SKILL 13-2 Administering a Large-Volume Cleansing Enema Goal: The patient expels feces. 1.

Verify the order for the enema. Identify the patient. Explain procedure to patient. Discuss where the patient will defecate. Have a bedpan, commode, or nearby bathroom ready for use. . !arm solution in amount ordered, and chec" temperature with a bath thermometer if available. If bath thermometer is not available, warm to room temperature or sli#htly hi#her, and test on inner wrist. If tap water is used, ad$ust temperature as it flows from faucet. %. &erform hand hy#iene. '. (dd enema solution to container. )elease clamp and allow fluid to pro#ress throu#h tube before reclampin#. *. &ull the curtains around the bed and close the room door. If bed is ad$ustable, place it in hi#h position. +. &osition the patient on the left side ,-ims. position/, as dictated by patient comfort and condition. 0old top linen bac" $ust enou#h to allow access to the patient.s rectal area. &lace a waterproof pad under the patient.s hip. 1. &ut on nonsterile #loves. 2. Elevate solution so that it is no hi#her than 123 ,'* cm/ above level of anus. &lan to #ive the solution slowly over a period of * to 14 minutes. The container may be hun# on an IV pole or held in the nurse.s hands at the proper hei#ht.

5. 6enerously lubricate end of rectal tube 3 to %3 ,*71 cm/. ( disposable enema set may have a prelubricated rectal tube. 14. 8ift buttoc" to expose anus. -lowly and #ently insert the enema tube %3 to '3 ,1714 cm/ for an adult. Direct it at an an#le pointin# toward the umbilicus, not bladder. (s" patient to ta"e several deep breaths. 11. If resistance is met while insertin# tube, permit a small amount of solution to enter, withdraw tube sli#htly, and then continue to insert it. Do not force entry of the tube. (s" patient to ta"e several deep breaths. 1 . Introduce solution slowly over a period of * to 14 minutes. Hold tubin# all the time that solution is bein# instilled. 1%. 9lamp tubin# or lower container if patient has desire to defecate or crampin# occurs. &atient also may be instructed to ta"e small, fast breaths or to pant. 1'. (fter solution has been #iven, clamp tubin# and remove tube. Have paper towel ready to receive tube as it is withdrawn. 1*. )eturn the patient to a comfortable position. Encoura#e the patient to hold the solution until the ur#e to defecate is stron#, usually in about * to 1* minutes. :a"e sure the linens under the patient are dry. )emove your #loves and ensure that the patient is covered. 1+. )aise side rail. 8ower bed hei#ht and ad$ust head of bed to a comfortable position. 11. )emove any remainin# e;uipment. &erform hand hy#iene. 12. !hen patient has a stron# ur#e to defecate, place him or her in a sittin# position on a bedpan or assist to commode or bathroom. -tay with patient or have call li#ht readily accessible.

15. )emind patient not to flush commode before nurse inspects results of enema. 4. &ut on #loves and assist patient if necessary with cleanin# of anal area. <ffer washcloths, soap, and water for handwashin#. )emove #loves. 1. 8eave the patient clean and comfortable. 9are for e;uipment properly. . &erform hand hy#iene.