Administering an Enema

EQUIPMENTPrepackaged enema or enema containerDisposable glovesWater-soluble jellyWaterproof padBath blanketBedpan or commodeWashcloth and towelBasinToilet tissue

PROCEDURENursing Action RationalePreparatory phase1.Assess the patient's bowel habits (last

bowel movement, laxative usage, bowel patterns) and physical condition (hemorrhoids, mobility, external sphincter control).

1.Enema should not be given if there is a suspicion of appendicitis or bowel obstruction.

2.Provide for privacy, and explain procedure to patient.

2.Provides comfort.

Performance phase1.Wash hands. 1.Promotes hygiene.2.Place patient on left side with right knee

flexed (Sims' position). Place waterproof pad underneath patient, and cover with bath blanket.

2.Allows for enema solution to flow by gravity along the natural curve of the sigmoid colon and rectum.

3.Place bedpan or bedside commode in position for patients who cannot ambulate to the toilet or who may have difficulty with sphincter control.

3.Allows for easy accessibility.

4.Remove plastic cover over tubing, and lubricate tip of enema tubing 3-4 inches (7.5-10 cm) unless prepackaged (tip is already lubricated). Even prepackaged enema may need more lubricant.

4.Prevents trauma and eases application.

5.Apply disposable gloves.    6.Separate buttocks, and locate rectum.    7. Instruct patient that you will be inserting

tubing and to take slow, deep breaths.7.Allows for patient relaxation

and readiness.8. Insert tubing 3-4 inches for adult patients. 8.Prevents tissue trauma of

rectum.9.Slowly instill the solution using a clamp and

the height of the container to adjust flow 9.Rapid infusion can cause

colon distention and

rate if using an enema bag and tubing. For high enemas, raise enema container 12-18 inches (30.5-45.5 cm) above anus; for low enemas, 12 inches. If using a prepackaged enema, slowly squeeze the container until all solution is instilled.

cramping. Container elevated past 12-18 inches and controller on tubing not regulated contribute to rapid infusion.

10.

Lower container or clamp tubing if patient complains of cramping.

   

11.

Withdraw rectal tubing after all enema solution has been instilled or until clear (usually not more than three enemas).

11.

“Until clear†� means until results do not contain fecal matter and are clear.

12.

Instruct patient to hold solution as long as possible and that a feeling of distention may be felt.

12.

Promotes better results.

13.

Discard supplies in the appropriate trash receptacle.

13.

Maintains hygiene, minimizes patient embarrassment.

14.

Assist patient on the bedpan or to the bedside commode or toilet when urge to defecate occurs.

14.

Prompt action will prevent soiling.

15.

Observe enema return for amount, fecal content. Instruct patient not to flush toilet until the nurse has seen the results.

15.

If enema has not had sufficient time to absorb, result may be mostly clear with little fecal material.

NURSING ALERT Enemas should not be given routinely to treat constipation because they disrupt normal defecation reflexes and the patient becomes dependent.

Follow-up phase1.Document the type of enema given,

volume, and results on the appropriate chart forms.

   

2.Assess and document presence or absence of abdominal distention after enema was given.

2.Relief of abdominal distention indicates success of gas relief.

3.Assist the patient with washing perineum and rectal area, if indicated; may also need a clean gown or linen change.

3.Fecal soiling may result, especially in bedridden patients.

Purposes of Enema Administration Bowel preparation for diagnostic tests or surgery to empty the bowel of

fecal content Delivery of medication into the colon (such as enemas containing

neomycin to decrease the bowel's bacteria count or a kayexalate enema to decrease the serum potassium level)

To soften the stool (oil-retention enemas) To relieve gas (tidal, milk and molasses, or Fleet's enemas) Promote defecation and evacuate feces from the colon for patients

with constipation or an impaction