ENEMA

The instillation of a solution into the rectum and sigmoid colon to promote defecation.

Types of Enema
1. Cleansing enema – promotes complete evacuation of feces from the colon by stimulating peristalsis through infusion of large volumes of solution.
-in preparation to surgery and or diagnostic procedure

2. Oil-retention enema- lubricates the rectum and colon, soften the feces, and facilitates defecation.
- used alone or as an adjunct to manual removal of fecal impaction

3. Medicated enema – contains pharmacological therapeutic agents.
- to reduce dangerously high serum potassium levels, or to reduce bacteria in the colon before bowel surgery.

4. Carminative enema – small amount of enema solution (100-200 ml) is administered into the client’s rectum and colon. Container is then lowered & the solution flows back through the enema tubing to the container. Flatus will also return.
- to relieve accumulated flatus

Equipments:

Enema bag/enema can toilet tissue
Water proof absorbent underpads bath blanket
Water-soluble lubricant disposable gloves
Bedpan/bedside commode/access to toilet IV stand/pole
Wash basin, wash cloths, towel and soap

PROCEDURE
1. Inform client about the procedure
R: To promote cooperation

2. Assemble articles needes
R: for efficiency

3. I f using an enema bag, fill it with 750-1000 ml warm tap water as it flows from the faucet. Check temperature of water by pouring small amount over inner wrist. Remove air from tubing by allowing solution to fill tubing.
R: Hot water can burn intestinal mucosa. Cold water can cause abdominal cramping and is difficult to retain.

4. Clamp tubing

5. Assist client into left side-lying position with right knee flexed. Encourage client to remain in position until procedure is completed. Place client in as comfortable and private environment as possible.
R: Allows enema solution to flow downward by gravity along natural curve of sigmoid colon and rectum, thus improving retention of solution.

6. Place waterproof pad absorbent side up under hips and buttocks.
R: To prevent soiling of linen

7. Cover client with bath blanket, exposing only rectal area, and clearly visualize anus.
R: Provide warmth, reduces exposure of body parts, allows client to feel more relaxed and comfortable.

8. Lubricate 7.5 to 10 cm (3-4 in) of tip pf rectal tube with lubricating jelly.
R: Lubrication provides for smooth insertion of rectal tube without rectal irritation or trauma.

9. Gently separate buttocks and locate anus.

10. Instruct client to relax by breathing out slowly through the mouth.
R: Breathing out promotes relaxation of external anal sphincter.

11. Insert tip of rectal tube slowly by pointing tip in direction of client’s umbilicus.
Adult: 7.5 to 10 cm (3-4 in) past the rectal sphincter
R: Careful insertion prevents trauma to rectal mucosa from accidental lodging of tube against rectal wall. Forceful insertion beyond 10 cm (4 in) could cause bowel perforation.

12. Hold tubing in rectum constantly until end of fluid instillation.
R: Bowel contraction can cause expulsion of rectal tube.

13. With container at client’s hip level, open regulating clamp and allow solution to enter slowly.
R: Rapid infusion can stimulate evacuation and cause cramping

14. Raise height of enema bag slowly to 30 to 45 cm (12 to 18 in) above the anus. Infusion time varies with volume of solution administered (1 L may take 7 to 10 min).
R: Raising container too high causes rapid infusion and possible painful distention of colon.

15. Hang container on IV pole

16. Lower container or clamp tubing if client complains of cramping or if fluid escapes around rectal tube.
R: Temporary cessation of infusion minimizes cramping and promotes ability to retain all the solution.

17. Clamp tubing after all the solution is infused

18. Tell client that the procedure is completed and that you will be removing rectal tube. Then gently remove rectal tube.
R: Client may misinterpret the sensation of removing the tube as a loss of control

19. Explain to client that feeling of distention is normal. Ask client to retain solution as long as possible (5 to 10 min) while lying quietly in bed.
R: Solution distend bowel. Length of retention varies with type of enema and client’s ability to contract rectal sphincter. Longer retention promotes more effective stimulation of peristalsis and defecation.

20. Assist client to bathroom or commode if possible.
R: Normal squatting position promotes defecation.

21. Instruct client with a history of cardiovascular disease to exhale while expelling enema to avoid the valsalva maneuver (forced effort against a closed airway)
R: The valsalva maneuver is strenuously trying to move a constipated stool and may result in cardiac arrest.

22. Assist client to wash anal area with warm soap and water.
R: Fecal content can irritate the skin. Hygiene promotes client’s comfort

23. Do after care.

RECORDING
1. Client’s signs and symptoms
2. Type of enema given
3. Results including color, amount, and appearance of stool