ENEMA ADMINISTRATION
Definition
The term enema is used to refer to the process of instilling
fluid through the anal sphincter into the rectum and lower
intestine for a therapeutic purpose. An enema administration is
performed using a flexible plastic rectal tube with several large
holes in the tip. This is connected to the tubing from a solution
bag or container. An enema can also be performed using a
prepackaged solution that comes in a soft plastic bottle with a
pre-lubricated rectal tip attached.
Enema solutions are
prepared using plain tap water or saline, soapsuds solutions, oil
solutions, or various medication solutions.
Purpose
The most common purpose for administering an enema is to
stimulate peristalsis (involuntary contraction) and to evacuate
stool from the rectum. A tap water or soapsuds enema dilates the
bowel, stimulates peristalsis, and lubricates the stool to encourge
a bowel movement. These types of enemas are instilled and held for
five to 10 minutes, as tolerated. They are used to treat
constipation, to cleanse the bowel before a bowel exam, and to
cleanse the bowel before bowel surgery. Another type of enema, the
oil retention enema, is prepared in a smaller volume and is
retained in the bowel for 300 minutes. The purpose of the oil
retention enema is to soften the hardened stool and allow normal
elimination. Enemas are also used to deliver medication directly
onto the rectal mucous membranes to be absorbed into the
bloodstream. Steroid enema solutions can be administered to
alleviate bowel inflammation in patients with ulcerative colitis.
Antibiotic enema solutions can be administered to treat localized
bacterial infections. Medicated hypertonic enema solutions can be
used to pull excessive potassium or ammonia from the bloodstream
through the rectal wall. These substances are then eliminated with
the stool.
Precautions
Enemas should not be used as a first-line treatment for
constipation. Frequent use of enemas can lead to fluid overload,
bowel irritation, and loss of muscle tone of the bowel and anal
sphincter. Never deliver more than three consecutive enemas to
treat a patient. A patient with
diarrhea may not be able to
hold an enema. Enema administration must be used with caution in
cardiac patients who have arrhythmias or have had a recent
myocardial infarction. Insertion of the enema tube and
solution can stimulate the vagus nerve which may trigger an
arrhythmia such as bradycardia. Enemas should not be given to
patients with undiagnosed abdominal
pain because the
peristalsis of the bowel can cause an inflamed appendix to rupture.
Enemas should be used cautiously in patients who have had recent
surgery on the rectum, bowel, or prostate gland. If the patient has
rectal bleeding or prolapse of rectal tissue from the rectal
opening, cancel the enema and consult with the physician before
proceeding. Do not force the enema catheter into the rectum against
resistance. This can cause trauma to the rectal tissue. Use only
mild castile soap for soapsuds enemas because other soap
preparations are too harsh and irritate the rectal tissue.
Description
To administer an enema solution, the clinician should have the
patient lie down on the left side, knees bent. Lift the upper
buttock so that the rectal opening can be visualized. Place the
lubricated tip of the enema catheter at the anal opening, and
gently advance the catheter through the anal sphincter into the
rectum toward the umbilicus (navel), 3 in (7.50 cm) for an
adult. Insert the tubing 2 in (5 cm) for a child less than six
years and 1 in (2.5 cm) for an infant. After alerting the patient,
open the enema tubing to allow the solution to flow or squeeze
premixed enema solutions slowly into the rectum. If the patient
complains of cramping, slow or stop the enema flow and have the
patient breathe slowly through the mouth to encourage relaxation.
When giving fluid through an enema bag, start with the bag
suspended from an IV pole at the patient's hip level. As the tubing
is opened, slowly raise the IV pole to promote fluid flow until the
bag is 12 inches (30.5 cm) above the hip for an adult. Continue to
hold the rectal tube in place throughout the procedure or it will
be expelled from the rectum. If the fluid will not flow in, gently
rotate the tubing within the rectum to clear the holes of the
tubing from the wall of the bowel or the impacted stool that may be
occluding the flow. If ordered to give a high enema, slowly raise
the bag no more than 18 inches (46 cm) above the adult patient's
hip (12 inches (30.5 cm) above a child's hip and six inches (15 cm)
above an infant's hip). This will increase the water pressure to
deliver the fluid higher into the bowel. When all of the solution
has been administered, clamp the tubing, remove the enema catheter,
and release the buttock.
Preparation
Before administering an enema, ensure the patient's privacy by
closing the room door. The patient should be encouraged to empty
both bladder and bowels before the procedure. Have the patient
undress completely from the waist down. Position the patient on the
bed on his or her left side with the top knee bent and pulled
slightly upward toward the chin. Place a waterproof pad under the
patient's hips to protect the bedding and drape a sheet over the
patient covering the entire body except the buttocks. Place a
bedpan and toilet paper within quick access. Explain the procedure
to the patient. Emphasize the importance of breathing slowly
through the mouth to encourage relaxation of the rectal sphincter
and to avoid oppositional pressure. Let the patient know that while
he or she may feel the urge to defecate, most enemas need time to
work and he or she should try to hold the fluid for at least five
to 10 minutes after instillation (300 minutes for retention
enemas and longer for some medicated enema solutions). Check the
medication label if it is a medicated solution to avoid medication
errors. Be sure it is the right medicine, the right dose
(strength), the right time, the right person, and the right method.
Verify the expiration date on the label. Do not use outdated
medicine.
Wash hands thoroughly and put on gloves. To prepare for premixed
disposable enema instillations, follow the directions on the
package. Most premixed disposable enemas come with the tip already
lubricated. Shake the solution bottle. Remove the cap from the tip
and expel excess air from the apparatus before use. To prepare
solutions to be administered using an enema bag, heat the solution
to 105°F. Adult solutions are generally 750000cc of solution for
a non-retention enema and 15000cc of fluid for a retention enema.
Children's solutions are 25000cc of solution for a non-retention
enema and 7550cc of solution for a retention enema. Infants'
solutions are 15050cc of solution for a non-retention enema. If
preparing a medicated solution, follow the physician's orders.
Select a rectal tube appropriate
Aftercare
After administering an enema, remain near the patient in case he
or she needs assistance with the bedpan or to get to the bathroom.
Medicated enemas that are expelled immediately may need to be
repeated, using fresh solution. Follow the directions or consult
with the physician. To assist the patient with retaining an enema
after instillation, apply gentle pressure to the rectal opening
using a 4 gauze pad or squeeze the buttocks together. Tuck a 4
gauze pad between the buttocks to collect seepage. This maneuver
may help the patient feel more secure. Cover the patient after the
procedure and instruct him or her to lie still for five to 10
minutes or longer if a medicated solution or retention enema is
administered. This will allow time for the solution to take effect.
Wash items that might be reused, such as non-disposable enema bags
and tubing, in warm soapy water. Rinse and allow them to air dry.
Place disposable items, gauze pads, and gloves in a trash bag, then
seal and discard it. Assist the patient to the bathroom or with the
bedpan after he or she has held the enema solution for the correct
amount of time. Hands should be washed after performing the
procedure. Note the results of the enema.
Complications
Complications of enema administration are not common but can
include irritation, swelling, redness, bleeding, or prolapse of the
rectal tissue. If any of these symptoms are apparent, or if the
patient complains of pain or burning during enema instillation,
stop the procedure and notify the physician.
Results
Most enemas, because of their liquid state, are absorbed quickly
and work rapidly. Retention enemas will take 300 minutes to
achieve full therapeutic effect. Cleansing enemas usually work
within 105 minutes to cleanse the bowel and relieve constipation.
They may, however, need to be repeated one or two times to
thoroughly cleanse the bowel in preparation for a bowel exam or
bowel surgery. Medicated enemas, such as antibiotic or
anti-inflammatory solutions, may need to be repeated daily over a
period of a week or more for full therapeutic effect.
References
http://www.enotes.com/enema-administration-reference/enema-administration
