college of nursing 1

ENEMA ENEMA ADMINISTRATIONADMINISTRATION

By:

Jose Byron Dadulla-Evardone RN

college of nursing 2

ENEMAENEMA

• Enema – the process of instilling fluid through the anal sphincter into the rectum & lower intestine for a

therapeutic purpose.• Is performed using a flexible plastic rectal

tube with several large holes in the tip.• This is connected to the tubing from a

solution bag or container.

college of nursing 3

ENEMAENEMA

• An enema can also be performed using a prepackaged solution that comes in a soft plastic bottle with a pre-lubricated rectal tip attached.

• Enema solutions are prepared using plain tap water or saline, soapsuds solutions, oil solutions, or various medication solutions.

college of nursing 4

MECHANISM OF ENEMAMECHANISM OF ENEMA

• The most common purpose for administering an enema is to stimulate peristalsis (involuntary contraction) and to evacuate stool from the rectum.

college of nursing 5

PURPOSE OF ENEMAPURPOSE OF ENEMA

Enemas are used to treat:

1.1. ConstipationConstipation

2. Cleanse the bowel before a bowel exam or before bowel surgery.

3. Deliver medication directly onto the rectal mucous membranes to be absorbed into the bloodstream.

college of nursing 6

TYPES OF ENEMATYPES OF ENEMA1. Tap water or soapsuds enema dilates the

bowel, stimulates peristalsis, and lubricates the stool to encourage a bowel movement.

• These types of enemas are instilled and held for five to 10 minutes, as tolerated.

2. Oil retention enema is prepared in a smaller volume and is retained in the bowel for 30-60 minutes.

• The purpose is to soften the hardened stool and allow normal elimination.

college of nursing 7

TYPES OF ENEMATYPES OF ENEMA

3. Steroid enema solutions can be administered to alleviate bowel inflammation in patients with ulcerative ulcerative colitiscolitis.

4. Antibiotic enema solutions can be administered to treat localized bacterial infections.

college of nursing 8

TYPES OF ENEMATYPES OF ENEMA

5. Medicated hypertonic enema solutions can be used to pull excessive potassiumexcessive potassium or ammoniaammonia from the bloodstream through the rectal wall.

• These substances are then eliminated with the stool.

college of nursing 9

PRECAUTIONSPRECAUTIONS

• Enemas should not be used as a first-line treatment for constipation.

• Frequent use of enemas can lead to fluid overload, bowel irritationbowel irritation, and loss of muscle tone of the bowel and anal sphincter.

• NeverNever deliver more than three consecutive enemas to treat a patient.

college of nursing 10

PRECAUTIONSPRECAUTIONS

• A patient with diarrheadiarrhea may not be able to hold an enema.

• Must be used with caution in cardiac patients who have arrhythmias or have had a recent myocardial infarctionmyocardial infarction.

• Insertion of the enema tube and solution can stimulate the vagus nerve which may trigger an arrythmias such as bradycardia.

college of nursing 11

PRECAUTIONSPRECAUTIONS

• Enemas should not be given to patients with undiagnosed abdominal pain because the peristalsis of the bowel can cause an inflamed appendix to rupture.

• Should be used cautiously in patients who have had recent surgery on the rectum, bowel, or prostate gland.

• If the patient has rectal bleeding or prolapse of rectal tissueprolapse of rectal tissue from the rectal

college of nursing 12

PRECAUTIONSPRECAUTIONS

opening, cancel the enema and consult with the physician before proceeding.

• Do not force the enema catheter into the rectum against resistance. This can cause traumatrauma to the rectal tissue.

• Use only mild castile soap for soapsuds enemas because other soap preparations are too harsh and irritate the rectal tissue.

college of nursing 13

EquipmentsEquipments

• Disposable incontinent pad

• Disposable gloves

• Swabs

• Lubricant Jelly

• Enema

• Bath Thermometer

college of nursing 14

PREPARATIONPREPARATION• Before administering an enema, ensure the

patient’s privacy by closing the room door.• The patient should be encouraged to empty

both bladder and bowels before the procedure.

• Have the patient undress completely from the waist down.

• Position the patient on the bed on his or her left side with the top knee bent and pulled slightly upward toward the chin.

college of nursing 15

college of nursing 16

• Place a waterproof pad under the patient’s hips to protect the bedding and drape a sheet over the patient covering the entire body except the buttocks.

• Place a bedpan and toilet paper within quick access.

• Explain the procedure to the patient.• Emphasize the importance of breathing

slowly through the mouth to encourage relaxation of the rectal sphincter and to avoid oppositional pressure.

college of nursing 17

• Let the patient know that while he or she may feel the urge to defecate, most enemas need time to work and he or she should try to hold the fluid for at least 5 to 10 at least 5 to 10 minutesminutes after instillation (30-60 minutes30-60 minutes for retention enemas and longer for some medicated enema solutions).

• Check the medication label if it is a medicated solution to avoid medication errors.

college of nursing 18

• Be sure it is the right medicine, the right dose (strength), the right time, the right person, and the right method.

• Verify the expiration date on the label. Do Do not use outdated medicinenot use outdated medicine.

• Wash hands thoroughly and put on gloves.• To prepare for premixed disposable enema

instillations, follow the directions on the package.

• Most premixed disposable enemas come with the tip already lubricated.

college of nursing 19

Inflatable Silicone Balloon Tip Inflatable Silicone Balloon Tip Enema NozzlesEnema Nozzles

college of nursing 20

• Shake the solution bottle.

• Remove the cap from the tip and expel excess air from the apparatus before use.

• To prepare solutions to be administered using an enema bag, heat the solution to 105`F105`F (40.6`C40.6`C).

• Adult solutions are generally 750-1000cc750-1000cc of solution for a non-retention enema and 150-200cc150-200cc of fluid for a retention enema.

college of nursing 21

Enema AdditivesEnema Additives

college of nursing 22

• Children’s solutions are 250-500cc250-500cc of solution for a non-retention enema and 75-75-150cc150cc of solution for a retention enema.

• Infant’s solutions are 150-250cc150-250cc of solution for a non-retention enema.

• If preparing a medicated solution, follow the physician’s orders.

• Select a rectal tube appropriate to the pt’s size (#14-30 French rectal tube14-30 French rectal tube for an adult, #12-1812-18 for a child, #1212 for an infant) and connect it to the tubing from the bag.

college of nursing 23

Rectal Inflation Nozzle with Rectal Inflation Nozzle with Syringe (working tip inflated)Syringe (working tip inflated)

•

college of nursing 24

• Fill the enema bag with the solution and open the tubing.

• Run the solution through the tubing to the tip of the rectal tube to clear air from the line.

• Clamp the tubing and adjust the bag on an IV pole so that it will hang at the patient’s hipline.

• Put water soluble lubricant on a clean 4x4 gauze pad and roll the tip of the rectal tube in the lubricant.

college of nursing 25

Retention Enema Bag SystemRetention Enema Bag System

college of nursing 26

• Coat all of the rectal tube that will be inserted into the rectum to avoid traumatizing the rectal tissue [3-4 inches3-4 inches (7.3-10 cm7.3-10 cm) for an adult, 2-3 inches2-3 inches (5-7.5 5-7.5 cmcm) for a child, 1-1 ½ inches1-1 ½ inches (2.5-4 cm2.5-4 cm) for an infant].

college of nursing 27

PROCEDUREPROCEDURE• To administer an enema solution, the

clinician should have the patient lie down on the left side, knees bent. Lift the upper buttock so that the rectal opening can be visualized.

• Place the lubricated tip of the enema catheter at the anal opening, and gently advance the catheter through the anal sphincter into the rectum toward the umbilicus (navel), 3-4 in (7.5-10 cm)3-4 in (7.5-10 cm) for an adult.

college of nursing 28

• Insert the tubing 2 in (5 cm)2 in (5 cm) for a child < 6 yrs and 1 in (2.5 cm)1 in (2.5 cm) for an infant.

• After alertingalerting the patient, open the enema tubing to allow solution to flow or squeeze premixed enema solutions slowly into the rectum.

• If the patient complains of cramping, slow slow or stop the enema flowor stop the enema flow and have the patient breathe slowly through the mouth to encourage relaxation.

• When giving fluid through an enema bag, start with the bag suspended from an IV

college of nursing 29

pole at the patient’s hip level.• As the tubing is opened, slowly raise the IV

pole to promote fluid flow until the bag is 12 inches (30.5 cm) above the hip12 inches (30.5 cm) above the hip for an adult.

• Continue to hold the rectal tube in place throughout the procedure or it will be expelled from the rectum.

• If the fluid will not flow in, gently rotate the tubing within the rectum to clear the holes of the tubing from the wall of the bowel or the impacted stool that may be

college of nursing 30

occluding the flow.• If ordered to give a high enema, slowly

raise the bag no more than 18 in (46 cm) 18 in (46 cm) above the adult patient’s hipabove the adult patient’s hip; 12 in (30.5 12 in (30.5 cm) above a child’s hipcm) above a child’s hip and 6 in (15 cm) 6 in (15 cm) above an infant’s hipabove an infant’s hip. This will increase the water pressure to deliver the fluid higher into the bowel.

• When all of the solution has been administered, clamp the tubing, remove the enema catheter, and release the buttock.

college of nursing 31

The Enema TankThe Enema Tank

college of nursing 32

AFTERCAREAFTERCARE

• After administering an enema, remain near the patient in case he or she needs assistance with the bedpan or to get to the bathroom.

• Medicated enemas that are expelled immediately may need to be repeated, using fresh solution.

• Follow the directions or consult with the physician.

college of nursing 33

• To assist the patient with retaining an enema after instillation, apply gentle pressure to the rectal opening using a 4X4 gauze pad or squeeze the buttocks together.

• Tuck a 4X4 gauze pad between the buttocks to collect seepage. This maneuver may help the patient feel more secure.

• Cover the patient after the procedure and instruct him or her to lie still for 5 to 10 5 to 10 minutes or longerminutes or longer if a medicated solution or retention enema is administered. This

college of nursing 34

will allow time for the sol’n to take effect.• Wash items that might be reused, such as

non-disposable enema bags and tubing, in warm soapy water. Rinse and allow them to air dry.

• Place disposable items, gauze pads, & gloves in a trash bag, then seal & discard it.

• Assist the patient to the bathroom or with the bedpan after he or she has held the enema solution for the correct amount of time.

college of nursing 35

• Hands should be washed after performing the procedure.

• Note the results of the enema (color, consistency, content and amount of feces produced).

college of nursing 36

COMPLICATIONSCOMPLICATIONS

• Complications of enema administration are not common but can include irritation, irritation, swelling, redness, bleeding, or prolapse of swelling, redness, bleeding, or prolapse of the rectal tissuethe rectal tissue.

• If any of these symptoms are apparent, or if the patient complains of pain or burningpain or burning during enema instillation, stop the procedure and notify the physician.

college of nursing 37

The End!