Proctoclysis, austere alternative to IV

Discussions of the best (or worst) equipment to have on hand for use in the event of an injury during an emergency.

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Re: Proctoclysis, austere alternative to IV

Post by Pieter » Sun May 01, 2011 3:45 am

I can't give any recommendations on gear to use, because I don't have practical experience with this and I can't find any good/trustworthy information. I think that one should be very careful, because a perforated colon in a situation where surgery is unavailable would be very very bad indeed. Also (as said before) when giving medications this way it may be hard to determine correct dosage and results may be very unreliable. Rehydration of a patient who keeps vomitting might be the best application for this. Using an oral rehydration solution seems like a good idea, but I have no solid source to back this up.
There also appears to be very little if any scientific research regarding rehydration this way. This study found no articles on rectal rehydration. The researchers did conclude that nasogastric (a tube through the nose to the stomach) rehydration was as effective as i.v. rehydration for moderate-to-severe dehydration in children, though. This study seems promising, but I can't get the full-text version at home (I'll try to get it at the faculty).
* edited to add second study

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Re: Proctoclysis, austere alternative to IV

Post by KnightoftheRoc » Sun May 01, 2011 4:25 am

naso-gastric may be recommended as a better practice, but I'm betting they already know how to get a hose up a nose... If I HAVE to be shoving a rubber hose inside someone's body, I'd rather not experiment, and I'm pretty sure, after all the years I've threatened to do the same with various items on a job site to certain people, that I could handle shoving a tube up a butt a couple inches. I'm not so worried about perforating a colon, as I am about perforating, well, just about anything else with the other methods, including IV.

A thought on the tubing we discussed earlier- once the tube is in, you want it to stay there, right? So, how do you make sure the internal pressures of the body, and normal muscle movement of the digestive tract doesn't shove the tube out? I'm thinking reflexes alone might do it. So, I was thinking, tie a LOOSE knot in the line, to create a bulky spot, but not a kink in the line, insert the tube till the knot is past the anus, and the anus itself should hold the tube in. This should also have the advantage of not being so big that it could not be removed without injury, and by tying the knot before inserting the hose, you can use it as a stop point- once the knot's in, you know how far the line is in. I'd imagine an actual enema tip would be better, since it's designed for this, but I'm thinking "field expedient" here.
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Re: Proctoclysis, austere alternative to IV

Post by Katica » Sun May 01, 2011 7:13 am

KnightoftheRoc wrote:naso-gastric may be recommended as a better practice, but I'm betting they already know how to get a hose up a nose... If I HAVE to be shoving a rubber hose inside someone's body, I'd rather not experiment, and I'm pretty sure, after all the years I've threatened to do the same with various items on a job site to certain people, that I could handle shoving a tube up a butt a couple inches.
Butt's probably the safer route to go. If I ever had to shove a tube down someone's nose I'd be terrified of going in the airway by mistake.

I hope I never have to shove a tube in anyone.
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Re: Proctoclysis, austere alternative to IV

Post by GP11 » Sun May 01, 2011 12:34 pm

KnightoftheRoc wrote:A thought on the tubing we discussed earlier- once the tube is in, you want it to stay there, right? So, how do you make sure the internal pressures of the body, and normal muscle movement of the digestive tract doesn't shove the tube out? I'm thinking reflexes alone might do it. So, I was thinking, tie a LOOSE knot in the line, to create a bulky spot, but not a kink in the line, insert the tube till the knot is past the anus, and the anus itself should hold the tube in. This should also have the advantage of not being so big that it could not be removed without injury, and by tying the knot before inserting the hose, you can use it as a stop point- once the knot's in, you know how far the line is in. I'd imagine an actual enema tip would be better, since it's designed for this, but I'm thinking "field expedient" here.
I'm thinking a Foley catheter might be the way to go for this this reason. It has a balloon to inflate to keep it in the rectum, and there are setups made to attach an IV bag to the catheter (intended to be used for bladder irrigation).
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Re: Proctoclysis, austere alternative to IV

Post by Kutter_0311 » Sun May 01, 2011 3:40 pm

GP11 wrote:I'm thinking a Foley catheter might be the way to go for this this reason. It has a balloon to inflate to keep it in the rectum, and there are setups made to attach an IV bag to the catheter (intended to be used for bladder irrigation).
This sounds like the way to go, I should get a few.

I wonder if they come in pediatric and neonatal sizes...

ETA: Anyone have a link to buy these?
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Re: Proctoclysis, austere alternative to IV

Post by Pieter » Tue May 03, 2011 2:07 pm

So, I've been looking into this a bit more (from a rehydration point of view) and I have found the following:
- the colon can absorb about 5-8 liters of fluid a day (in a grown up), so the maximum you can give should be 200-300 mililiters per hour;
- the absorbtion of water follows from the active transport of sodium and chloride, so adding a little salt (0,9%) to the fluid probably helps absorbtion.
(source: Guyton, Textbook of Medical Physiology 11e p817)

I've been talking to a paediatrician today and while he never had seen it in practice, he said it should theoretically work. He did warn about backfiring though! :shock:
Last edited by Pieter on Wed May 04, 2011 5:07 am, edited 1 time in total.

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Re: Proctoclysis, austere alternative to IV

Post by SCSi » Tue May 03, 2011 4:18 pm

Liff wrote:Yeah, the way I was taught drug/pharmaceutical absorption was that "all" of the blood from the small intestine goes to the liver first, then out to systemic circulation. The whole large intestine and veins "do not" do this. Administration there goes back to the heart, then out to the body. Ultimately a portion of the cardiac output goes to the liver, but not all of the cardiac output, so the first pass of blood from the intestines to the liver is bypassed.

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I understood it to work the same way. I wouldn't do anything but electrolyte replacement/water via this route, drug absorbtion (unless its made to go up there) is going to be really sketchy at best. At the hospital we administered MSContin tablets PR and got really iffy results. Residual poo, pH fluctuations, etc throw in a ton of factors that make this the route of last resort. If you're dehydrated to the point of needing IV fluids, I think you are better off risking a bad stick than waste valuable time with a funnel and precious drinking water.

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Re: Proctoclysis, austere alternative to IV

Post by Dogan » Tue May 03, 2011 5:06 pm

Didn't Bear Grylls do this with birdshit-filled water on a raft somewhere?
ETA: Yup. :?
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Re: Proctoclysis, austere alternative to IV

Post by Krustofski » Tue May 03, 2011 5:16 pm

Krustofski wrote:In before a B. G. enema reference.
Dogan wrote:Didn't Bear Grylls do this with birdshit-filled water on a raft somewhere?
ETA: Yup. :?
I beat you to it. :P (Yeah, yeah, that's what she said)

@ Topic: Incidentally I read something about the Falkland war today. In the cold subpolar weather, British medics had a lot of trouble gaining access to peripheral veins and simply did volume replacement up the arse. The more you know...
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Re: Proctoclysis, austere alternative to IV

Post by CitizenZ » Tue May 03, 2011 6:52 pm

There are many stories of POW's using this method, after killing a few friends with bamboo needles and catheders.

W.H.O. suggests making a solution of 1L water, 7 teaspoons sugar, 1 teaspoon salt, and (optional) 1 teaspoon baking soda. This is similar to pedialite or gatorade.
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Re: Proctoclysis, austere alternative to IV

Post by KnightoftheRoc » Tue May 03, 2011 9:58 pm

CitizenZ wrote:There are many stories of POW's using this method, after killing a few friends with bamboo needles and catheders.

W.H.O. suggests making a solution of 1L water, 7 teaspoons sugar, 1 teaspoon salt, and (optional) 1 teaspoon baking soda. This is similar to pedialite or gatorade.
So, would my question about using gatorade this way be answered with a "yes", then?

re: Foley Catheters- while I will ALWAYS go with the right tool for the job, when it's available, my statements about the tubing and a knot were with improvising from what was around in mind. Not being in the medical field myself, and having no certifications that would entitle me to purchase medical supplies beyond a certain, basic level, I try to file information away (like this topic) mentally, so that if the need should arise, I'll have a clue about how to make it work with what's on hand. With any luck at all, the small amount of medical knowledge I do have will never be needed. But, that would be in a perfect world, and the world simply isn't set up that neatly.
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Re: Proctoclysis, austere alternative to IV

Post by Pieter » Wed May 04, 2011 5:11 am

Krustofski wrote:@ Topic: Incidentally I read something about the Falkland war today. In the cold subpolar weather, British medics had a lot of trouble gaining access to peripheral veins and simply did volume replacement up the arse. The more you know...
Do you happen to have a link to that article? Interesting stuff and for once something about the Falkland war that's not about trenchfoot...

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Re: Proctoclysis, austere alternative to IV

Post by GP11 » Wed May 04, 2011 5:30 pm

KnightoftheRoc wrote:re: Foley Catheters- while I will ALWAYS go with the right tool for the job, when it's available, my statements about the tubing and a knot were with improvising from what was around in mind.
I dunno; I'd be concerned the knot would occlude the tubing no matter how loose you made it. I'd probably go with liberal application of tape if a Foley weren't available.
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Re: Proctoclysis, austere alternative to IV

Post by KnightoftheRoc » Wed May 04, 2011 10:40 pm

GP11 wrote:
KnightoftheRoc wrote:re: Foley Catheters- while I will ALWAYS go with the right tool for the job, when it's available, my statements about the tubing and a knot were with improvising from what was around in mind.
I dunno; I'd be concerned the knot would occlude the tubing no matter how loose you made it. I'd probably go with liberal application of tape if a Foley weren't available.
I thought of a wad of tape, but was worried about what chemicals might be absorbed by the body from the adhesive- I honestly have no idea how safe it might be, or not. I would go with a figure 8 knot in the tubing- it would be hardest to pinch off the tubing, and least damaging to the body. It's not like anyone (hopefully) is going to be tugging on it to cinch up the knot, once in place- it's not a tent line, after all.
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Re: Proctoclysis, austere alternative to IV

Post by GP11 » Thu May 05, 2011 12:02 pm

KnightoftheRoc wrote:I thought of a wad of tape, but was worried about what chemicals might be absorbed by the body from the adhesive- I honestly have no idea how safe it might be, or not.
I guess I'm biased by being in the medical field and having numerous rolls of medical tape lying around the house--I was just assuming that everyone has medical tape. You can pick up medical-grade tape at any pharmacy (heck, most grocery stores) and that would eliminate any concern, but I doubt that regular tape would cause any problems (although removing a tube duct taped to someone's ass may not be too comfortable).
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Re: Proctoclysis, austere alternative to IV

Post by Liff » Thu May 05, 2011 2:14 pm

Has no one honestly thought of taping the tube to your leg/cheek instead? Seems much more comfortable than making a plug out of tape.

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Re: Proctoclysis, austere alternative to IV

Post by Gingerbread Man » Thu May 05, 2011 2:27 pm

I studied this in college a bit and yes, it works. You can re-hydrate anally. It's not a flush, it's a slow drip. The plumbing down there is highly vascularized and will absorb water. This is also the most rapid way to get drugs into the system without an injection. It's very normal to give the elderly and infants drugs this was. It's quickly absorbed and they can't spit out/choke on the pills.
If some one is unconscious and unable to swallow, you can rehydrate them this way. It is this simple.
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Re: Proctoclysis, austere alternative to IV

Post by dyslexicpenguin » Thu May 05, 2011 3:06 pm

Confucius wrote:
Aww shucks...




Correct me if I am wrong here (and good chance that I am), but if trying to replenish electrolytes (or give nutrients or whatnot via broth, pedialite, sugar, whatever), wouldn't the fluid have to be of a greater osmotic pressure than blood?
You would want the osmolarity of the solution to be as close to that of blood as possible(isotonic) which I think is about 300 milliosmoles/liter...but I'm not 100% sure on that. Having a hypertonic or hypotonic solution can cause major problems if it's a significant difference in osmolarity. Hypertonic will cause red blood cells to shrivel, hypotonic will cause red blood cells to swell, and even burst.

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Re: Proctoclysis, austere alternative to IV

Post by CitizenZ » Thu May 05, 2011 3:17 pm

Apparently there is also a S&M type erotic aspect where peope give themselves alchohl enemas, for a cheap quick drunk... with an unsually high incidence of death. Don't do that.
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Re: Proctoclysis, austere alternative to IV

Post by Gingerbread Man » Thu May 05, 2011 4:29 pm

CitizenZ wrote:Apparently there is also a S&M type erotic aspect where peope give themselves alchohl enemas, for a cheap quick drunk... with an unsually high incidence of death. Don't do that.
Yeah, the body goes into alcohol poisoning fast due to the rate at which the alcohol is absorbed. Kinda overwhelms the system. The body can metabolize the alcohol fast enough.
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Re: Proctoclysis, austere alternative to IV

Post by GP11 » Thu May 05, 2011 5:30 pm

Liff wrote:Has no one honestly thought of taping the tube to your leg/cheek instead? Seems much more comfortable than making a plug out of tape.
That's what I was suggesting--trying to tape it like you would an IV. It hadn't occurred to me to do it any other way.
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Re: Proctoclysis, austere alternative to IV

Post by KnightoftheRoc » Thu May 05, 2011 9:49 pm

Liff wrote:Has no one honestly thought of taping the tube to your leg/cheek instead? Seems much more comfortable than making a plug out of tape.
Really? :roll:
Ever try waxing your taint? :lol:

I'm just kidding with you, don't take offense, as none is meant.
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Re: Proctoclysis, austere alternative to IV

Post by MJS8725 » Wed May 11, 2011 12:58 pm

Liff wrote:Has no one honestly thought of taping the tube to your leg/cheek instead? Seems much more comfortable than making a plug out of tape.
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Re: Proctoclysis, austere alternative to IV

Post by Darxus » Thu Sep 22, 2011 3:18 pm

I was doing a google images search for "shtf gloves", saw a funny cat picture, clicked it, and came across this subject.

A guy ate some bad soup, ended up with such bad diarrhea that he was took weak make it back to his bedroom from his bathroom, ended up in an emergency room, with a re-hydrating IV. He was talking about getting gear to give himself an IV in an emergency, and other people pointed out that in an emergency, without medical experience, an enema is much safer: http://thesurvivalpodcast.com/forum/ind ... pic=4511.0" onclick="window.open(this.href);return false;
I'm wondering if the most useful bit of information from this might be, if you have really bad diarrhea, and you're feeling weak, don't assume it's a direct effect of whatever your sickness is, recognize that it's probably dehydration, and make sure to force fluid consumption as much as you possibly can.

CitizenZ wrote: W.H.O. suggests making a solution of 1L water, 7 teaspoons sugar, 1 teaspoon salt, and (optional) 1 teaspoon baking soda. This is similar to pedialite or gatorade.
That's a link I'd be interested in.

Kutter_0311 wrote: By the way, what sort of gear should be used for this? IV tube? Small garden hose? Bicycle tire inner tube?
I'm thinking anything you can get in there smaller than a garden hose.

KnightoftheRoc wrote: Is there a simple, field expedient recipe a person could mix for this? I'd like to know I could deal with a person's need for hydration, nourishment, restoring electrolytes, etc. if I had to. Would applying a dose of Gatorade this way work for two out of three? Could it be that simple?
Water. If you can, a little table salt. An ex-girlfriend of mine who was a piercer pointed out that you can roughly guess appropriate salinity by getting it to taste like tears. Not exactly expert medical advice, but if somebody was crippled by dehydration and you don't have a professional, it's a good place to start.

dallas wrote:I have heard of one family that survived a ship wreck with no water by using saltwater enemas.
That sounded potentially useful to me. So potentially useful that it seemed very likely that if it were true I would have seen enemas in life-boat ration gear, and I haven't. A quick google search brought me to: "In case of severe dehydration the body will more quickly be hydrated with an enema. It is a method that has saved knowledgeable survivors. But careful not to use salt water (sea water is as dangerous absorbed rectally as it is orally)." - http://www.caske2000.org/survival/survivesea.htm" onclick="window.open(this.href);return false;
Makes sense, osmosis would pull water out of your body to balance the salinity in the water.
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