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ENEMA ADMINISTRATION

CC.12.35 BC Childrens Hospital Child & Youth Health Policy and Procedure Manual Page 1 of 4
PURPOSE
Procedure for administering an enema.
POLICY STATEMENTS
In children with renal dysfunction or bowel dysfunction, phosphate enemas (e.g. Fleet

) may lead to
ADVERSE EVENTS. Even in normal children, phosphate enemas should not be used in children under
2 years of age and only with extreme caution between 2 and 5 years of age.
Give phosphate enema (e.g. Fleet

) only once. If a second enema is required, a saline enema may be


administered to reduce exposure to sodium phosphates.
Performing an enema requires a prescriber's order which specifies the drug name or solution type, volume,
indication, route and frequency of administration.
Pediatric Dosing for phosphate enema (Fleet

):
Children 2-4 years: one half pediatric enema = 30 mL X 1 dose only
Children 5-11 years: pediatric enema = 60 mL X 1 dose only
Children 12 years and Adolescents: adult enema = 120 mL X 1 dose only
SITE APPLICABILITY
All inpatient areas.
PRACTICE LEVEL/COMPETENCIES
Administering an enema is a foundational nursing competency.
EQUIPMENT
o commercially prepared enema (e.g. Fleet

) or appropriate container (syringe or bag) with ordered


solution (e.g. 0.9% NaCl) at body temperature (approximately 37.8) and tubing if required for bag
administration
o appropriate sized rectal tube or feeding tube as appropriate (size 12 F for infants; size 14F-18F for
children and adolescents)
o water soluble lubricant
o incontinence pads
o bedpan/commode
o clean gloves
PROCEDURE Rationale
1. ASSESS patient for presence of any condition that
may contraindicate enema administration and
DISCUSS concerns with prescriber:
o renal dysfunction/renal failure
o abnormal serum electrolytes
o low calcium, hyperphosphatemia, or
hypernatremia
o dehydration
o heart disease (recent cardiac surgery,
congestive heart failure, arrhythmias,
history of QT prolongation)
o hypertension
o appendicitis (or symptoms of appendicitis:
abdominal pain, nausea, fever or vomiting)
o GI obstruction
Identifies contraindications to the procedure.
LastReviewDate
Jun 22, 2009
Create Date
Jul 28, 1982
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ENEMA ADMINISTRATION
CC.12.35 BC Childrens Hospital Child & Youth Health Policy and Procedure Manual Page 2 of 4
o recent or past bowel surgery
o rectal prolapse
o paralytic ileus
o ulcerative colitis
o anorectal malformations
o rectal bleeding
o rectal fissures
o hemorrhoids
o increased intracranial pressure
o glaucoma
o thrombocytopenia
o neutropenia
o seizure risk
2. ASSESS patient for abdominal distention, pain,
and presence of bowel sounds.
Establishes a baseline assessment for determining
efficacy of the enema.
3. IDENTIFY patient and EXPLAIN procedure. Failure to correctly identify patients prior to
procedures may result in errors.
Reduces child and familys anxiety. Evaluates and
reinforces understanding of previously taught
information and confirms consent for procedure.
4. PROVIDE for privacy. Shows respect for child; promotes cooperation and
decreases anxiety.
5. PERFORM hand hygiene and DON clean gloves. Routine infection control practices; reduces
transmission of microorganisms.
6. PLACE incontinence pad under patient and
POSITION the patient on the left side with knees
flexed or in the knee-chest position.
Provides easy passage of the solution by following
the natural curve of the sigmoid colon and rectum.
7. ATTACH rectal tube to syringe or solution tubing
and prime entire length of tubing with solution to
remove air.
NOTE: If administering only 30 mL Fleet enema from
60 mL bottle, prepare bottle by expelling 30 mL of
liquid, then replace cap and administer as usual.
Instillation of air into the GI tract can cause
abdominal distention and discomfort.
8. LUBRICATE tip of rectal tube or remove cap from
commercial enema.
Facilitates insertion and promotes comfort.
9. SEPARATE the buttocks and locate the anus. Good visibility and positioning aid in ease of
procedure.
10. Gently INSERT rectal tube or tip of commercial
enema into the patient's rectum to recommended
depth per chart below with the tip directed towards
the umbilicus.
Age Insertion distance
Prevents irritation or trauma to the rectal mucosa or
rectum.
LastReviewDate
Jun 22, 2009
Create Date
Jul 28, 1982
Disclaimer Message
Refer to online version Print copy may not be current Discard after use
Date/Time Generated
Dec 02, 2013 02:15
Generated By
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ENEMA ADMINISTRATION
CC.12.35 BC Childrens Hospital Child & Youth Health Policy and Procedure Manual Page 3 of 4
infant 2.5 cm (1")
2-4 years 5 cm (2")
4-10 years 7.5 cm (3")
11 and over 10 cm (4")
11. If using container and tubing: ELEVATE the
container no more than 30-45 cm (12-18") above
the rectum. RELEASE clamp and allow the
solution to flow for 10-15 minutes. Hold tubing in
place with one hand. Lower the height of the
container if the child has pain or if fluid leaks
around the catheter.
If using syringe: gently PUSH on syringe plunger
until solution has been administered.
For prepackaged enemas, SQUEEZE bottle until
all the solution has been administered.
Promotes continuous slow instillation of solution,
with minimization of complications. Too rapid
administration can cause painful distention of the
colon. High pressure could rupture the bowel of an
infant.
12. After instilling the solution, gently REMOVE the
rectal tube or bottle tip.
Prevents leakage of fluid around the tubing.
13. MAINTAIN patient in side-lying position until urge
to have a bowel movement is felt (2-15 minutes).
Longer retention of the solution promotes more
effective stimulation, peristalsis, and defecation.
14. POSITION and SUPPORT patient on
bedpan/commode or ASSIST to the bathroom.

15. PROVIDE routine perineal care. Promotes comfort and prevents skin breakdown.
16. MEASURE the amount and quality of returned
solution.
Evaluates efficacy of the procedure.
Assesses for return of all infused fluid.
17. REMOVE equipment and supplies and DISPOSE
of appropriately. PERFORM hand hygiene.
Routine infection control practices; reduces
transmission of microorganisms.
DOCUMENTATION
DOCUMENT on appropriate record(s):
o date and time
o abdominal assessment before and after enema
o type, route, volume of fluid/solution administered
o length of time enema retained
o colour, consistency, amount of stool and fluid returned
o abnormal findings, such as bloody stool or presence of mucous
o individual administering enema
o patient's response to procedure, including changes in vital signs
o patient/family education
o unexpected outcomes and related treatment
o any other pertinent actions or observations
REFERENCES
Blackmer, A.B. and Farrington, E.A. (2010). Constipation in the Pediatric Patient: An Overview and
Pharmacologic Considerations. Journal of Pediatric Healthcare, 24(6):385-99.
Fleet Enema Manufacturers Monograph. Retrieved August 22, 2013 from
http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-
%20(General%20Monographs-%20F)/FLEET%20ENEMA.html
Harrington, L. and Schuh, S. (1997). Complications of Fleet enema administration and suggested guidelines
for use in the pediatric emergency department. Pediatric Emergency Care, 13(3):225-6.
LastReviewDate
Jun 22, 2009
Create Date
Jul 28, 1982
Disclaimer Message
Refer to online version Print copy may not be current Discard after use
Date/Time Generated
Dec 02, 2013 02:15
Generated By
Anonymous
ENEMA ADMINISTRATION
CC.12.35 BC Childrens Hospital Child & Youth Health Policy and Procedure Manual Page 4 of 4
Lexicomp Drug Information: Sodium Phosphates. Retrieved August 22, 2013.
Marraffa, J.M., Hui, A., and Stork, C.M. (2004). Severe hyperphosphatemia and hypocalcemia following the
rectal administration of a phosphate-containing Fleet pediatric enema. Pediatric Emergency Care,
20(7):453-6.
Mason, D., Tobias, N., Lutkenhoff, M., Stoops, M. and Ferguson, D. (2004). The APN's Guide to Pediatric
Constipation Management. The Nurse Practitioner, 29(7):13-21
Mauricio, R. (2008). Bowel Irrigation. In Trivits, V.J. and Lebet, R.M., (Ed). AACN Procedure Manual for
Pediatric Acute and Critical Care (pp. 678-684). St Louis, Missouri: Saunders Elsevier.
Mendoza, J., Legido, J., Rubio, S. and Gisbert, J.P. (2007). Systematic Review: the Adverse Effects of Sodium
Phosphate Enema. Alimentary Pharmacology and Therapeutics, 26(1):9-20.
National Institute for Health and Clinical Excellence. (2010). Constipation in Children and Young People.
Clinical Guideline No. 99. NICE, London.
Rogers, J. (2012). Assessment, prevention and treatment of constipation in children. Nursing Standard.
26(29):46-52.
LastReviewDate
Jun 22, 2009
Create Date
Jul 28, 1982
Disclaimer Message
Refer to online version Print copy may not be current Discard after use
Date/Time Generated
Dec 02, 2013 02:15
Generated By
Anonymous