![]() The patient should be encouraged to empty both bladder and bowels before the procedure. Preparationīefore administering an enema, ensure the patient's privacy by closing the room door. When all of the solution has been administered, clamp the tubing, remove the enema catheter, and release the buttock. This will increase the water pressure to deliver the fluid higher into the bowel. If ordered to give a high enema, slowly raise the bag no more than 18 inches (46 cm) above the adult patient's hip (12 inches (30.5 cm) above a child's hip and six inches (15 cm) above an infant's hip). ![]() If the fluid will not flow in, gently rotate the tubing within the rectum to clear the holes of the tubing from the wall of the bowel or the impacted stool that may be occluding the flow. Continue to hold the rectal tube in place throughout the procedure or it will be expelled from the rectum. As the tubing is opened, slowly raise the IV pole to promote fluid flow until the bag is 12 inches (30.5 cm) above the hip for an adult. ![]() When giving fluid through an enema bag, start with the bag suspended from an IV pole at the patient's hip level. If the patient complains of cramping, slow or stop the enema flow and have the patient breathe slowly through the mouth to encourage relaxation. After alerting the patient, open the enema tubing to allow the solution to flow or squeeze premixed enema solutions slowly into the rectum. Insert the tubing 2 in (5 cm) for a child less than six years and 1 in (2.5 cm) for an infant. Place the lubricated tip of the enema catheter at the anal opening, and gently advance the catheter through the anal sphincter into the rectum toward the umbilicus (navel), 3–4 in (7.5–10 cm) for an adult. Lift the upper buttock so that the rectal opening can be visualized. To administer an enema solution, the clinician should have the patient lie down on the left side, knees bent. Use only mild castile soap for soapsuds enemas because other soap preparations are too harsh and irritate the rectal tissue. This can cause trauma to the rectal tissue. Do not force the enema catheter into the rectum against resistance. If the patient has rectal bleeding or prolapse of rectal tissue from the rectal opening, cancel the enema and consult with the physician before proceeding. Enemas should be used cautiously in patients who have had recent surgery on the rectum, bowel, or prostate gland. Enemas should not be given to patients with undiagnosed abdominal pain because the peristalsis of the bowel can cause an inflamed appendix to rupture. Insertion of the enema tube and solution can stimulate the vagus nerve which may trigger an arrhythmia such as bradycardia. Enema administration must be used with caution in cardiac patients who have arrhythmias or have had a recent myocardial infarction. A patient with diarrhea may not be able to hold an enema. ![]() Never deliver more than three consecutive enemas to treat a patient. Frequent use of enemas can lead to fluid overload, bowel irritation, and loss of muscle tone of the bowel and anal sphincter. PrecautionsĮnemas should not be used as a first-line treatment for constipation. These substances are then eliminated with the stool. Medicated hypertonic enema solutions can be used to pull excessive potassium or ammonia from the bloodstream through the rectal wall. Antibiotic enema solutions can be administered to treat localized bacterial infections. Steroid enema solutions can be administered to alleviate bowel inflammation in patients with ulcerative colitis. Enemas are also used to deliver medication directly onto the rectal mucous membranes to be absorbed into the bloodstream. The purpose of the oil retention enema is to soften the hardened stool and allow normal elimination. Another type of enema, the oil retention enema, is prepared in a smaller volume and is retained in the bowel for 30–60 minutes. They are used to treat constipation, to cleanse the bowel before a bowel exam, and to cleanse the bowel before bowel surgery. These types of enemas are instilled and held for five to 10 minutes, as tolerated. A tap water or soapsuds enema dilates the bowel, stimulates peristalsis, and lubricates the stool to encourge a bowel movement. The most common purpose for administering an enema is to stimulate peristalsis (involuntary contraction) and to evacuate stool from the rectum. Enema solutions are prepared using plain tap water or saline, soapsuds solutions, oil solutions, or various medication solutions. An enema can also be performed using a prepackaged solution that comes in a soft plastic bottle with a pre-lubricated rectal tip attached. This is connected to the tubing from a solution bag or container. An enema administration is performed using a flexible plastic rectal tube with several large holes in the tip. The term enema is used to refer to the process of instilling fluid through the anal sphincter into the rectum and lower intestine for a therapeutic purpose.
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