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.
Give full explanation of the procedure to the child 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 to try and go to the toilet to open their bowels first (Rationale 3).
Gather equipment together (Rationale 4):
Administration of suppository
Remove the child’s nappy or underwear.
Ask the child 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).
Put on disposable gloves (Rationale 8).
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 9 and 10).
Suppositories are usually placed rounded end first, however 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).
Ask the child to retain the suppository as long as possible (Rationale 11).
If the suppository is used to evacuate the rectum, sit the child on the toilet, commode or bedpan to empty the bowel (Rationale 12).
If the suppository is for medication purposes eg analgesia; wipe excess lubricating jelly off the perineum and replace the child’s nappy or underwear (Rationale 13).
Issues to consider regarding suppository administration
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 (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) (RCN, 2003).
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 universal 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: To adhere to universal precautions.
Rationale 9: Lubrication of the suppository will make insertion easier.
Rationale 10: Fully inserting the suppository against the wall of the rectum will allow it to be retained longer and therefore be more effective.
Rationale 11: The longer the suppository is retained the better the result, and the more medication is absorbed.
Rationale 12: Sitting on the toilet or commode allows the most effective position to empty the rectum.
Rationale 13: Absorption rates of medication in suppository form are variable and can take anything up to one hour.
Rationale 14: Any anastamosis could be damaged and haemorrhage could occur if biopsies have been taken.
Rationale 15: Children who have lowered immunity are susceptible to increased bacteria within the rectum and 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.
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.
Royal College of Nursing (RCN publication 000934) (2003) Digital rectal examination and the manual removal of faeces: the role of the nurse. 3rd edition. Viewed on: 17/05/2005.
Royal College of Nursing (RCN publication 002 062) (2003) Digital rectal examination: guidance for nurses working with children and young people. Viewed on: 17/05/2005.
Document control information Lead author(s)
Helen Johnson, Clinical Nurse Specialist - Stoma Care, Surgery Document owner
Helen Johnson, Clinical Nurse Specialist - Stoma Care, Surgery Approved by
Clinical Practice Committee First introduced:
17 May 2005
4 October 2012
4 October 2014