rationale 13: To maintain an accurate record.
Rationale 14: Any anastomosis could be damaged and haemorrhage could occur if rectal biopsies have been taken.
Rationale 15: Children who have lowered immunity are susceptible to bacteria within the rectum and are at higher risk of infection.
Rationale 16: The rectum may be very inflamed and friable, perforation of the bowel may occur.
Rationale 17: Full explanation must be given and the support of a parent or carer is vital during the procedure.

References

Reference 1:
National Institute for Health and Care Excellence (NICE) (2014) Pathway clinical management of idiopathic constipation in children and young people. Constipation in children and young people: Diagnosis and management of idiopathic constipation in primary and secondary care. NICE Guidelines (CG99) www.nice.org.uk. Viewed on 09/12/2014.

Reference 2:
Abd-El Maeboud et al (1991) quoted in Norton C (1996) The causes and nursing management of constipation British Journal of Nursing 5(20): 1252-8.

Reference 3:
Bradshaw A, Price L (2007) Rectal Suppository Insertion, the reliability of the evidence as a basis for nursing practice. Journal of Clinical Nursing 16(1): 98-103.

Reference 4:
Royal College of Nursing (RCN publication 002 062) (2003) Digital rectal examination: guidance for nurses working with children and young people.  Viewed on: 09/12/2014. 

Document control information

Lead Author(s)

Helen Johnson, Clinical Nurse Specialist - Stoma Care, Surgery

Document owner(s)

Helen Johnson, Clinical Nurse Specialist - Stoma Care, Surgery

Approved by

Clinical Practice Committee

Reviewing and Versioning

First introduced: 
17 May 2005
Date approved: 
04 October 2014
Review schedule: 
Three years
Next review: 
04 December 2017
Document version: 
2.0
Previous version: 
1.0