Nursing Procedure : Enema Administration
Theorical Note
Enema – the introduction of fluid into the rectum and the sigmoid colon, or into the higher parts of the colon in order to flush the colon, remove the remains of faeces, gas, introduce a drug into the mucous membrane of the rectum, insert a contrast agent into the colon or to support peristalsis of the large intestine.
Types of enema
• Cleansing
• Medical
• Diagnostic
The most commonly used solution is water and physiological saline in children. Water is a hypotonic solution, which means that it has a lower osmotic pressure than the blood; therefore repeated enemas with large amounts of water can cause water absorption into the blood stream with a danger of hyperhydration. An enema is usually administered with a silicone rectal tube. The rectal tube is made in different sizes, see Table 11.3-1.
1. Cleansing Enema
A cleansing enema is administered in order to clean the intestines when constipated, as part of the preoperative preparation of the digestive tract, as part of preparation for examination of the intestines or as preparation for birth. High and low cleansing enemas are recognized. A low enema is used to cleanse the rectum and the sigmoid colon and a high enema is used to cleanse the higher sections of the colon. The solution used in a high cleansing enema is as follows: Infants up to 250ml, toddlers and preschool children 500ml, school-age children 1,000ml and adults 1,000-1,500ml. The low form of cleansing enema is administered using approximately half the recommended liquid volumes. For adults, a few tablespoons of castor oil can be added into the warm liquid. The most commonly used low form of cleansing enema is Yal. It is recommended for cleansing the colon and rectum before examinations and before examination of the kidneys, urinary and genital organs where cleansing of the colon and rectum is a prerequisite. This also includes endoscopic and X-ray examinations (e.g. colonoscopy, rectosigmoideoscopy, proctoscopy etc.).
Yal can also be used for preoperative preparation of the colon and rectum, e.g. haemorrhoidectomy, anal fissures, fistulae surgery, in colon and rectum surgery or before various gynaecological or urological surgeries. Yal can also be used as form of medical micro-enema in the treatment of severe cases of constipation. Another product used for cleansing the intestines before surgery is Fortrans (sachets with powder which is dissolved in 2 litres of water then drunk). The patient must be notified of the need to remain near the toilet
| Objective After studying this chapter, you should be able to: |
| • Prepare the patient for enema administration; • Prepare the aids for enema administration; • Explain the factors affecting regular bowel movement; • Demonstrate this procedure using a model or simulator in the laboratory and later in clinical practice; • Assess the risks of potential complications; • Explain the terminology associated with bowel movement. |
| Purpose |
| • Stimulate stool evacuation in constipation; • Part of preoperative preparation; • Part of preparation for intestine examination; • Preparation before birth; • Introduction of a contrast agent into the colon. |
| Patient preparation |
| • The enema is administered in a designated room or in the patient’s room using screens for immobile patients. • The patient is explained the reason and the course of the procedure. • The patient is instructed in the need to hold the liquid in as long as possible. • The patient is warned about a feeling of discomfort during and after the procedure. • The patient is put into appropriate position, usually on the side (see Fig. 11.3-1). |
| Preparation of aids |
| Disposable mat, bedpan, enema kit – irrigator with a tube and stopper to regulate the flow of liquid (see Fig. 11.3-2), if the enema kit does not include a stopper, a pean can be used instead, solution, lubricant, mesocain, Vaseline, gloves, infusion stand for hanging the irrigator kit, squares of wadding, kidney bowl. |
| Performing the procedures |
| • Place the disposable mat under the patient • Put on the gloves • Lubricate the end of the rectal tube for easier insertion • Separate the gluteal muscles, making the anal opening accessible • Insert the prepared rectal tube • Wait for the passage of gas when administrating the rectal tube • Connect the irrigator • Regulate the speed of administering the solution (stopper, pean) • After introducing the entire amount of the prescribed solution, remove the rectal tube and wipe it with the square wadding • Ask the patient to clench the gluteal muscles together and hold for several seconds. • Inform the patient of the need to hold the solution inside for at least 15 minutes |
| Patient care after the procedure |
| • Assess the patients reaction to enema administration • Monitor the effect of the inserted drug, any pain, rectal bleeding, etc. • Record the data in the nursing documentation • Report any complications to a doctor immediately |
2. Medical Enema
When a medical enema is prescribed, the medicinal substances are introduced into the rectum usually via a micro-enema; a less commonly used method is an enema in droplet form.
Micro-enema
This is a form of enema administration, i.e. small liquid volumes (in adults 60 – 180 ml). An example of a micro-enema solution used for cleansing the rectum is Yal, which is already prepared by the manufacturer in a transparent bottle with an attached applicator. The contents of the bottle must be thoroughly shaken before use and the sealed end of the applicator cut off (see Fig. 11.3-3). If administering a micro-enema with another solution, not originally prepared by the manufacturer, rinsing is done with a Janet rectal syringe and an appropriate sized rectal tube. Other aids are the same as for other types of enema.
| Patient preparation |
| The preparation is the same for all types of enemas. |
| Preparation of aids |
| Disposable mat, bedpan, enema solution ready to use, lubricant, mesocain, Vaseline, protective rubber gloves, wadding squares, kidney bowl (see Fig. 11.3-4). |
| Performing the procedure |
| • Place the disposable mat under the patient. • Put on the gloves. • Ask the patient to breathe through their mouth (in order to relax the anal sphincter). • Shake the medicinal solution. • Cut off the sealed end of the applicator tip. • Smear the end of the applicator with Vaseline or mesocain gel for easier facilitation. • Use the non-dominant hand to separate the gluteal muscles, making entrance to the anus accessible. • Keep pressing the plastic bottle and apply the solution into the rectum. • After introducing the entire amount of the prescribed solution, remove the applicator tube and wipe it with the square wadding. • Ask the patient to clench the gluteal muscles together and hold for several seconds. • Inform the patient of the need to hold the solution inside for at least 15 minutes. |
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Referensi :
- Jirkovský, D. e. (2014). Nursing Procedure and Interventions. Prague: Česká republika. doi:ISBN: 978-80-87347-16-4
- FAIX, Pavol. B Braun Echo [online]. 2002 [cit. 2011-04-06]. Intravenous cannula. Available from <http://www.bbraun.sk/bbecho/r2002/bbe_mar2002b.htm>.
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