UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Hemorrhoid Banding
Effective Date: February, 2005 Approval: See Authorization
Supersedes Protocol: None Contact: Clinical Staff Education
Reviewed March 2008 May 2009 November 2011
PURPOSE: To provide guidelines for setting up and assisting with hemorrhoid banding at UWMF Clinics.
DEFINITION: The removal of enlarged internal hemorrhoids.
POLICY: The clinical staff will utilize the following guidelines to set up and assist with hemorrhoid banding.
SUPPLIES: Provider’s order, Patient’s record, Non-sterile Drape, Anoscope, Ligator (2) and rubber bands for
the ligator, clamp, Hemostat, Gauze, Lubricant
1. Check provider’s order and clarify any inconsistencies.
2. Introduce yourself and identify the patient. Include date of birth. Verify allergies.
3. Provide good light and provide privacy by closing curtains and door.
4. Room patient – Refer to Provider Preference List for Rooming Patients.
5. Explain procedure to the patient.
6. Following the provider’s discussion with patient, have patient sign Consent form.
7. Wash hands and gather equipment.
8. Have patient kneel at the end of the table, stretching his/her body forward over the table. Uncover patient’s
buttocks. Cover patient’s exposed area with non-sterile drape.
9. Put on gloves and connect anoscope to light source, assist provider (as needed).
10. Remove gloves and wash hands
11. Assist patient to comfortable position and assist with dressing (if needed).
Direct patient to restroom (if needed)
Direct patient back to waiting room
Assist patient with follow-up appointment (if needed)
12. Re-glove and disconnect anoscope from light source.
13. Apply gloves and clean all surfaces with Dispatch
Bring surgical tray and instruments to dirty utility room
Discard waste and disposable equipment in proper receptacles
Wash instruments and tray in dirty utility room
Soak anoscope, ligator and clamps in Metricide
Remove gloves and wash hands
Bring instruments to clean utility room
Package hemostats for sterilization (if used)
14. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
Procedure performed, date and completed
name and amount of any medications given (using SmartPhrase: .medinclinic)
how the patient tolerate the procedure
follow-up appointment (if any)
WRITTEN BY: Betty Casey, R.N., General Surgery Clinic
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Educator
REVIEWED BY: Kelly Meyer R.N., Department of General Surgery
Kowalak, J. P. (Ed.). (2009). Lippincott’s nursing procedures (5th ed.). Ambler, PA: Lippincott Williams &
Perry, A.G. & Potter, P.A. (2002). Clinical nursing skills & techniques. (5th ed.). St. Louis, MO: Mosby.
Perry, A.G. & Potter, P.A. (2009). Fundamentals of nursing. (7th ed.). Hall, A. & Stockert, P.A. (Eds.). St.
Louis, MO: Mosby Elsevier.
Department of Surgery Date
Medical Director Date