Proctoclysis, austere alternative to IV

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Re: Proctoclysis, austere alternative to IV

Post by dallas » Thu Sep 22, 2011 4:35 pm

Sodium is actively absorbed in the colon which pulls water in with it.

http://www.siumed.edu/mrc/research/nutrient/gi42sg.html" onclick="window.open(this.href);return false;

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1412420/" onclick="window.open(this.href);return false;

http://gut.bmj.com/content/43/2/294.extract" onclick="window.open(this.href);return false;

That could work against an osotic gradiant. Maybe dilute salt water with fresh and use enemas to double your supply to be safe?

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Re: Proctoclysis, austere alternative to IV

Post by Krustofski » Thu Sep 22, 2011 5:12 pm

Pieter wrote:
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...
Pieter, sorry, I didn't catch the question when you posted it. No, unfortunately I can't find the article. When using google, I find a bunch of people saying "the Brits did that during the Falkland war" (American Preppers network forum, armchairgeneral.com forum, the German Wikipedia article on the Falkland war etc...), but no primary source where that information originally came from.
It was a strange war anyway. The first one in history that had more vets commit suicide over PTSD then actual battle casualties.
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Re: Proctoclysis, austere alternative to IV

Post by 98pointsix » Fri Sep 23, 2011 12:33 pm

357 Sig and Rectal fluid administration?????
I think Liff may be my soulmate
Hey I would also like to mention that in a situation where aseptic technique is next to impossible, one might ponder the question would this be a better protocol that IV?

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Re: Proctoclysis, austere alternative to IV

Post by JIM » Sun Sep 25, 2011 10:41 am

98pointsix wrote:357 Sig and Rectal fluid administration?????
I think Liff may be my soulmate
Hey I would also like to mention that in a situation where aseptic technique is next to impossible, one might ponder the question would this be a better protocol that IV?
For fluid replacement? Yes. Medication? No. Any technique that can save you from breaking the protective barrier (skin) is pretty good in austere conditions. A lot simpler to learn and the water doesn't even have to be potable in order to use it for rectal rehydration.

You don't even have to buy special solutions, tubing and needles for it. Just use a camelbak.. (of the victim, that is :wink: )
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Re: Proctoclysis, austere alternative to IV

Post by colinz » Tue Sep 27, 2011 8:35 am

Darxus wrote:
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.

Link to source
Secondly, get your measurements right: Normal saline is 0.9% concentration. Water weighs 1g per 1ml, so it's pretty easy to figure out that we need to use 9 grams of sea salt per litre of water. If you don't have accurate enough scales, that's about one large, heaped teaspoon of salt per litre of water.

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Re: Proctoclysis, austere alternative to IV

Post by HULK17 » Tue Nov 08, 2011 3:39 am

This topic was discussed in my Wilderness First Responder class. Basically when you would use this method is when the person can not swallow due to trauma(oral, nasal, throat, etc) and/or patient is unconscious or can not keep fluids down (vommitting). Easiest and most common thing to use in the backwoods is a CamelBak type hydration bladder with the bite valve removed. It can be refilled as needed without having to remove and reinsert the tube from the patient and is easy to control the amount of fluid in the bag so they are not getting too much. You can also carry an extra pair of hemostats in your first aid bag to pinch the tubing some to reduce flow rate.


One important thing to remember......... use their CamelBak and not yours:)
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Re: Proctoclysis, austere alternative to IV

Post by Zombiepress » Tue Nov 08, 2011 5:54 am

Does this work, in principle and is there a Physiological explanation as why this could work …yes . Does it out weight IV Fluid administration..... Heck NO!!! Are there other uses for a Proctoclysis that have palpable results ….yes. Would I ever use it to administer Fluids generally NO, very few some times yes.
A IV will always the Golden Standard in regards to Fluid administration.
The only real medical use that has results that would make this a real option is in Neonatal and infant patients, until a IV can be administered. (But if a patient is neonate the best method to administer fluids in peripheral vains are not available is a Intraosseous infusion (IO). IO can also be used on adults on extreme cases like Cholera, in which a patient is losing more them 3-4 lt of liq in mins!!!! IO hit its high light in the 80´s, currently is used only in Pediatrics. Even thou it can and is used in adults with cardiac arrest, major trauma, airway compromise, severe dehydration and shock. There are awesome IO Kits F.A.S.T.1 and the EZ-IO system,very safe and easy to use, granted u need Medical training to use)
If Proctoclysis were to be used as Fluid administration system,the best method would be as a Murphy drip (1000ml/8-24 hrs), with a Folley cathader 16 or larger. Large volumes will only act as a enema. The large intestine can hold 50 – 100 or 150 ml of liq with out inducing a bowel movement. But even that will produce intestinal peristalsis……. This would only be to administer Enough fluids to get a IV Line started.
Other benefits for a Proctoclysis would be help control high grade fever, as Cold/Ice water enemas can be administered and a clamp can be used to let cold/ice fluid absorb some body heat, before its released. The use of a 3 valve key is uses full to not waste time connecting and reconnecting & keeps system from not getting contaminated.
As a whole, the real life scenarios were a Proctoclysis as IV alternative in my professional experience and judgement really don’t exist. I have used it as a via to administer drugs and control high grade fevers while waiting for the IV fever medication to do its work.
If we consider that a patient is in such bad state that Professional medical trained personal can’t find a peripheral vein to start a IV line. The chance of that patient are slim to none and that would leads us to more extreme options that only require a more skilled and more trained medical personal to do. This being in a actual Hospital setting or in the Field with a Hospital near by. But in a actual disaster area were there is no trained personal or Hospital near by, a Proctoclysis would not do anything for that patient.
I would be interested on others ppl field experience on this method as a Proctoclysis, austere alternative to IV. I see no benefit in it.
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Re: Proctoclysis, austere alternative to IV

Post by NorthernAlpine » Thu Nov 17, 2011 11:43 pm

So I was looking for the field recipe for an IV bag. WOW. This one took a terrible turn...or awesome depending on how twisted you are. Thanks for the recipe.

Where I come from, we call the bottom's up route a 'Ranger IV', I have witnessed one being given by one of our exceptionally trained medics during a terrible situation that left us with not much in terms of medical gear to work with. I will vouch for it working, albeit uncomfortable to watch and I'm sure to receive.
I have never tried it the nasal route, but I imagine in theory, using an NPA as a guide device and tubing that fits would work, but I think an NPA goes to the trach and not the esophagus, which would not be good...interesting thought though. Maybe someone who has more in-depth training could enlighten us.

In general, we can only carry so many IV kits, recycling needles and catheters is absurd and the bags have expiration dates or become cloudy, or you may be in a situation which requires fluids with none of the standard nature to administer. At the least this is one of the more colorful reads I've had in a while.


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Re: Proctoclysis, austere alternative to IV

Post by CitizenZ » Fri Dec 02, 2011 11:18 pm

Zombiepress wrote: As a whole, the real life scenarios were a Proctoclysis as IV alternative in my professional experience and judgement really don’t exist. I have used it as a via to administer drugs and control high grade fevers while waiting for the IV fever medication to do its work.
If we consider that a patient is in such bad state that Professional medical trained personal can’t find a peripheral vein to start a IV line. The chance of that patient are slim to none and that would leads us to more extreme options that only require a more skilled and more trained medical personal to do. This being in a actual Hospital setting or in the Field with a Hospital near by. But in a actual disaster area were there is no trained personal or Hospital near by, a Proctoclysis would not do anything for that patient.
I would be interested on others ppl field experience on this method as a Proctoclysis, austere alternative to IV. I see no benefit in it.
Second hand, but someone I know uses this method frequently while caring for dying paitents. Elderly, AIDS and diabetes patients requested it rather than needles, which don't always heal well.
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Re: Proctoclysis, austere alternative to IV

Post by PotatoMuncher » Sat Dec 03, 2011 1:56 am

HULK17 wrote:This topic was discussed in my Wilderness First Responder class. Basically when you would use this method is when the person can not swallow due to trauma(oral, nasal, throat, etc) and/or patient is unconscious or can not keep fluids down (vommitting). Easiest and most common thing to use in the backwoods is a CamelBak type hydration bladder with the bite valve removed. It can be refilled as needed without having to remove and reinsert the tube from the patient and is easy to control the amount of fluid in the bag so they are not getting too much. You can also carry an extra pair of hemostats in your first aid bag to pinch the tubing some to reduce flow rate.


One important thing to remember......... use their CamelBak and not yours:)
In the Army, we called that a Ranger IV.
We medics threatened new infantry privates with this if they didnt drink enough water lol.
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Re: Proctoclysis, austere alternative to IV

Post by Medic Nemec » Sat Dec 10, 2011 7:58 pm

Okay, I have to finally weigh in on this.

To the guy who said IO's are only used in Pediatrics - We (Paramedics) use them in the field on any patients who have poor vasculature and IV access is unobtainable but must be obtained. It is also standard gear for combat medics for the same reason. Combat medics being the reason civilain medics now have the tool, really.

To the rest of the thread - This is a technique taught in paramedic school. It is not covered in great detail, just the principals behind it. It's mentioned along with the part about giving patients rectal medications via large gauge catheter (no needle) with medication filled syringe attached to it when you don't have an IV or IO. Also mentioned in 68W training (combat medic school). Largely being replaced with nasal administration devices now for those medications.
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Re: Proctoclysis, austere alternative to IV

Post by Juliekins » Mon Jan 12, 2015 3:35 pm

Im late to the party, but I get a free pass because im new and shiny.

Hey! I know the difference between my a-hole and a hole in the ground (even though my patients might argue otherwise) :)

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.


I have a question. They typically miss me and stick me 20 times. Last time they had to do a central line which sucked. In a disaster situation, won't many people be dehydrated to some extent, thus making starting an IV incredibly hard?

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Re: Proctoclysis, austere alternative to IV

Post by zXzGrifterzXz » Mon Jan 12, 2015 8:26 pm

Juliekins wrote:I have a question. They typically miss me and stick me 20 times. Last time they had to do a central line which sucked. In a disaster situation, won't many people be dehydrated to some extent, thus making starting an IV incredibly hard?
There is always an IO...... :mrgreen:
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Re: Proctoclysis, austere alternative to IV

Post by Juliekins » Tue Jan 13, 2015 1:18 am

NO GRIFTER!!!!!!!!!!!!! That is NOT an option!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I went to a new hospital in the area, my doc thought I was having another heart attack and sent me there. After 30 missed attempts (even in my feet and IJ (neck)) they opted for a central line which hurt like hell. All this to find out I was to be transferred to Memphis because they weren't authorized to perform heart caths yet.........sigh.

In all seriousness, I am always told ignore instructions and hydrate hydrate hydrate before any procedure. In a SHTF circumstance, you have to figure many will be in various stages of dehydration, and as such will be insanely hard sticks.

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Re: Proctoclysis, austere alternative to IV

Post by duodecima » Tue Jan 13, 2015 10:43 am

Juliekins wrote: In all seriousness, I am always told ignore instructions and hydrate hydrate hydrate before any procedure. In a SHTF circumstance, you have to figure many will be in various stages of dehydration, and as such will be insanely hard sticks.
If it's SHTF or PAW, we'll be damn luck to have IV's for very long at all, and they'll need to be reserved for those in whom really, really agressive oral rehydration is not working.

[rant] IV hydration is great, it is either absolutely necessary, or the best option for some patients. Those patients are usually really seriously ill, tho. In the modern US, I think IV's are somwhat over used. I see a percentage of patients (granted it's a small minority but they are an aggrevating and rant-inducing minority) who simply cannot be bothered to orally hydrate sufficiently because they'd rather just come get an IV. And because IV's are available, they know they don't have to push themselves to drink, and they'll feel better quickly with a couple liters of fluid rather than rehydrating over several hours. I realize these folks are sick, but I've seen young healthy people orthostatic and even shocky because they stopped drinking (and taking their pain pills) because their simple sore throat (no abcesses or anything) "hurt too much." I don't doubt their throat was extremely painful but at some point, if you are nauseaous but not actively throwing up right this sec, or your throat hurts like a son of a gun, or you don't feel like it, you just have to gather your gumption and swallow your liquids, because it's not food, it's not convenience, you're not drinking it because you like to or it tastes good, this is medical treatment and that's sometimes quite unpleasant but it's important. In the PAW, we're not going to be wasting limited IV start kits and fluids if we even have them on people who are capable of oral rehydration WHICH IS THE SUPERIOR THERAPY TO IV'S WHEN POSSIBLE ANYWAY. (Equal to better outcomes, less complications.)[/rant]

Sorry, that's a pet peeve of mine.

Julie, you're absolutely right - the people we really need the IVs in are already really dehydrated and therefore the hardest people to get them in. Murphy's law strikes again...
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Re: Proctoclysis, austere alternative to IV

Post by zXzGrifterzXz » Tue Jan 13, 2015 2:27 pm

Juliekins wrote:NO GRIFTER!!!!!!!!!!!!! That is NOT an option!!!!!!!!!!!!!!!!!!!!!!!!!!!!
I swear I would take the horrible pain of an IO Drill boring into my shin or sternum before anything goes into my butt. Just sayin.
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Re: Proctoclysis, austere alternative to IV

Post by CitizenZ » Fri Mar 06, 2015 5:27 pm

Since this has been revived...

A simple way to hydrate some one is to just soak their butt in a small tub if water with a little salt. Especially useful for kids and the elderly.
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Re: Proctoclysis, austere alternative to IV

Post by duodecima » Fri Mar 06, 2015 8:45 pm

CitizenZ wrote:Since this has been revived...

A simple way to hydrate some one is to just soak their butt in a small tub if water with a little salt. Especially useful for kids and the elderly.
Citation? Because most people's anal sphincters are awesome at keeping stuff (like pool water, or pond water) out, so I'm not sure what the mechanism for this would be.
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Re: Proctoclysis, austere alternative to IV

Post by procyon » Sat Mar 07, 2015 4:26 pm

duodecima wrote:IV hydration is great,
It is wonderful at times. It's biggest sell (for me) is that it allows meds to reach therapeutic levels faster and more reliably. Some meds only work IV, as they won't absorb when given PO. But I agree with Duo, it is WAY overused.
I would say the biggest reason I see IV rehydration used, is that it is far faster than PO. Getting an IV started and a bolus in takes a small fraction of the time that PO rehydration takes and that turns over the room quicker - so folks feel better, faster (happy pts = better survey scores...) and have shorter waits (which means happier pts and more pts through the room in a day).

When our hospital allowed the nurses to handle the after hour peds office phone calls - we helped a lot of folks do oral rehydration at home with their sick kids, and made sure they understood when to call it quits and come out for a visit. It isn't that hard, and nearly always works on the usual stomach bugs that go around.

But I would say that if oral rehydration wasn't an option, and you simply had no way to reach a facility that could provide IV therapy or that IV administration supplies weren't available - that supplies for PR rehydration could be scrounged much more easily.

Med administration PR with a PO med might not be the most reliable, but it beats no meds at all if PO won't work. Just like giving Epi by the ET isn't ideal when we are resuscitating babes, but not giving it isn't going to help either.
Last edited by procyon on Sat Mar 07, 2015 4:32 pm, edited 1 time in total.
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Re: Proctoclysis, austere alternative to IV

Post by procyon » Sat Mar 07, 2015 4:31 pm

zXzGrifterzXz wrote:
Juliekins wrote:NO GRIFTER!!!!!!!!!!!!! That is NOT an option!!!!!!!!!!!!!!!!!!!!!!!!!!!!
I swear I would take the horrible pain of an IO Drill boring into my shin or sternum before anything goes into my butt. Just sayin.
I think the best selling point for PR rehydration would be that - if for some reason hospitals were not an option for some reason (stranded somewhere, whatever...), then PR rehydration supplies are reusable (ok, I know - serious ick). That IO will work - once. And that is it.
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Re: Proctoclysis, austere alternative to IV

Post by zXzGrifterzXz » Tue Mar 10, 2015 2:59 pm

procyon wrote:I think the best selling point for PR rehydration would be that - if for some reason hospitals were not an option for some reason (stranded somewhere, whatever...), then PR rehydration supplies are reusable (ok, I know - serious ick). That IO will work - once. And that is it.
Oh don't get me wrong, if it gets close to life or death I think I won't care what goes in me and where if it gives me a chance.
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Re: Proctoclysis, austere alternative to IV

Post by ColoradoMtnMan » Sun Nov 12, 2017 8:32 am

Edit:
As others have said this intervention requires sodium to be added to facilitate osmotic shift. A patient that is unresponsive and requiring supplemental hydration potentially could have a loss of anal tone. Attempting to flow a liter of water in would be disasterous. A patient that remains obtunded for longer than a few seconds to a minute after trauma, or at all due to a medical condition, requires prompt evacuation and evaluation. It would be appropriate to contact 911 and seek helicopter evacuation for this patient. Post disaster / zombie event - "you are the definitive care", I'd be very supportive of rectal hydration. Hydration in the comatose patient means much so more than just taking care of the metabolic needs of excretion, it helps replace fluid volume that was lost due to illness or injury. I foresee lots of septic patients post-event and the treatment for sepsis is large boluses of fluid to combat the volume loss. This volume depletion ("hypovolemia" aka low volume) leads to poor perfusion, tissue death, organ death and total organ dysfunction and failure. Pioneer days in America, and much of the developing world, was plagued with deaths by hypovolemic shock due to diahhrea, specifically the bloody diahhrea caused by v. cholera. Cure? Fluid replacement via bolus.

I'll look for some specific literature about the proper solution for rectal fluid replacement. In austere conditions with no vascular (or intra osseuos) access I think it would be very beneficial and appropriate.

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Re: Proctoclysis, austere alternative to IV

Post by SRO1911 » Fri Nov 17, 2017 11:53 pm

While IO is greatly preferred when venous access is insufficient, according to a few classes I have been through and situation I have been in - one of the main draws of rectal hydration is with burn patients in the absence of the ability to start a central line or IO.

It was recommended that the cath be removed at intervals (every 500ml) to allow normal BM activity and clear any impaction on the tubing. - Will post citation when I can find it.

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Re: Proctoclysis, austere alternative to IV

Post by grennels » Sun Nov 19, 2017 3:17 pm

The State of Ohio Dept. of Corrections should read this thread. They just interrupted an execution attempt and postponed execution
for 1 1/2 years because they couldn't find a vein for IV.
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