Administration of Enema Nursing Procedure by Nurses Note
A common procedure to relieve constipation or evacuate the lower bowel is an enema, the installation of a solution into the rectum and sigmoid colon. Faecal impaction may cause constipation or small amounts of diarrhoea or liquid faecal seepage around the obstructing impaction. Impaction may be removed manually to promote bowel elimination
Purpose of Enema Administration
- Bowel preparation for diagnostic tests or surgery to empty the bowel of faecal content
- Delivery of medication into the colon (such as enemas containing steroids to treat ulcerative proctitis 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)
- To promote defecation and evacuate faeces from the colon for patients with constipation or an impaction
Indications and Contraindications of Fecal Impaction Removal
- Consider manual removal of faecal impaction in the following patients at risk
- Elderly people with chronic constipation or insufficient hydration, or who are inactive
- Orthopaedic patients who have been in traction or in body casts.
- When barium has not been adequately removed after radiologic examination.
- Patients with neurologic or psychotic disorders.
- Faecal impaction can occur with a descending/sigmoid colostomy. The fingers may be used to break up feces through the stoma, followed by cleansing irrigation
- Manual removal of faecal impaction can stimulate the vagus nerve and cause syncope. It is contraindicated in the following conditions:
- Pregnancy.
- After genitourinary, rectal, perineal, abdominal, or gynecologic surgery.
- Myocardial infarction, coronary insufficiency, pulmonary embolus, heart failure, heart block.
- GI or vaginal bleeding.
- Blood dyscrasias, bleeding disorders.
- Hemorrhoids, fissures, and rectal polyps.
Administering an Enema
EQUIPMENT
- Prepackaged enema or enema container.
- Disposable gloves.
- Water-soluble jelly.
- Waterproof pad.
- Bath blanket.
- Bedpan or commode.
- Washcloth and towel.
- Basin.
- Toilet tissue
Steps of Administering an Enama
| 1 | Assess the patient’s bowel habits (last bowel movement, laxative usage, bowel patterns) and physical condition (haemorrhoids, 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 the procedure to patient. | 2 | Provides comfort. |
| 3 | Wash hands. | 3 | Promotes hygiene. |
| 4 | Place patient on left side with right knee flexed (Sims’ position). Place waterproof pad underneath patient, and cover with bath blanket. | 4 | Allows for enema solution to flow by gravity along the natural curve of the sigmoid colon and rectum. |
| 5 | Place bedpan or bedside commode in position for patients who cannot ambulate to the toilet or who may have difficulty with sphincter control. | 5 | Allows for easy accessibility. |
| 6 | 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 | 6 | Prevents trauma and eases application. |
| 7 | Apply disposable gloves | 7 | Standard precautions |
| 8 | Separate buttocks, and locate rectum. | 8 | |
| 9 | Instruct patient that you will be inserting tubing and to take slow, deep breaths | 9 | Allows for patient relaxation and readiness. |
| 10 | Insert tubing 3–4 inches for adult patients | 10 | Prevents tissue trauma of rectum |
| 11 | Slowly instill the solution using a clamp and the height of the container to adjust flow 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. | 11 | Rapid infusion can cause colon distention and cramping. Container elevated past 12–18 inches and controller on tubing not regulated contribute to rapid infusion |
| 12 | Lower container or clamp tubing if patient complains of cramping | 12 | Allows fluid time to disperse. |
| 13 | Withdraw rectal tubing after all enema solution has been instilled or until clear (usually not more than three enemas). | 13 | “Until clear” means until results do not contain faecal matter and are clear. |
| 14 | Instruct patient to hold solution as long as possible and that a feeling of distention may be felt. | 14 | Promotes better results |
| 15 | Discard supplies in the appropriate trash receptacle. | 15 | Maintains hygiene, minimizes patient embarrassment |
| 16 | Assist patient on the bedpan or to the bedside commode or toilet when urge to defecate occurs | 16 | Prompt action will prevent soiling |
| 17 | Observe enema return for amount, faecal content. Instruct patient not to flush toilet until the nurse has seen the results. | 17 | If enema has not had sufficient time to absorb, result may be mostly clear with little faecal material |
| 18 | Document the type of enema given, volume, and results on the appropriate chart forms | 18 | For continuity of care. |
| 19 | Assess and document presence or absence of abdominal distention after enema was given. | 19 | Relief of abdominal distention indicates success of gas relief. |
| 20 | Assist the patient with washing perineum and rectal area, if indicated; may also need a clean gown or linen change. | 20 | Faecal soiling may result, especially in bedridden patients |