EXTERNAL DOUCHE

Definition: It is the washing of genitals and anal area with water, soap and/or medicated solution.
Purposes:
1. To cleanse the area of secretion and excretions.
2. To reduce unpleasant odors.
3. To prevent skin irritation and excoriation.
4. To control the potential for infection.
5. To promote comfort.
Equipment:
1. Bedpan with cover.
2. Waterproof underpad.
3. Bath blanket (optional)
4. A tray containing the following:
a. Sterile covered flushing can with sterile water or solution to be used.
b. Sterile pick up forceps in a disinfectant solution.
c. A jar of dry sterile CB (optional).
d. A jar of sterile CB soaked in soap sud solution.
e. A jar of sterile CB soaked in antiseptic solution.
f. Kidney basin lined with paper for waste.
g. Toilet paper. (client’s supply)
h. A piece of paper to wrap vaginal pads.
i. Working forceps in a sterile pack
j. Working gloves (2 pairs)
k. Sterile bowl or sterile kidney basin
5. Adult diaper or sanitary pad (client’s supply; optional)
6. Perineal cream or lotion if needed

Procedure
Action Rationale
1. Assess the need for external douche.

2. Identify the patient and explain the Exchanging information allays fears and
procedure. promotes cooperation.

3. Wash your hands. Handwashing reduce the transient

microorganism thus, deters the spread to
client and self.

4. Assemble and bring equipment to Organization promotes efficient time

the bedside. management.

5. Screen the client and close the door/ This ensures the patient’s privacy.
windows if possible.

6. Raise the bed to working height.

To protect the nurse from infection
7. Don gloves

8. Place waterproof pad, if available, as Cleansing may wet or soil an unprotected bed.
well as change the top sheet with
bath blanket if available.
9. Drape the client. This provides warmth and respect the privacy
of the client.
10. Remove adult diaper/sanitary pad.
Roll with the contaminated inside
and wrap with a piece of paper. Place
it on the paper lining under the bed.
11. Place the client on a bedpan in a
dorsal recumbent position. A bedpan will collect the water used during
perineal cleansing.
12. Change working gloves. Prepare
sterile pack. Open sterile bowl or
kidney basin. Place 7 or more CB
soaked in soap suds solution. Open
sterile working forceps and place it
on the sterile field with the handle at
the edge. Prepare tissue wipes at the
edge of the sterile field.

13. Lift the cover of the flushing can and

fold with sterile side inside. Test the To protect the inner side of the flushing can
water temperature (105°F or 41°C) from contamination. Testing the temperature
by pouring small amount of water of water prevents burns.
over the back of your hand and then
on the client’s thigh.
14. Flush the area with warm water or a
soapy solution until the area is clean. Water dissolves or dilutes dried secretions.
Soap emulsifies fatty substances in the skin
15. With one cotton ball soaked in SSS, and reduces the ability of microbes to grow
wash the mons veneris in zigzag and multiply.
motion going upward toward the
lower portion of the hypogastrium.
16. Use a second cotton ball in SSS to
wash the inner aspect of the farther Thorough cleansing and care should be taken
thigh. Beginning in the crease of the to avoid introducing secretions and bacteria
groin and continuing outward into the opening through which urine is
toward the knee. These strokes are release. Contamination of this area can lead to
made with a back – and - forth a urinary tract infection.
motion and are carried well
underneath the thigh.
17. A third cotton ball in SSS is used to
wash the inner aspect of the nearer
thigh using similar stroke.
18. A fourth cotton ball in SSS is used to
wash the farther labia majora in a
downward stroke towards the groin.
19. Do the same on the other labia.
20. A sixth cotton ball in SSS is used to
wash, with one downward stroke,
from the clitoris, meatus, vaginal
opening to perineum.
21. The above step is repeated with a 7th
cotton ball in SSS, and to include the
anus.
22. Rinse with sterile water and pat dry
using toilet paper from front to back.
23. Remove the client from the bedpan.
Loosen the drape from the legs. Turn Moisture supports the growth of
to side and dry the buttocks. microorganisms and contributes to
discomfort.
24. Apply lotion on the buttocks as
needed (optional).
 An emollient helps to soothe excoriated
25. Put on diaper or sanitary pad and or
tissue.
underwear. Remove the waterproof
pad and replace the bath blanket
with topsheet. Make the patient
comfortable.
24. Bring equipment back to the utility
room and do the after care.
Controlling the spread of pathogens is a
25. Remove gloves and wash your hands. primary principle of asepsis.
26. Document the performance of the Handwashing deters the spread of
procedure, the objective and microorganisms.
subjective findings and the patient’s
response. Written information documents the
individualized care of the patient.

1
2 3

4 5

Legend:
1. mons 4. far labia
2. far leg 5. near labia
3. near leg 6. meatus to anus

Figure 2. Strokes Used in External Douche

SAMPLE DOCUMENTATION

Date Time Nurse’s Notes

4 – 28 – 2017 8:00 AM Perineal care provided. Moderate amount

of lochia rubra noted on perineal pad.
Episiotomy wound and perineum swollen. Bean-
sized external hemorrhoids noted. Verbalized
feeling of comfort after the procedure.
 SAN PEDRO COLLEGE
Davao City

PERFORMANCE CHECKLIST
EXTERNAL DOUCHE

Name: __________________________________ Grade: ________________________

Year and Sec.: _________________ Date : ________________________

Legend: 5 – Excellent; 4 – Very good; 3 – Good; 2 – Fair; 1 – Poor

Rating
5 4 3 2 1
1. Washes hands thoroughly.
2. Prepares equipment and adjusts bed to a comfortable
working height.
3. Brings preparation to the bedside. Identifies patient and
explains procedure.
4. Provides privacy to the patient. Positions the patient
supine.
5. Changes topsheet with bath blanket.
6. Places bed protector.
7. Drapes patient with bath blanket and exposes the
perineal area.
8. Places patient on bedpan in a dorsal recumbent position.
9. Tests temperature of the water (410C or 1050F).
10. Flushes the area with warm water.
11. Applies soap using CB soaked with soap sud solution
using zigzag motion starting from the mons pubis. Uses
one cotton ball on each stroke.
12. Applies another cotton ball on the far groin going up
using zigzag stroke. Uses the same stroke on the near
groin.
13. Separates labia and applies another CB on each labia
using gentle downward stroke.
14. Applies the 6th CB soaked in soap sud solution using
downward stroke from the clitoris, meatus, vaginal
opening and perineum. The stroke is repeated with the
last CB, including the anus.
15. Rinses the area well.
16. Dries area from top down using toilet paper.
17. Removes bedpan and turns client to side immediately.
Dries the buttocks with toilet paper.
18. Applies lotion as needed.
19. Removes bed protector by rolling it to the center.
20. Replaces blanket with topsheet and makes client
comfortable.
21. Examines the content of the bedpan and throws it into
the toilet bowl.
22. Brings equipment back to the utility room and does the
after care.
23. Removes gloves and washes hands.
24. Documents the procedure and other pertinent
observation.
25. Maintains body mechanics throughout the performance
of the procedures.
26. Manifests neatness in the performed procedure.
27. Receptive to criticisms.
28. Observes courtesy.
29. Shows calmness while performing the procedure.
30. Uses correct English.
31. Shows mastery of the procedure.

Remarks:
Criteria : I Knowledge (quiz) 30%
II Performance 70%
100%

________________________________ __________________________
Student’s Signature Over Printed Name Date

________________________________ __________________________
Instructor’s Signature Over Printed Name Date