Giving enemas

Enema
Definition:
• An injection of a liquid in to the rectum, to be returned or retained.
• Used to refer to the process of instilling fluid through the anal sphincter into
the rectum and lower intestine for a therapeutic purpose.
Purpose:
• To cleanse the lower bowel,
• To assist in the evacuation of stool or flatus
• To instill medication
Cleansing enema/evacuating enema/

Definition
• Cleansing of a portion of the bowel by insertion of fluid rectally

Purpose
• To relieve gas, constipation or fecal impaction
• To cleanse the bowel prior to surgery, childbirth, or diagnostic examination.
• To evacuate the bowel in patients with neurologic dysfunction.
• Evacuates feces in clients with hemiplegia, quadriplegia or paraplegia
• Delivers medication
Types of liquid used for cleansing enema
Tape water = 5000 to 1000 cc
Soap solution= 5000 to 1000 cc
Normal saline - made by mixing one teaspoon of salt in a liter of water
usually contains 1000cc of normal saline.
Epsom salt 15 gm - 120 gm in 1000 cc of water
Precautions
• No need to use too much soap - this may produce sever irritation of the
membrane of the colon.

• Tap water must be administered consciously for infants or adults who have
altered kidney or cardiac reserve this is to avoid water intoxication.
Contraindications
• Rectal surgery
• Rectal /anal/ cancer
• Rectal infection
• for a patient with appendicitis
• Rectal /Ana/ fissure
Equipments 7. Gauze to apply lubricant /swab/

1. Container for solution 8. Bed pan and toilet tissue

2. Solution at temperature for adult 40-9. IV pole/stand

430c 10. Gloves
3. Bath thermometer for infant (37.70c) 11. Receiver /kidney dish/

4. Water proof material /mackintosh/ 12. Lubricant

5. Screen, bath blanket, towel 13. Rectal tube /catheter /

6. Enema can with tube 14. Clamp, connector, funnel
Procedure
1. Check physician's order patient

2. Prepare solution for cleansing enema

3. Gather equipment

4. Provide privacy

5. Wash your hand

6. Identify correct patient and explain the procedure to the patient

7. Fill water container with 750 to 100 cc of Luke warm solution

8. Allow solution to run through the tubing so that air is removed

9. Raise bed to high position and lower side rails

10. Place bed protector under patient

11. Place patient on left side /left lateral / in a sim’s position

12. Lubricate the tip of the tubing with water soluble lubricant
13. Gently insert tubing 3 to 4 inch (6-8cm) in to patients rectum pass the
external and internal sphincters

14. Raise the water container to a maximum height of 45cm

15. Allow solutions to flow slowly

16. Hold the tubing in place in the patient's rectum at all times. Keep abed
pan near by

17. After you have instilled the solution, gently remove the tubing instruct
patient to hold solution for 10 to 15 minutes.
18. Elevate the head of the bed so that the patient can assume as squatting
position on the bedpan or assist to bathroom.
19. Provide privacy until the patient has expelled the total volume of the
instilled solution
20. Removal and cover bed pan
21. Assist patient with perineal care and help patient to assume a comfortable
position
22. If the patient is on strict input and out measure returns to make sure total
volume of the solution is expelled.
23. Clean all equipment and replace in both room or appropriate vocation
24. Wash your hands
Retention enema
Definition: -
• An injection of a liquid in to the rectum, to be retained in the rectum for
some period of time

Purpose:
• To supply the body with fluid
• To give medication
• To soften impacted fecal matter
Equipment
1. Enema can
2. Lubricant
3. Clean bedpan
4. Small enema tube
5. Towel
6. Small enema tube
7. Rubber sheet
8. Possible solution (normal saline, tab water etc)
9. Ordered medication
Procedure

1. Identify and prepare patient as for any enema

2. Fill the ordered solution to the enema can

3. Position patient

4. Expose anal opening and insert rectal tube tip of container 3-4 inches

5. Squeeze contents slowly and empty entire amount in to rectum

6. Remove rectal tube gently

7. Explain to patient that the solution should be retained for one to three
hours before it is expelled

8. A cleaning enema may need to be given to remove the solution (oil) and
stimulate defecation

9. Clean all equipment and wash your hand

Offering rectal wash
out
Definition
• An injection of a liquid in to the rectum to be wash out the rectum and colon

Purpose
• To prepare the patient for x-ray examination and sigmoidoscopy
• To prepare the patient for rectum and colon operation
Precaution
• The rectal wash out should not exceed for more than 2 hours

• The rectal wash out should be finished one hour be for examination (e.g. x-
ray, sigmoidoscopy) this is to give time for the large intestine to absorb the
rest of the fluid

• Give cleansing enema half hour be for the rectal wash out.
Equipment 8. Tubing and glass connecting
1. Pitcher 9. Rectal tube or catheter and clamp
2. Newspaper 10. lotion thermometer
3. small jug 11. Mackintosh and towel
4. Large mug for fluid 12. swab and Vaseline
5. Bucket 13. Solution of (40 co)
6. Funnel 14. glove
7. Bedpan
Procedure
1. Explain the purposes of the procedure to patient

2. Prepare the solution ordered by the physician

3. Bring equipment to bedside

4. Screen the bed and place the patient in the left lateral position with the
buttocks on the edge of the bed
5. Place the mackintosh and towel underneath the buttocks

6. Check the temperature of the fluid and fill the small jug

7. Lubricate the catheter

8. Run the fluid through to expel air and clamp it.

9. Expose the anal region separate the buttocks, with one hand and insert the
rectal tube in to the rectum 8-10 cm
10. Open the clamp and allow to run about 100 cc of fluid in the bowl, then
siphon back in to the bucket

11. Carry on the procedure until the fluid returned is clear

12. Remove the catheter and leave the patient comfortable

13. The amount returned should be measured to ensure that none has been
retained

14. Record or chart the time, result and effect on the patient
Inserting flatus/rectal
tube
Definition

• The insertion of a rectal tube is done to manage flatulence (gas)

following abdominal surgery and/or reduce abdominal distention
due to flatulence.
Purpose

• It can be used to alleviate abdominal distention.

• It is used to control diarrhea that cannot be controlled with medical

management and/or the use of rectal pouches, pads, or diapers due to
extensive skin breakdown
Equipment
1. Rectal tube or catheter, 22 to 30 French

2. Water-soluble lubricant

3. Bedside drainage bag (optional, if rectal tube used to manage diarrhea)

4. Ostomy odor eliminator or similar product (optional)

5. Clean gloves

6. Disposable pads or towels

Procedure
1. Explain rationale regarding need of tube and its short duration of use.

2. Collect the necessary equipment

3. Wash hands.

4. Assemble equipment.

5. Explain procedure to client.

6. Position client in left lateral position with upper leg bent over lower leg
7. Place disposable pads (if not available, use towels).

8. Use odor eliminator per manufacturer (optional).

9. Apply gloves.

10. Apply lubricant to a gloved finger.

11. Insert lubricated finger into rectum to check for possible obstructions prior
to insertion of rectal tube.

12. Change gloves if soiled from rectal exam.

13. Lubricate end of catheter.

14. Gently insert catheter into anal canal approximately 10–15 cm (4–6 inches)

15. Attach plastic bag or drainage bag to end of catheter if needed to control
odor or stool

16. Inflate balloon of catheter or tape tube to the lower buttock if rectal tube
is not to be removed within 30 minutes

17. Dispose of pad. Remove soiled gloves and place in appropriate receptacle.

18. Wash hands

Contraindications
Suspected or confirmed rectal mucosa impairment
Recent large bowel surgery or rectal surgery within the past year
Sensitivity or allergies to any of the materials used in the device
Rectal or anal injury
Severe rectal or anal stricture or stenosis
Fecal impaction
Poor rectal tone
Rectal/anal tumor
Severe hemorrhoids,
Thank
you