Types of Enema:
1. Carminative enema- done to expel flatus. 60-180 ml of water is introduced
2. Retention enema - introduce oil into the rectum and sigmoid colon. Oil retained in 1 to 3 hours
Instillation- introduction of a liquid (usually mineral oil) into thew colon to facilitate fecal activity
by lubricating effect
3. Return flow enema ( Harris flush/ colonic irrigation) - 100 to 200 ml of fluid is introduced into
and out of the large intestines to stimulate peristalsis and expulsion of flatus
Equipments:
- enema can
- kelly forcep
- IV pole
- solution
- KY jelly
- rectal tube
- gloves
- hose
Nursing procedure/ Rationale
1. Inform the client about the procedure/ To promote cooperation
2. Assemble articles/ For efficiency
3. If using an enema bag, fill it with 750-1000 ml warm tap water / Hot water can burn intestinal mucosa, cold water can cause abdominal cramping
4. Clamp tubing / To keep solution intact
5. Place waterproof pad absorbent/ To prevent soiling
6. Assist client into the left side lying with knee flexed/ Allows enema solution to flow downward by gravity
7. Cover client with bath blanket exposing only rectal area / Provide warmth, allows client to feel more relaxed
8. Lubricate 3-4 inches tip of rectal tube / Provides smooth insertion without irritation and trauma
9. Gently separate buttocks and locate anus / For accurate exposure
10. Instruct client to relax / It promotes relaxation of external anal sphincter
11. Insert tip of rectal tube 3-4 inches / Careful insertion prevents trauma to rectal mucosa
12. Hold tubing in rectum constantly until end of instillation/ Bowel contraction can cause expulsion of tube
13. With container at client's hip level, open regulating clamp and allow solution to enter slowly / Rapid infusion can stimulate evacuation and cause cramping
14. Raise height of enema bag slowly to 30-45cm (12-18 inches) / Raising container too high causes rapid infusion and possible painful distention of colon
15. Hang container on IV pole
16. Clamp tubing if client complains of cramping / Temporary cessation minimizes cramping
17. Tell client that the procedure is completed and that you will be removing rectal tube / Client may misinterpret the sensation of removing the tube as a loss of control
18. Explain feeling of distention is normal. Tell client to retain 5-10 minutes / Solution distend bowel. Longer retention promotes more effective stimulation.
19. Assist to bathroom
20. Instuct client with a history of cardiovascular disease to exhale while expelling enema to avoid valsalva maneuver/ Valsalva maneuver- strenuously trying to move a constipated stool and may result in cardiac arrest
21. Assist client to wash anal area with wearm soap and water / Fecal content can irritate the skin. Hygiene promotes comfort.
22. Do after care
Characteristics of a Good Recording :
1. Accuracy
2. Conciseness
3. Thoroughness
4. Currentness
UPDATE:
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