Sunday, September 27, 2009

How To Administer An Enema To A Patient

The other day was the presentation day for all the nursing procedure that Miss Tracey has given us. Each group presented their respective nursing procedure. so in few days i will be posting here some of the the different nursing procedure that we are going to undertake during our clinical posting.

The first nursing procedure i will give you is how to administer an enema to a patient.

An enema is a solution introduced into the large intestine. The action of an enema is to distend the intestine and sometime to irritate the intestinal mucosa , thereby increasing peristalsis and the excretion of feces and flatus.

Enema are classified into 4 groups: 
  • Cleansing - Cleansing enemas are intended and remove feces.
  • Carminative - A carminative enema is given primarily to expel flatus.
  • Retention - A retention enema introduces oil or medication into the rectum and sigmoid colon
  • Return- flow enema - A return- flow enema is used occasionally to expel flatus. 
Why You Should Perform The Procedure?
  • To achieve one or more of following actions; cleansing, carminative, retention or return-flow.
  • When the client last had a bowel movement and the amount, color and consistency of the feces.
  • Presence of abdominal distention ( the distended abdomen appears swollen and feels firm rather than soft when palpated)
  • Whether the client has sphincter.
  • Whether the client can use a toilet or must remain in bed and use a bedpan. 
Steps Of The Procedure?
  • Introduce yourself and verify the client’s identity using agency protocol. Explain to the client what you are going to do.
  • Perform hand hygiene, apply clean gloves, and observe appropriate infection control procedure.
  • Provide for client privacy.
  • Assist the adult client to a left lateral position, with the right leg as acutely flexed as possible and the linen-saver pad under the buttock
  • Insert the enema tube. 

  • Insert the tube smoothly and slowly into the rectum, directing it towards the umbilicus.

  • If resistance is encountered at the internal sphincter, ask the client to take a deep breath, then run a small amount of solution through the tube to relax the internal anal sphincter.

  • never force the tube or solution entry.

    •  Slowly administer the enema solution.

  • Compress a pliable container by hand.

  • During most low enemas hold or hang the solution than 30 cm (12 in) above the rectum.

  • Administer the fluid slowly.

  • Using the plastic commercial container, roll it up as the fluid is instilled. This prevent subsequent suctioning of the solution.

  • After the solution , close the clamp and remove the enema tube from the anus.

  • Place the enema tube in a disposable towel as you withdraw it.

    • Encourage the client to retain the enema.

  • Request that the client retain the solution.

  • ask the client to remain lying down

    • Assist the client to defecate.  
    • Assist the client to a sitting position on the bedpan or toilet. A sitting position facilitates the act of defecation.
    • Ask the client to using the toilet but not to flush because needs to observe the feces.



    Steven Peterson said...
    June 13, 2016 at 8:22 AM

    Not bad but another tip would be for caregivers to experience the types of enemas they'll be giving. It should be done more in training. I have MS with bowel difficulties. I've been given several enemas over the last year. The rushed, unempathetic staff I've dealt with have been bad at times, either being rough, too fast uncaring about pt modesty. (tip, don't open or leave a door or curtain open, except rare training, don't bring other staff. Don't shout "I have to give mr. X an enema" in a crowded clinic. It's a difficult task for the pt, don't get impatient (ive had two staff try to force an enema when I was tensed, twice had impatient staff start squeezing the bag to hurry it. Once I had a tech who was rough, nasty, and refused to discharge me until I'd had enough volume or tries. After about the tenth attempt (I was spasm ing and couldn't take more than a few oz) he had me admitted and warned that it would start again at 6am,(I was only given one more which went well.

    I have also had awesome,caring staff who were thoughtful,gentle and quite skilled.(the first lg vol sse id ever had was at the hands of a skillfull rn whos demeanor and technique made it some of the most comfortable enemas I've had, (that's rare due to the bowel condition, which usually makes tries at self administration very difficult to impossible )

    Nursing in Australia said...
    February 8, 2017 at 6:07 PM

    Thank you for sharing. Its informative and full of information.

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