Administering An Enema(Enema Bag & Prepackaged Enema)

Outlines •Definition

•Types Of Enema

•Indication &contraindication

•Equipment

•Clinical procedure

Definition

An enema is the procedure of introducing liquids into the rectum and colon via the anus . The increasing volume of the liquid causes rapid

expansion of the lower intestinal tract, often resulting in very uncomfortable bloating,

cramping, powerful peristalsis, a feeling of extreme urgency and complete evacuation of

the lower intestinal tract.

Types of Enema,indication&contraindication

1-Tap water (TWE) (hypotonic): Amount: 500- 1000cc Action: distends, increases

peristalsis Time: 15 minutes Indicated: inflamed bowels /

rritated colon Contraindicated: Atonic bowels, fluid restrictions

2- Physiological normal saline (Isotonic) Amount: 500 -1000 Action: distends, increases

peristalsis Time: 15 minutes Indicated: inflamed bowels /

irritated colon Contraindicated: Na retention problems, fluid restrictions

3-Hypertonic solution: -It requires small volumes to stimulate defecation, so

it is useful for patients who cannot tolerate large volumes of fluid (e.g., commercially prepared Fleet

enema). Amount: 120 -180 Ml Action:

distends, irritates colon Time: 5 – 10 minutes Indicated:

constipation Contraindicated: dehydration, Na problems

4-Cleansing enema: It is the instillation of enough fluid

into the colon to help soften the feces, stimulate peristalsis, and provide lubrication in preparation for

evacuation .

5- Harris flush enema:

It is a return flow enema that helps to expel intestinal gas .Fluid alternately flows into and out of the large

intestine. This stimulates peristalsis in the large intestine and assists in expelling gas. 6- Soapsuds enema (SSE):

It is pure castile soap added to either tap water or normal saline, depending on patient's condition and frequency of administration. Add soap to enema bag

after water is in place to reduce suds Amount: 500 -1000 cc (Castile 5 ml/1000cc)

Action: distends, irritates colon Time: 15 minutes Indicated: constipation Contraindicated: prior

to rectal exam

7- Oil-retention enema: Uses an oil-based solution. The colon absorbs

small volume, which allows the oil to Soften stool for easy evacuation.

Amount: 120 – 200 cc Action: Lubricating rectum and colon

Time: 30 minutes Indicated: Fecal impaction

Contraindication: none 8- Anthelminthic Enema:

Anthelminthic drugs help destroy intestinal parasites, a solution of an anthelmintic drug

may be instilled with enema for retention

9-Medicated Enema: It’s administration of a drug with enema solution, it is indicated for

unconscious, mouth or throat surgery.

Contraindications to enema administration: Larger volumes of solution that cause a forceful evacuation of

the bowel, bringing about straining on the part of the client are contraindicated in the following:

- Increased intracranial pressure

- Recent brain surgery or dangerous brain tumor - Rectal or uterine prolapse - Recent eye or rectal surgery

- Uncontrolled high blood pressure Precautions

-Improper administration of an enema may cause electrolyte imbalance (with repeated enemas)

-The enema tube and solution may stimulate the vagus nerve, which may trigger an arrhythmia such as

bradycardia. - Enemas should not be used if there is an undiagnosed

abdominal pain since the peristalsis of the bowel can cause an inflamed appendix to rupture.

-Regular treatments should be avoided by people with heart disease or renal failure.

Equipment Clean gloves water soluble lubricant

Waterproof pad Toilet tissue Bedpan or access to toilet IV pole

Basin, washcloth, towel and soap stethoscope

enema Bag Administration -Appropriate-size rectal tube (adult: 22-30 Fr; child: 12-18 Fr)

-Correct volume of warmed solution (adult: 750- 1000 ml, adolescent: 500-700 ml; school-age child 300-500ml, toddler:

250-350 ml; infant: 150- 250 ml)

Prepackaged Enema Prepackaged enema container with

rectal tip

Steps Rational

Assessment

1-Review physician's order for type and

times

2-Assess patient's status Last bowel

movement, presence of hemorrhoids,

mobility and presence of abdominal pain

-determines need for enema and establishes baseline for bowel function

3-Assess medical record for presence of

increased intracranial pressure, cardiac

disease, glucoma, or recent abdominal,

rectal, or prostate surgery.

-conditions contraindicates use of enemas

4-Inspect abdomen for presence of

distention and auscultate for bowel

sounds

-Establishes baseline for determining effectiveness of enema

5-Determine patient's idea about

enema purposes

Implementation

1-Perform hand hygiene, and apply

clean gloves

-reduces

microorganisms

2-Provide privacy by closing curtains

around bed or closing door

-reduces

embarrassment for

patient

3-Raise bed to appropriate working

height for nurse; raise side rail on

patient's left side

-promotes good

body mechanics

&pt. safety

4-Assist patient into left side-lying (Sim's)

position with right knee flexed.(child in

dorsal recumbent .)

-allows enema solution

to flow downward by

gravity along natural

curve of sigmoid colon

and rectum

5-Place waterproof pad under hips and

buttocks

-prevents soiling of

linen

6-Cover patient with bath blanket, exposing

only rectal area clearly visualizing anus

-Provides warmth,

reduces exposure of

body parts

7-Separate buttocks, and examine

perianal region for abnormalities,

including hemorrhoids, anal fissure,

and rectal prolapse.

-findings will

influence nurse's

approach to

insertion of enema.

8-Place bedpan in easily accessible

position. If patient will be expelling

contents in toilet, ensure that toilet is

free.

9-Administer enema

a- Administer prepackaged

disposable enema

1-Remove plastic cap from tip of

container. Tip is already lubricated, but

you can lubricate it more

-lubrication provides

for smooth insertion

of rectal tube to

avoid irritation or

trauma.

2-Gently separate buttocks, and locate

rectum. Instruct patient to relax by

breathing out slowly Through mouth

-breathing out

promotes relaxation

of external rectal

sphincter

3-Expel any air from the enema container -Introducing air into

colon causes distention,

discomfort

4-Insert tip of container gently into anal

canal

And angle tip toward the umbilicus

-Gentle insertion

prevents trauma to

rectal mucosa

5-Roll plastic bottle from bottom to tip

until all of solution has entered rectum

and colon. Instruct patient to retain

solution until urge to defecate occurs,

usually 2 to 5 minutes.

-prevents instillation

of air into colon and

ensures all contents

enters rectum.

6 -Place layers of toilet tissue around

tube at anus, and

gently withdraw rectal tube and tip

7- Explain to patient that some

distention and abdominal cramping is

normal. Ask patient to retain solution

as long as possible while lying quietly

in bed.(for infant or young child or

unconscious, gently hold buttocks

together for few minutes.)

8- Discard enema container and tubing

in proper receptacle

9-Assist patient to bathroom, or help to

position patient on bedpan

10-Observe character of feces and solution

(caution patient against flushing toilet before

inspection)

11-Assisst patient as needed with washing

anal area With warm water and soap

12-Remove and discard gloves, and perform

hand hygiene

Evaluation

1-Inspect color, consistency,

and amount of stool, odor,

and fluid passed

2-Assess condition of

abdomen

Recording and Reporting -Record type, volume of enema given,

time of administration, characteristics of results, and patient's tolerance of

procedure. -Report failure of patient to defecate and

any adverse effects.

b-Administer enema using enema bag:

1-Add 750 to 1000 ml of warmed solution to

enema bag: warm tap water as it flows from

faucet, place saline container in basin of

warm water before adding saline to enema

bag, and check temperature of solution by

pouring small amount of solution over inner

wrist .

-hot water will burn

intestinal mucosa. Cold

water will cause

abdominal cramping

and is difficult to retain.

2-If SSE ordered, add castile soap after water. -prevents bubbles in bag

3-Raise container, release clamp, and

allow solution to flow long enough to

fill tubing

-Removes air from

tubing

4-Reclamp tubing -prevents loss of

fluid

5-Lubricate 6 to 8 cm of tip of rectal

tube with lubricating jelly

-Allows smooth

insertion of rectal

tube to avoid

trauma.

6-Gnetly separate buttocks, and locate anus.

Instruct patient to relax by breathing out

slowly. Then, touch patient's skin next to

anus with tip of rectal tube.

-Breathing out and

touching skin with the

tube promotes

relaxation of external

anal sphincter.

7-Insert tip of rectal tube slowly by pointing

tip in

-careful insertion

prevents

8-Hold tubing in rectum constantly until end

of fluid instillation

-prevents expulsion of

rectal tube during

bowel contraction

9-Open regulating clamp, allow solution to

enter slowly with container at patient's hip

level .

-Rapid instillation

stimulates evacuation

of rectal tube

10-Raise height of enema container slowly to

appropriate level above anus: 30 to 45 cm for

high enema, 30 cm for regular enema, 7.5 cm

for low enema. Instillation time varies with

volume of solution administered (e.g.,

1L/10min)

(High pressure causes rupture of bowel in

infants)

-Allows for continuous,

slow instillation of

solution; raising

container too high

causes rapid instillation

and possible painful

distention of colon.

10-Instill all solution, then clamp

tubing

-prevents

entrance of air

into rectum

11-Repeat the steps from 6 to 12

,evaluation, recording and

reporting as in the prepackaged

enema procedure.

Prepackaged Enema

Thank you