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Summary
This article describes the use and effectiveness of proctoclysis (rectal fluid infusion) in providing fluid resuscitation in the absence of intravenous access in rural and remote environments.
Keywords
Fluid replacement therapy, haemorrhage, pre-hospital care, rectal infusion, remote nursing
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EMERGENCY PRE-HOSPITAL treatment of haemorrhage includes immediate fluid replacement therapy, which requires intravenous access, rapid infused intravenous fluids and control of the source of bleeding. The aim is to restore an adequate circulating blood volume and reverse hypotension to perfuse vital organs and reduce the risk of death (National Institute for Clinical Excellence 2004). In remote or rural settings, a lack of sterile fluids, intravenous equipment or the knowledge to use them might limit the options available for fluid replacement therapy. In a pre-hospital emergency situation where clinical intervention is indicated, rectal fluid infusion can provide an easy and effective solution to fluid replacement.
Advent of proctoclysis
At the beginning of the 20th century John Benjamin Murphy, an entrepreneurial American surgeon, introduced the drip method of saline solution via the rectum in the treatment of patients with peritonitis (Rutkow 2001). This infusion technique, known as proctoclysis, or the 'Murphy drip', was used to rehydrate and deliver medication in solution to treat a number of conditions.
With the advent of the first world war, medical developments were required urgently for the management of battlefield injuries. Concerned that blood volume in soldiers recovering from blood loss returned to normal slowly, Robertson and Bock (1919) recognised that fluids introduced via the rectal mucosa could increase tiie circulating blood volume. The researchers first gave proctoclysis to soldiers who had previously received blood transfusions, but still had a low blood volume. Soldiers were also encouraged to take oral and rectal fluids. As soon as possible after injury, wounded soldiers were given large quantities of water orally, and salt solution via the rectum. In turn, the blood pressure rose progressively and the circulating volume increased. These changes were often apparent after only two or...