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.Next, we’ll need to administer the enema.

Raise the bed to a comfortable working height, and lower the side rails on the side you’ll be working. Help the client into the left Sims’ position.

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.

With one hand, raise the upper buttock. Then, grasp the enema tube with the other hand, and lubricate it with the water-soluble lubricant.

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 complains of discomfort. Ask the client to breath 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.

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.

Inform the client that they might feel some cramping and distention. However, if they complain of pain or nausea, clamp the tubing and wait for the symptoms to subside before restarting.

Let the enema flow for around 10 to 15 minutes, during which time the enema tube should be held in place. 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. 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.

Raise the side rails and lower the bed. Finally, finish up by disposing the waste and returning the supplies for proper storage.

During the procedure, report to the nurse immediately if you can’t insert the tube due to resistance or pain or if you notice bleeding.

After the insertion, report if the client experiences severe cramping or pain or if they can’t tolerate the procedure. Document the date and time of the amount and type of solution used, how long the enema solution was retained, and the amount, color, aspect and consistency of the resulting feces and enema fluid.

Also report any difficulties or complications that you encountered as well as the client’s tolerance to the procedure. ##SummaryAll right, as a quick recap… 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.

Depending on the solution, there are tap water, normal saline, Harris Flush, soapsuds, carminative solution, and oil-retention enemas.

Stop administration and tell the nurse if bleeding, resistance, or pain occurs during tube insertion, or if the person has pain or severe cramping afterwards.