Perineal сare for a bedridden patient (female)

Authors: V.Rednenko 

Editor: V.Rednenko 

Equipment for the practical skill:

• Simulated patient (patient manikin)
• Hospital bed with bedding
• Manipulative table
• Disinfection table with wast containers
• Disposable cleaning cloths (cloth, cotton wool, gauze)
• Towels
• Bath blanket
• Bed protector
• Wash basin
• Pitcher with warm (40-45º С) water
• Bath thermometer
• Soap
• Paper towels
• Gloves, sleeve protectors, apron
• Clean clothing
• Clean linens (if needed)
• Bedpan

Clinical situation:

Patient N. is in the neurological department with acute cerebrovascular accident, she is assigned to the perineal care. The patient is bedridden. Carry out the prescribed procedure.

Order of the skill performance:

Preparatory stage:

• Introduce yourself
• Identify patient
• Obtain informed consent to the procedure (if the patient's condition allows it)
  • Give all the information to the person about what the procedure involves, including the benefits and risks, whether there are reasonable alternative, and what will happen without this procedure
  • Explain what you are going to do.
  • Ask the patient to consent to procedure.
  • Explain to the patient how he can help.
• Make sure you have the necessary equipment and put it on the over-bed table (the chair next to the bed)
• Sanitize your hands, put on gloves
• Prepare the patient bed:
• Raise the bed to a comfortable working height.
• Make sure the wheels on the bed are locked

Main stage:

•  Arrange the procedure supplies on the manipulative table (Cover the over-bed table with the paper towels and arrange these supplies).
  • Open the package with disposable cleaning cloths (cloth, cotton wool, gauze). Put them in a tray if necessary.
  • Fill the wash basin with warm water from the pitcher. Use the bath thermometer to verify that the water temperature is between 105° F and 115° F (40-45º С). Place the wash basin on the top shelf of manipulatieve table (over-bed table).
• Prepare the patient for the procedure
  • Lower the head of the bed as low as the person can tolerate.
  • Cover the person and the top sheet with the bath blanket (to provide privacy and warmth). Ask the person to hold the edge of the bath blanket (or tuck the edges under the person’s shoulders) while you fold the top linens down to the bottom of the bed.
  • Put on the gloves.
  • Help the person to remove soiled clothing.
  • Have the person bend her knees and spread her legs as much as possible. Have the person raise her buttocks off the bed, and place a bed protector under the person’s hips.
  • Elevate the woman’s pelvis by placing a bedpan (or a folded towel or bath blanket under her buttocks).
  • Adjust the bath blanket as needed so that only the perineal area is exposed.
• Prepare a disposable cleaning cloth.
  • If it is a cloth or gauze square 
    • Holding a corner of the washcloth between your thumb and fingers.
    • Wrapping the rest of the washcloth around your hand and holding it with your thumb.
    • Folding the cloth over your fingers and tucking it under the fold in your palm.
  • If it is cotton, shape it into cotton swabs.
  • Wet the washcloth and put soap on the washcloth.
  • Separate the labia with one hand.
  • Wash the perineal area using a new wipe (or clean side) for the each next step (for each stroke). Place the used clothes in the waste container
    • pubis;
    • right inguinal fold at the top toward the anus;
    • left inguinal fold at the top toward the anus;
    • right labia majora at the top to down;
    • left labia majora at the top to down;
    • right fold between the labia majora and labia minora at the top to down;
    • left fold between the labia majora and labia minora at the top to down;
    • middle (vaginal opening) at the top to down;
    • peruneum at the top toward the anus;
    • anus. 

• • If necessary, rinse the treated area with water from a pitcher
  • Dry the perineal area with a clean clothes, using the same steps as you did when washing and rinsing. Place the used clothes in the waste container
  • Remove the bedpan or the folded towel or bath blanket.

• Help the person turn onto one side so that his or her back is facing you.
• Using your other hand, separate the buttocks.
• Moving from the genitals toward the anus (front to back), wash one side, then the other side, and then the middle, using a different part of the washcloth for each stroke.

• Dry the anal area with a clean towel, using the same steps as you did when washing and rinsing.
• Remove the bed protector.
• If the linens are soiled or wet, change the linens.
• Remove and dispose of your gloves.
• Help the person back into the supine position.
• Help the person to put on clean clothing.
• Pull up the top linens and remove the bath blanket.

 Final stage:

• Ensure the person’s comfort and good body alignment.
• Adjust equipment for safety: Lower the bed to the level specified in the person’s care plan. Make sure the wheels on the bed are locked. Place the person’s method of calling for help within reach. Lower or raise the side rails according to the person’s care plan.
• Clean up your work area.
• Wash your hands.