ENEMA ADMINISTRATION

Enema is the instillation of solution into RECTO-SIGMOID COLON

Action: distends or irritates colon to stimulate peristalsis and promote defecation
Purposes:
o to relieve constipation most common problem
o to relieve fecal impaction
o to expel flatus
o to lower body temp
o to facilitate admin of medications
o to prepare for diagnostic procedures or surgery
Types Action Special Consideration
Cleaning Enema
NSS
Tap water
Hypertonic
Soap Suds
Stimulates peristalsis by:
o irritating the colon or rectum and/
o distending the colon by the volume of
solution
Size of Rectal tube
Adult: 22-30 Fr
Children: 14-18Fr
Infant: 12Fr

High Cleansing Enema
o cleans entire colon
o large volume: 1000ml Adult
o container height: 12 18 inches
above rectum

Low Cleaning Enema
o cleans rectum and sigmoid colon
only
o small volume: 500 adult
o container height: 12 inches above
rectum

WOF complications:
water intoxication
electrolyte imbalance
Soap Suds Stimulates peristalsis by irritating the colon Mild soap (castile soap) + warm water
Isotonic:
Normal Saline (NSS)
0.9%NaCl
Volume stimulates peristalsis Safest solution
For infants and children
Hypotonic: Tap Water Volume stimulates peristalsis Do not repeat water intoxication
Hypertonic Solution/Fleet
Enema
Promotes distention by drawing out water from
circulating blood volume to the bowel (pulls out
water into intestines)
Not for young children and dehydrated
clients
Return Flow Enema
Harris Flush Enema
Colonic Irrigation
To expel flatus o 100 200 ml of fluid introduced
in and out of colon
o After instilling solution, container
is lowered so that solution flows
back into the container
o Repeat 5 6 x until client expels
flatus and abdominal distention is
relieved
o Replace solution several times as
it becomes thick with feces
o Procedure is 15 - 20 minutes
RETENTION ENEMA
Oil retention Enema
Lubricates rectum and colon and softens stool
(mineral oil, olive oil, or cottonseed)
Instruct client to retain enema for 1
3 hours to enhance absorption of oil
RETENTION ENEMA
Carminative Enema
To expel flatus 60 80 ml with combination of
* 30 ml magnesium
*60 ml glycerine
*90 ml water
MEDICATED ENEMA
Sodium Polystyrene
Sulfonate (KAYEXALATE)
Decreases Potassium levels
Facilitates exchange of sodium ions for potassium
ions in large intestines
For Hyperkalemia
MEDICATED ENEMA
Neomycin
Reduces bacteria in colon prior bowel surgery May cause diarrhea
Correct Volume of Warmed Solution
Infant 150 250 ml
Toddler 250 350 ml
School Age 300 500 ml
Adolescents 500 750 ml
Adults 750 1000 ml

Size of Rectal tube
Infant 12 Fr
Children 14 18 Fr
Adult 22 30 Fr

Equipment
o disposable linen pad
o bedpan or commode
o clean gloves
o water soluble lubricant
o paper towel

For Large Volume Enema
o Correct solution, amount, and temperature (42 C or less)
o Solution container
o Rectal tube of correct size
o Tube clamp
o IV pole

For Small Volume Enema
o Prepackaged container of enema solution with lubricated tip (Fleet Enema)

Procedure Rationale
Check the doctors order
Identify the client, verify, inform, and explain procedure To allay anxiety
Wash hands and apply clean gloves. observe appropriate
infection control

Provide client privacy To prevent feeling of embarrassment
Promote relaxation To relax anal sphincter and facilitate
insertion of rectal tube
Position the client
Adult: Sims (left-lateral) or left-sidelying with right knee
flexed

Infant and Children dorsal recumbent
Facilitate the flow of solution by gravity as
sigmoid colon is on left side
Lubricate the rectal tube about 2 in (5cm)
Allow solution to flow through connecting tube and rectal
tube to expel air prior insertion
Prevents introduction of air in colon
Insert rectal tube 3 4 inches (7-10cm)
gently in rotating motion

Prevent trauma
Introduce solution slowly
o raise solution container and open clamp to allow
fluid to flow
o High enema 12 to 18 inches above rectum
To prevent sudden stimulation of peristalsis
The higher the solution the faster the flow
and greater pressure in the rectum
o Low enema 12 inches above rectum

If client complains of fullness or pain, clamp and stop
flow for 30 secs and restart at a slower rate
decrease intestinal spasm and premature
ejection of solution
If High Enema change position to distribute solution well
If Low Enema remain in left lateral
Left lateral (sigmoid) dorsal recumbent
(transverse) right sidelying

If the order is cleaning enema give order 3x alternate
hypotonic and isotonic
Prevent water intoxication
After all solution has been instilled or when client feels
the desire to defecate, close clamp and remove rectal
tube, dispose the tube properly

Encourage client to retain enema, ask to remain lying
down

Assist client to defecate in sitting position
If client is using the toilet, ask not to flush it.
Observe feces
Do perineal care
Make relevant documentation