administering an enema(enema bag & prepackaged enema)
TRANSCRIPT
Administering An Enema(Enema Bag & Prepackaged Enema)
Outlines •Definition
•Types Of Enema
•Indication &contraindication
•Equipment
•Clinical procedure
Definition
An enema is the procedure of introducing liquids into the rectum and colon via the anus . The increasing volume of the liquid causes rapid
expansion of the lower intestinal tract, often resulting in very uncomfortable bloating,
cramping, powerful peristalsis, a feeling of extreme urgency and complete evacuation of
the lower intestinal tract.
Types of Enema,indication&contraindication
1-Tap water (TWE) (hypotonic): Amount: 500- 1000cc Action: distends, increases
peristalsis Time: 15 minutes Indicated: inflamed bowels /
rritated colon Contraindicated: Atonic bowels, fluid restrictions
2- Physiological normal saline (Isotonic) Amount: 500 -1000 Action: distends, increases
peristalsis Time: 15 minutes Indicated: inflamed bowels /
irritated colon Contraindicated: Na retention problems, fluid restrictions
3-Hypertonic solution: -It requires small volumes to stimulate defecation, so
it is useful for patients who cannot tolerate large volumes of fluid (e.g., commercially prepared Fleet
enema). Amount: 120 -180 Ml Action:
distends, irritates colon Time: 5 – 10 minutes Indicated:
constipation Contraindicated: dehydration, Na problems
4-Cleansing enema: It is the instillation of enough fluid
into the colon to help soften the feces, stimulate peristalsis, and provide lubrication in preparation for
evacuation .
5- Harris flush enema:
It is a return flow enema that helps to expel intestinal gas .Fluid alternately flows into and out of the large
intestine. This stimulates peristalsis in the large intestine and assists in expelling gas. 6- Soapsuds enema (SSE):
It is pure castile soap added to either tap water or normal saline, depending on patient's condition and frequency of administration. Add soap to enema bag
after water is in place to reduce suds Amount: 500 -1000 cc (Castile 5 ml/1000cc)
Action: distends, irritates colon Time: 15 minutes Indicated: constipation Contraindicated: prior
to rectal exam
7- Oil-retention enema: Uses an oil-based solution. The colon absorbs
small volume, which allows the oil to Soften stool for easy evacuation.
Amount: 120 – 200 cc Action: Lubricating rectum and colon
Time: 30 minutes Indicated: Fecal impaction
Contraindication: none 8- Anthelminthic Enema:
Anthelminthic drugs help destroy intestinal parasites, a solution of an anthelmintic drug
may be instilled with enema for retention
9-Medicated Enema: It’s administration of a drug with enema solution, it is indicated for
unconscious, mouth or throat surgery.
Contraindications to enema administration: Larger volumes of solution that cause a forceful evacuation of
the bowel, bringing about straining on the part of the client are contraindicated in the following:
- Increased intracranial pressure
- Recent brain surgery or dangerous brain tumor - Rectal or uterine prolapse - Recent eye or rectal surgery
- Uncontrolled high blood pressure Precautions
-Improper administration of an enema may cause electrolyte imbalance (with repeated enemas)
-The enema tube and solution may stimulate the vagus nerve, which may trigger an arrhythmia such as
bradycardia. - Enemas should not be used if there is an undiagnosed
abdominal pain since the peristalsis of the bowel can cause an inflamed appendix to rupture.
-Regular treatments should be avoided by people with heart disease or renal failure.
Equipment Clean gloves water soluble lubricant
Waterproof pad Toilet tissue Bedpan or access to toilet IV pole
Basin, washcloth, towel and soap stethoscope
enema Bag Administration -Appropriate-size rectal tube (adult: 22-30 Fr; child: 12-18 Fr)
-Correct volume of warmed solution (adult: 750- 1000 ml, adolescent: 500-700 ml; school-age child 300-500ml, toddler:
250-350 ml; infant: 150- 250 ml)
Prepackaged Enema Prepackaged enema container with
rectal tip
Steps Rational
Assessment
1-Review physician's order for type and
times
2-Assess patient's status Last bowel
movement, presence of hemorrhoids,
mobility and presence of abdominal pain
-determines need for enema and establishes baseline for bowel function
3-Assess medical record for presence of
increased intracranial pressure, cardiac
disease, glucoma, or recent abdominal,
rectal, or prostate surgery.
-conditions contraindicates use of enemas
4-Inspect abdomen for presence of
distention and auscultate for bowel
sounds
-Establishes baseline for determining effectiveness of enema
5-Determine patient's idea about
enema purposes
Implementation
1-Perform hand hygiene, and apply
clean gloves
-reduces
microorganisms
2-Provide privacy by closing curtains
around bed or closing door
-reduces
embarrassment for
patient
3-Raise bed to appropriate working
height for nurse; raise side rail on
patient's left side
-promotes good
body mechanics
&pt. safety
4-Assist patient into left side-lying (Sim's)
position with right knee flexed.(child in
dorsal recumbent .)
-allows enema solution
to flow downward by
gravity along natural
curve of sigmoid colon
and rectum
5-Place waterproof pad under hips and
buttocks
-prevents soiling of
linen
6-Cover patient with bath blanket, exposing
only rectal area clearly visualizing anus
-Provides warmth,
reduces exposure of
body parts
7-Separate buttocks, and examine
perianal region for abnormalities,
including hemorrhoids, anal fissure,
and rectal prolapse.
-findings will
influence nurse's
approach to
insertion of enema.
8-Place bedpan in easily accessible
position. If patient will be expelling
contents in toilet, ensure that toilet is
free.
9-Administer enema
a- Administer prepackaged
disposable enema
1-Remove plastic cap from tip of
container. Tip is already lubricated, but
you can lubricate it more
-lubrication provides
for smooth insertion
of rectal tube to
avoid irritation or
trauma.
2-Gently separate buttocks, and locate
rectum. Instruct patient to relax by
breathing out slowly Through mouth
-breathing out
promotes relaxation
of external rectal
sphincter
3-Expel any air from the enema container -Introducing air into
colon causes distention,
discomfort
4-Insert tip of container gently into anal
canal
And angle tip toward the umbilicus
-Gentle insertion
prevents trauma to
rectal mucosa
5-Roll plastic bottle from bottom to tip
until all of solution has entered rectum
and colon. Instruct patient to retain
solution until urge to defecate occurs,
usually 2 to 5 minutes.
-prevents instillation
of air into colon and
ensures all contents
enters rectum.
6 -Place layers of toilet tissue around
tube at anus, and
gently withdraw rectal tube and tip
7- Explain to patient that some
distention and abdominal cramping is
normal. Ask patient to retain solution
as long as possible while lying quietly
in bed.(for infant or young child or
unconscious, gently hold buttocks
together for few minutes.)
8- Discard enema container and tubing
in proper receptacle
9-Assist patient to bathroom, or help to
position patient on bedpan
10-Observe character of feces and solution
(caution patient against flushing toilet before
inspection)
11-Assisst patient as needed with washing
anal area With warm water and soap
12-Remove and discard gloves, and perform
hand hygiene
Evaluation
1-Inspect color, consistency,
and amount of stool, odor,
and fluid passed
2-Assess condition of
abdomen
Recording and Reporting -Record type, volume of enema given,
time of administration, characteristics of results, and patient's tolerance of
procedure. -Report failure of patient to defecate and
any adverse effects.
b-Administer enema using enema bag:
1-Add 750 to 1000 ml of warmed solution to
enema bag: warm tap water as it flows from
faucet, place saline container in basin of
warm water before adding saline to enema
bag, and check temperature of solution by
pouring small amount of solution over inner
wrist .
-hot water will burn
intestinal mucosa. Cold
water will cause
abdominal cramping
and is difficult to retain.
2-If SSE ordered, add castile soap after water. -prevents bubbles in bag
3-Raise container, release clamp, and
allow solution to flow long enough to
fill tubing
-Removes air from
tubing
4-Reclamp tubing -prevents loss of
fluid
5-Lubricate 6 to 8 cm of tip of rectal
tube with lubricating jelly
-Allows smooth
insertion of rectal
tube to avoid
trauma.
6-Gnetly separate buttocks, and locate anus.
Instruct patient to relax by breathing out
slowly. Then, touch patient's skin next to
anus with tip of rectal tube.
-Breathing out and
touching skin with the
tube promotes
relaxation of external
anal sphincter.
7-Insert tip of rectal tube slowly by pointing
tip in
-careful insertion
prevents
8-Hold tubing in rectum constantly until end
of fluid instillation
-prevents expulsion of
rectal tube during
bowel contraction
9-Open regulating clamp, allow solution to
enter slowly with container at patient's hip
level .
-Rapid instillation
stimulates evacuation
of rectal tube
10-Raise height of enema container slowly to
appropriate level above anus: 30 to 45 cm for
high enema, 30 cm for regular enema, 7.5 cm
for low enema. Instillation time varies with
volume of solution administered (e.g.,
1L/10min)
(High pressure causes rupture of bowel in
infants)
-Allows for continuous,
slow instillation of
solution; raising
container too high
causes rapid instillation
and possible painful
distention of colon.
10-Instill all solution, then clamp
tubing
-prevents
entrance of air
into rectum
11-Repeat the steps from 6 to 12
,evaluation, recording and
reporting as in the prepackaged
enema procedure.
Prepackaged Enema
Thank you