Enema administration

Encyclopedia of Nursing and Allied Health, 20050229 by R.N. Mary Elizabeth Martelli, B.S.

Wash hands thoroughly and put on gloves. To prepare for premixed disposable enema instillations, follow the directions on the package. Most premixed disposable enemas come with the tip already lubricated. Shake the solution bottle. Remove the cap from the tip and expel excess air from the apparatus before use. To prepare solutions to be administered using an enema bag, heat the solution to 105°F (40.6°C). Adults' solutions are generally 750-1000 cc of solution for a non-retention enema and 150-200 cc of fluid for a retention enema. Children's solutions are 250-500cc of solution for a non-retention enema and 75-150 cc of solution for a retention enema. Infants' solutions are 150-250 cc of solution for a non-retention enema. If preparing a medicated solution, follow the physician's orders. Select a rectal tube appropriate to the patient's size (#14-30 French rectal tube for an adult, #12-18 for a child, #12 for an infant) and connect it to the tubing from the bag. Fill the enema bag with the solution and open the tubing. Run the solution through the tubing to the tip of the rectal tube to clear air from the line. Clamp the tubing and adjust the bag on an IV pole so that it will hang at the patient's hip-line. Put water-soluble lubricant on a clean 4x4 gauze pad and roll the tip of the rectal tube in the lubricant. Coat all of the rectal tube that will be inserted into the rectum to avoid traumatizing the rectal tissue [3-4 inches (7.3-10 cm) for an adult, 2-3 inches (5-7.5 cm) for a child, 1-1 1/2 inches (2.5-4 cm) for an infant].

Aftercare

After administering an enema, remain near the patient in case he or she needs assistance with the bedpan or to get to the bathroom. Medicated enemas that are expelled immediately may need to be repeated, using fresh solution. Follow the directions or consult with the physician. To assist the patient with retaining an enema after instillation, apply gentle pressure to the rectal opening using a 4x4 gauze pad or squeeze the buttocks together. Tuck a 4x4 gauze pad between the buttocks to collect seepage. This maneuver may help the patient feel more secure. Cover the patient after the procedure and instruct him or her to lie still for five to 10 minutes or longer if a medicated solution or retention enema is administered. This will allow time for the solution to take effect. Wash items that might be reused, such as non-disposable enema bags and tubing, in warm soapy water. Rinse and allow them to air dry. Place disposable items, gauze pads, and gloves in a trash bag, then seal and discard it. Assist the patient to the bathroom or with the bedpan after he or she has held the enema solution for the correct amount of time. Hands should be washed after performing the procedure. Note the results of the enema.

Complications

Complications of enema administration are not common but can include irritation, swelling, redness, bleeding, or prolapse of the rectal tissue. If any of these symptoms are apparent, or if the patient complains of pain or burning during enema instillation, stop the procedure and notify the physician.