Administering an Enema
An enema is a solution inserted into the rectum and sigmoid colon for the purpose of removing feces and/or flatus. Enemas can also be used to instill medications or nutrition. A cleansing enema is probably the most common type of enema. This type of enema stimulates peristalsis via irritation of the colon/rectum and by causing intestinal distention with fluid. The solution used in a cleansing enema must be chosen with care. Some solutions, such as tap-water-based solutions, draw fluid and electrolytes out of the body. They should not be used in clients with preexisting fluid and electrolyte imbalances. There are two general types of cleansing enemas: the large-volume enema and the smallvolume enema. A large-volume enema is designed to clean the colon of as much feces as possible. In a large-volume enema between 500 and 1000 cc of fluid is instilled into the rectum/colon and the client is asked to retain the fluid as long as possible. This allows the fluid to soften and loosen the feces. The large volume of fluid also distends the bowel, stimulating peristalsis. Largevolume enemas are the traditional intervention for constipation. Traditionally soapsuds enemas were used, and many large-volume enema kits still come with a small packet of liquid soap to be dissolved in the enema solution. Soapsuds enemas are very irritating to the colon and are rarely ordered anymore. Large-volume enemas are often ordered prior to procedures or surgeries that require visualization of the colon. When used for this reason, the physician or qualified practitioner will often order “enemas until clear.” This indicates that large-volume enemas are to be given until the fluid returned is clear of fecal matter. Most institutions have guidelines regarding the maximum number of large-volume enemas that can be administered to a client. Small-volume enemas are designed to clear the rectum and the sigmoid colon of fecal matter. Smallvolume enemas can be delivered with the traditional enema kit using 50 to 200 cc of solution, but most frequently they are administered using a prepackaged disposable enema. There are a number of prepackaged small enemas available. These enemas work by using a hypertonic rectal stimulant that stimulates peristalsis and draws fluid from the intestinal walls to soften the feces. Because these enemas use the body’s own fluid to lubricate the stool, this type of enema is contraindicated in clients who are dehydrated. Prepackaged enemas are easily administered and available over the counter in most drug stores. This makes them ideal for home care use. purposes other than cleansing. An oil retention enema is a small-volume enema that instills oil into the rectum. The oil is retained for up to an hour and is designed to soften very hard stool. It is often followed by a large-volume cleansing enema. Medications can be administered by enema as well. A small-volume enema can deliver a medicated solution directly to the rectal mucosa. This method of medication administration is useful when the rectum is the area to be medicated if the client is unable to take oral medications or if rapid absorption of the medication is required. The return-flow enema is used to remove flatus and stimulate peristalsis. It is frequently used following abdominal surgery to reduce intestinal distention and to stimulate the resumption of bowel function. Many different solutions are used for enemas, including tap water, normal saline, hypertonic solutions, soap solutions, oil, and carminative solutions. Tap water is a hypotonic solution. Because it is a less concentrated solution than the body’s cells, it is drawn into the body and may cause water toxicity, electrolyte imbalance, or circulatory overload. Normal saline is an isotonic solution. It is the same concentration as the body’s own fluids and is considered to be a safe enema solution. It is important that children and infants only be given normal saline enemas since their small size predisposes them to fluid imbalances. Prepackaged smallvolume enemas use hypertonic solutions to draw fluid from the body to lubricate the stool and distend the rectum. Hypertonic solutions are contraindicated in dehydrated clients and small children. Carminative solutions are used to provide relief from gas. An example of a carminative enema is MGW solution, which is 30 cc of magnesium, 60 cc of glycerin, and 90 cc of water. Enemas are contraindicated in clients with bowel obstruction, inflammation, or infection of the abdomen or if the client has had recent rectal or anal surgery. If the nurse has any question regarding the advisability of administering an enema, she should consult the client’s physician or qualified practitioner.
EQUIPMENT NEEDED :
Large Volume, Cleansing Enema
• Absorbent pad for the bed
• Disposable gloves
• Bedside commode or bedpan if client will
not be able to ambulate to bathroom
• Enema container
• Tubing with clamp and nozzle
• Thermometer for enema solution
• Toilet tissue
• IV pole
• Washcloth, towel, and basin
Large Volume, Cleansing Enema
1. Wash hands.
2. Assess client’s understanding of procedure and provide privacy.
3. Apply gloves.
4. Prepare equipment
5. Place absorbent pad on bed under client. Assist client in attaining left lateral position with right leg flexed as sharply as possible. If there is a question regarding the client’s ability to hold the solution, place a bedpan on the bed nearby .
6. If specified, heat solution to desired temperature using thermometer to measure. Enemas administered to adults are usually given at 105°–110°F (40.5°–43°C), and those administered to children are usually administered at 100°F (37.7°C). Solution should be at least body temperature to prevent cramping and discomfort.
7. Pour solution into the bag or bucket; add water if needed . Open clamp and allow solution to prime tubing. Clamp tubing when primed.
8. Lubricate 5 cm (2 inches) of the rectal tube unless the tube is part of a prelubricated enema set
9. Holding the enema container level with the rectum, have the client take a deep breath. Slowly and smoothly insert rectal tube into rectum approximately 7–10 cm in an adult.The rectum of an adult is usually 10–20 cm (4–6 inches).The tube should be inserted beyond the internal sphincter.Aim the rectal tube toward the client’s umbilicus
10. Raise the container holding the solution and open clamp. (If using an enema set, squeeze the container holding solution).The solution should be 30–45 cm (12–18 inches) above the rectum for an adult, and 7.5 cm (3 inches) above the rectum for an infant.The solution may be placed on an IV pole at the proper height.
11. Slowly administer the fluid.
12. When solution has been completely administered or when the client cannot hold any more fluid, clamp the tubing and remove the rectal tube, disposing of it properly.
13. Clean lubricant, any solution, and any feces from the anus with toilet tissue.
14. Have the client continue to lie on the left side for the prescribed length of time.
15. When the client has retained the enema for the prescribed amount of time, assist to the bedside commode or toilet or onto the bedpan. If the client is using the bathroom, instruct not to flush the toilet when finished.
16. When the client is finished expelling the enema, assist to clean the perineal area if needed.
17. Return the client to a comfortable position. Place a clean, dry protective pad under the client to catch any solution or feces that may continue to be expelled.
18. Observe feces and document data.
19. Remove gloves and wash hands.