COLEGIO DE STA.

MONICA
COLLEGE OF NURSING

NAME: _______________________________ SCORE: _______________

YEAR & SECTION: _____________________ DATE: _________________

SKILLS CHECKLIST
ADMINISTERING A LARGE VOLUME ENEMA

DONE WITH NOT

ACTION DONE
ASSISTANCE DONE
REMARKS

1. Verify the physician’s order for enema

2. Bring the necessary equipment to the bedside table
3. Perform hand hygiene and put on PPE
4. Identify the patient
5. Close curtains and door if possible
6. Explain what you are going to do and why you are
going to do it to the patient.
7. Discuss where the patient is going to defecate.
Have a bedpan, commode, or nearby bathroom
ready for use
8. Warm solution (40°C) in amount ordered, and test
with a bath thermometer. If bath thermometer is not
available, warm to room temperature and test on
inner wrist
9. Add enema solution to container
10. Open clamp and allow the solution to flow to the tip
of the rectal tube
11. Adjust bed to comfortable work height
12. Assist the patient to assume a left side-lying (Sim’s)
position
13. Fold top linen back just enough to expose the
patient’s rectal area
14. Place a waterproof pad under the patient’s hips
15. Don non-sterile gloves
16. Elevate the solution to 18” above the patient’s anus.
Hang the enema bag to an IV pole if available
17. Lubricate 2-3” of the end of the rectal tube
18. Lift buttock to expose anus
19. Slowly and gently insert the rectal tube for 3-4”.
Instruct the patient to take several deep breaths
20. If resistance is met while inserting the tube, let out a
small amount of solution, withdraw tube slightly,
then continue to insert it
21. Introduce the solution slowly over a period of 5-10
 minutes. Hold the tubing all the time during the
instillation process
22.Clamp tubing or lower container if the patient has
desire to defecate, or is experiencing cramping.
Instruct patient to take short, deep breaths.
23. After solution is administered, clamp tubing and
remove the tube. A paper towel must be ready to
receive tube as it is withdrawn
24. Return the patient to a comfortable position
25. Encourage the patient to hold the solution until the
urge to defecate is strong, usually in about 5-15
minutes
26. Make sure the patient’s linens are dry and that the
patient is covered
27. Remove gloves
28. Raise side rail and lower bed height and adjust the
head of the bed to a comfortable position
29. Remove additional PPE and perform hand hygiene
30. When the patient has strong urge to defecate, place
him in a sitting position on a bedpan, or assist to
commode or nearby bathroom
31. Have tissue paper, or soap and water within the
patient’s reach. Do not leave the patient
32. Remind patient not to flush the toilet before you
could inspect the enema output
33. Put on gloves and assist patient, if needed, to
perform anal hygiene.
34. Ensure that the patient is clean and comfortable.
Offer a new gown if what is worn is already soiled
35. Remove gloves
36. Assist the patient back to bed, if he defecated on
the commode or bathroom toilet
37. Care for equipment properly
38. Perform hand hygiene
39. Document findings

________________________________

CLINICAL INSTRUCTOR

ENEMA – is a solution inserted into the rectum and sigmoid colon to remove feces/flatus; also to instill
medications
TYPES OF ENEMAS
1. Cleansing enema – stimulates peristalsis by irritation of the rectum/colon and by causing
intestinal distention by fluid
a. Large volume cleansing enema – designed to clean the colon as much feces as possible; about
500-1000 ml of fluid is instilled in the rectum and colon, and the client is instructed to hold it as long as
possible; usual solution used is NSS, although some may opt to use Castile soap (soap suds enema) but
this is known to cause extreme irritation of the colon
b. Small volume cleansing enema – designed to clear the rectum and sigmoid colon of fecal
matter, if constipated; commercially available small volume enemas (Fleet enema) are in 50-200 ml
prepackaged enema kits
2. Carminative enema – small volume enema used to expel flatus
3. Oil retention enema – small volume enema that instills oil into the rectum retained up to an hour
to soften very hard stool, usually this is followed by a large volume cleansing enema
4. Medicated enema – small volume enema that administers medications to the rectum needed for
fast absorption
5. Return-flow enema – used to remove flatus and to stimulate peristalsis usually after abdominal
surgery to reduce intestinal distention and stimulate peristalsis

Solutions used for enemas

1. Tap water
2. Normal saline solution
3. Hypertonic solutions
4. Soap solutions
5. Oil
6. Carminative solutions

Indications for enemas

1. Constipation / Flatulence
2. Preparation for abdominal surgery
3. Preparation for lower GI series (Barium enema)

Contraindications of enemas
1. Bowel obstruction
2. Bowel inflammation
3. Abdominal infection
4. Recent anorectal surgery

Equipment needed for large volume cleansing enema

1. Absorbent pad
2. Disposable gloves
3. Bedside commode or bedpan if client cannot ambulate to bathroom
4. Water-based lubricant
5. Enema container
6. Tubing with clamp and nozzle
7. Thermometer for enema solution
8. Toilet tissue
9. IV pole
10. Washcloth, towel, basin, and hand soap
11. Prescribed solution (500-1000ml of PNSS with or without 50 ml of Castile soap – to be added
only once solution is in the enema bag)