Enemas

Assess medical record for contraindications to—and rationale for—enema.

 Review physician's order for enema, and correctly identify patient.

  1. Perform hand hygiene, apply gloves, and provide privacy.
  2. Raise bed to working height, and raise side rail on patient's left side. Assist patient into left side-lying (Sims') position with right knee flexed.
  3. Place waterproof pad under buttocks. Cover patient with bath blanket, exposing only rectal area and clearly visualizing anus.
  4. Separate buttocks, and examine perianal region for abnormalities.
  5. Place bedpan or commode in easily accessible position. If patient will be expelling contents in toilet, ensure that toilet is free.

 Administer enema.

  1. Administer prepackaged disposable commercial Fleet enema.
  2. Remove plastic cap from tip of container. Apply more lubricant, if needed.
  3. Separate buttocks, and locate rectum. Tell patient to relax by breathing out slowly.
  4. Expel any air from enema container.
  5. Insert nozzle of container gently into anal canal, angling toward umbilicus. Insert it 7.5 to 10 cm for an adult, 7.5 to 10 cm for an adolescent, 5 to 7.5 cm for a child, or 2.5 to 3.75 cm for an infant.
  6. Squeeze bottle until all solution has entered rectum and colon. Instruct patient to retain solution until urge to defecate occurs, usually within 2 to 5 minutes.

Administer enema using enema bag.

  1. Add warmed—not hot—solution to enema bag.
  2. Raise container, release clamp, and allow solution to fill tubing. Then reclamp tubing.
  3. Lubricate 6 to 8 cm (2½ to 3 inches) of tip of rectal tube with lubricating jelly.
  4. Separate buttocks, and locate anus. Tell patient to relax by breathing out slowly.
  5. Insert tip of rectal tube slowly, pointing tip toward umbilicus. Insert it 7.5 to 10 cm for an adult, 7.5 to 10 cm for an adolescent, 5 to 7.5 cm for a child, or 2.5 to 3.75 cm for an infant.
  6. Hold tubing in rectum constantly until fluid instillation is complete.
  7. Open clamp, and allow solution to enter slowly with container at patient's hip level.
  8. Raise height of enema container slowly to appropriate level above anus: 30 to 45 cm (12 to 18 inches) for high enema, 30 cm (12 inches) for regular enema, or 7.5 cm (3 inches) for low enema. Instillation time varies with volume of solution administered.
  9. Lower container, or clamp tubing if cramping occurs or fluid escapes around rectal tube.
  10. Clamp tubing after all solution has been instilled.
  11. Place toilet tissue around tube at anus, and gently withdraw rectal tube and tip.
  12. Ask patient to retain solution as long as possible while lying quietly in bed. (For infant or young child, gently hold buttocks together for a few minutes.)
  13. Discard enema container and tubing properly, or clean thoroughly for reuse.
  14. Assist patient to bathroom, or help to position patient on bedpan.
  15. Observe character of feces and solution. (Caution patient against flushing toilet before inspection.)
  16. Assist patient, as needed, with washing anal area with soap and warm water.
  17. Remove and discard gloves, and perform hand hygiene.
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