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Administering an enema: Clinical skills notes

Notes

Notes

Gastrointestinal

Administering an Enema

Introduction

An enema is when fluid is inserted into the rectum and lower colon, and that’s usually done to stimulate the elimination of feces from the rectum. An enema can be performed to treat constipation (which is when people have trouble voiding their bowels) or a fecal impaction (which is when the feces form a dry, hard mass in the rectum and can’t be eliminated by the person). Another reason for using an enema is to clean the rectum and lower the colon before a diagnostic or surgical procedure.

Types of enemas

Enemas can be classified depending on their purpose or composition.

TYPE of ENEMA
PURPOSE
Cleansing
Clean the colon of feces entirely
Oil-retention
Lubricating enemas that soften the feces in order to make them easier to eliminate
Medicated
Contain medication that can be prescribed for a variety of reasons, e.g., lowering serum potassium levels
Composition
  • Tap water
  • Normal saline
  • Harrish Flush and carminative: help with gas elminiation
  • Soap suds
  • Oil-retention enema: an oil-based solution

Common care tips

  • Always double-check the client's identity to make sure the procedure is performed on the right person
  • Check the client's plan of care for the type of enema, the amount of solution, and any other special instructions
  • The client should empty their bladder before the procedure to make sure there are no accidents
  • It's important that there's a vacant bathroom nearby or a bedpan or a bedside commode if the client has mobility problems
  • Close the bed curtains and door, and keep the person covered as much as possible for privacy reasons
  • Before you begin, provide anticipatory guidance to the client about what to expect from the procedure
  • Other tips for making clients feel comfortable include: 
    • Lubricating the tip of the enema tube before insertion
    • Administering the solution slowly
    • Using a solution that's slightly warmer than body temperature
  • Finally, check the plan of care to determine how long the client should retain the enema
    • An "enemas until clear" order means repeating the enema, usually for a maximum of three times, until the client expels clear fluid without any feces

Administering a soap suds enema

To administer the enema, first gather the following supplies:
  • gloves
  • water-soluble lubricant
  • waterproof bed protector
  • bath blanket
  • bedpan or bedside commode
  • basin
  • washcloths
  • towel
  • IV pole
  • enema bag with tubing and rectal tube attached
  • a package of castile soap

Figure 1: Supplies for a soap suds enema.

Preparing the enema solution

The first step is to prepare the enema solution in the bathroom.
  1. Clamp the tubing and then fill the enema bag with warm water. Check the temperature with your inner wrist to make sure it'll be comfortable for the client
  2. Add the castile soap and mix by gently rotating the enema bag. Do not shake the solution vigorously
  3. Release the clamp on the tubing and allow a tiny amount of water out. This will remove all of the air from the tubing
  4. Reclamp the tubing and hang it from an IV pole

Administering the enema

  1. Raise the bed to a comfortable working height, and lower the side rails on the side you'll be working
  2. Help the client into the left Sims' position
  3. If one isn't already in place, put a bed protector under their buttocks to prevent the linens from getting dirty. Cover the person so that they are comfortable, leaving the buttocks exposed
  4. With one hand, raise the upper buttock. Then, grasp the enema tube with the other hand, and lubricate it with the water-soluble lubricant
  5. Slowly insert the tube so it moves toward the umbilicus
    • In an adult client, the tip should be inserted about 2–4 inches
    • Stop if you feel resistance or if the client reports feeling discomfort
    • Ask the client to breathe out slowly through the mouth. This will help relax the anal sphincter and make the procedure easier. Telling the person to take a deep breath during insertion can also ease discomfort
  6. After the tube is in place, the enema bag should be held about 12 inches above the level of the anus. Unclamp the tubing, and allow the solution to flow out slowly
  7. Inform the client that they might feel some cramping and distention. However, if they report pain or nausea, clamp the tubing and wait for the symptoms to subside before restarting
  8. Let the enema flow for around 10–15 minutes, during which time the enema tube should be held in place
  9. After the solution has been instilled, gently remove the tube, provide peri-care, and reposition the client into a more comfortable position. Inform the client about how long they should retain the enema, and stay by their side
  10. Once the time is up, assist them to the bathroom, or use a bedpan or the bedside commode. Observe the content of the stool, and note the quality and quantity of the content. Help the client back to bed, if needed
  11. Raise the side rails and lower the bed
  12. Finally, finish up by disposing the waste and returning the supplies for proper storage

Figure 2: Steps 4 and 5 (A) and Step 6 (B).

Documentation

Document:
  • Date and time
  • Amount and type of solution used
  • How long the enema solution was retained
  • Amount, color, aspect, and consistency of the resulting feces and enema fluid
  • Any difficulties or complications that you encountered, as well as the client's tolerance of the procedure