UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION
CLINICAL POLICY AND PROCEDURE
TITLE: Thrombosed Hemorrhoid
Incision and Drainage
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 the incision and drainage of a thrombosed
hemorrhoid at UWMF Clinics.
DEFINITION: The incision and drainage of a hemorrhoid is needed when blood clots form and accumulate
POLICY: The clinical staff will utilize the following guidelines to set up and assist with the incision and
drainage of a thrombosed hemorrhoid.
SUPPLIES: Provider’s order, Patient’s record, No. 11 or 15 blade, KY Jelly, anoscope, Non- sterile drape,
10cc Syringe with 25G or 26G needle, Hemostat, Gauze, 2 sets non-sterile gloves, chux,
betadine, Lidocaine with Epinephrine 1%, Pick up (with teeth), small scissors,
Permit for Operation
1. Check provider’s order and clarify any inconsistencies.
2. Wash hands and gather equipment.
3. Introduce yourself and identify the patient. Include date of birth. Verify allergies.
4. Provide good light and provide privacy by closing curtains and door.
5. Room patient – Refer to Provider Preference List for Rooming Patients.
6. Explain procedure to the patient.
7. Following the provider’s discussion with patient, have patient sign Permit for Operation and sign as a
8. Have patient remove bottom clothing and wrap non-sterile drape around waist.
9. Have patient kneel at the end of the table, and cover patient with drape.
10. Put on gloves, and assist provider (as needed).
11. Remove gloves and wash hands
12. 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)
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 instruments for sterilization
14. Documentation (in Progress Notes section of HealthLink) in the patient’s record:
the procedure performed, date & time 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
Sarah C Schaefer, R.N., General Surgery Clinic
REVISED BY: Carol Decker, RN, MSN, Clinical Staff Education
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