Gastrointestinal: Administering an enema (for nursing assistant training)

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. So, 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.

Enemas can be classified depending on their purpose or their composition. So in the first category, there are cleansing enemas, which are used to clean the colon of feces entirely. Then there are oil-retention enemas, which are lubricating enemas that soften the feces in order to make them easier to eliminate. Third, there are medicated enemas, which contain medication that can be prescribed for a variety of reasons, like lowering serum potassium levels for example.  Depending on their composition, the different types of enemas include tap water; normal saline; Harris Flush and carminative, which help with gas elimination; soap suds; and oil-retention enemas, which is an oil-based solution. Now before we go into the procedural details of administering an enema, here are some come common care tips. Always double-check the client’s ID to make sure the procedure is performed on the right person. Based on the facility’s policies, a nursing assistant can administer an enema under the supervision and at the direction of a licensed nurse, who will direct you on 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 bedside commode if the client has mobility problems. You should also close the bed curtains and door, and keep the person covered as much as possible for privacy reasons. Other tips for making clients feel comfortable include lubricating the tip of the enema tube before insertion, administering the solution slowly, and using a solution that’s slightly warmer than body temperature. If you have trouble inserting the enema tube or if the client has symptoms like nausea or pain, be sure to ask the nurse for help. Finally, you should ask the nurse 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.  

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, and a package of castile soap.
 The first step is to prepare the enema solution in the bathroom. 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.  Add the castile soap and mix by gently rotating the enema bag. Do not shake the solution vigorously. Release the clamp on the tubing and allow a tiny amount of water out. This will remove all of the air from the tubing. Reclamp the tubing and hang it from an IV pole.