ENEMA

ENEMA
• The introduction of a solution into the rectum for cleansing and therapeutic purposes.
• Enemas may be commercially packed disposable units or reusable equipment prepared just before use.

Administering Enema
Purposes:
1. To relieve constipation and fecal impaction
2. To relieve flatulence
3. To administer medication
4. To evacuate feces in preparation for diagnostic procedure or surgery
Types of Enema
1. Cleansing enema
 Simulates peristalsis by irritating the colon and rectum and or by distending the intestine with the volume of fluid introduced.
 High enema – to clean as much of the colon as possible; 1000 ml of solution is introduced to an adult.
 Low enema – to clean the rectum and the sigmoid colon; 500 ml of solution is introduced to an adult.
2. Carminative enema
 To expel flatus. 60-180 ml of fluid is introduced
3. Retention enema
 Introduces oil into the rectum and sigmoid colon; oil retained in 1 to 3 hours. Acts to soften the feces and to lubricate the rectum and anal canal, facilitating passages of feces
4. Return flow/Colonic irrigation
 Done to expel flatus
 300-500 ml of fluid is introduced into and out of the large intestines to stimulate peristalsis and to promote expulsion of flatus.
 The solution container us lowered so that the fluids backs out through the rectal tube into the container
 The inflow-outflow process is repeated 5-6 times
 Replace the solution several times during the procedure as it becomes thick with feces
 This procedure may take 15-20 minutes to be effective
Non-Retention Enema
 Solutions are as follows
 Tap water (500-1000ml)
 Soap suds (20 ml of castile soap in 500-1000ml of water)
 Normal Saline Solution (9ml of NaCl to 1000ml of water)
 Hypertonic Solution/Fleet enema (90-120ml)
 Height of Solution
 18 inches above the rectum
 Temperature of Solution
 115-125 F on preparation
 Time of retention
 5-10 mins. for better cleansing effect
Retention Enema
 Solutions are as follows
 Carminative enema
 Oil (90-120ml of mineral, olive or cottonseed oil
 Height of Solution
 12 inches above the rectum
 Temperature of Solution
 105-110 F on preparation
 Time of retention
 1-3 hours until desired therapeutic effect is obtained
Nursing Interventions in Enema Administration
1. Check the doctor’s order
2. Provide privacy
 To prevent feeling of embarrassment
3. Promote relaxation.
 To relax anal sphincter and facilitate insertion of rectal tube.
4. Position the client:
 Adult – left lateral position
 Infant/Small children – dorsal recumbent
5. Sizes of rectal tube to be used are as follows;
 Adult: Fr 22-32
 Children: Fr 14-18
 Infant: Fr 12
6. Lubricate 5 cm (2in) of the rectal tube
7. Allow solution to flow through the connecting tube and rectal tube to expel air before insertion of rectal tube.
 This prevents introduction of air into the colon
8. Insert 7-10 cm (3-4in) of rectal tube gently in rotation motion.
 To prevent irritation of anal and rectal canal.
9. Introduce solution slowly.
 To prevent sudden stimulation of peristalsis and the client can better tolerate introduction of solution.
10. Change the position to distribute solution well in the colon (high enema); if low enema, remain in left lateral position.
11. If the order is cleansing enema
 Give the enema 3x
 Alternate hypotonic solution with isotonic solution to prevent water intoxication or hypoosmolar fluid imbalance
12. If abdominal cramps occur during introduction of solution, temporarily stop the flow of solution by clamping the tube until peristalsis relaxes.
13. After introduction of the solution, press buttocks together to inhibit the urge to defecate.
14. Ask the client who is using the toilet not to flush it.
 The nurse must observe the return flow
15. Do perianal care
16. Make relevant documentation

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