ENEMA PROCEDURE

ENEMA PROCEDURE 

Preliminary assessment –

• Check the diagnosis, date & time of surgery.


• Assess the client for any evidence of constipation, abdominal pain or cramps, defecation difficulty etc.


• Assess the client’s complaints of anorexia, abdominal fullness.


• Assess the client’s mobility, history of any previous enema, associated with irritation, injury, fissures.


• Assess the client’s control of external sphincter, ability to retain fluid.


• Assess the physicians order – nature of enema, collection of specimen

 

PREPARATION OF PATIENT AND THE UNIT

• Explain the procedure to the patient to win his confidence & cooperation. Explain the discomfort caused by the enema fluid & need for retaining the solution for some time.


• Provide privacy to the patient with screen / curtains.


• Cover the patient with a bath blanket & fanfold the top linen on the foot end of the bed.


• Remove the backrest & pillows.


• Keep all the articles arranged on the bedside locker.


• Adjust I/V stand to hold the enema can at an appropriate height.


• Remove bottom garments or rise it above the waist level.


• Drape the patient immediately before giving enema. Fold back a small portion of the sheet or the bath blanket, covering the patient to expose only the anus.

PREPARATION OF THE ARTICLES

• Screen

An enema tray with

• An enema can


• Tubing & clamp


• A rectal tube in a sterile container

( size : adult – 22 to 30 Fr, children – 12 to 18 Fr )

• Enema solution

( temperature of solution for adults – 105 to 110⁰F, for children – 98.6⁰F )

• A lubricating jelly


• One ounce glass


• A mackintosh with a towel


• A bath blanket


• Disposable gloves


• I/V pole

ARTICLES FOR OFFERING A BED PAN AFTER ENEMA

• A tray containing :


• A mackintosh


• A jug with warm water or an antiseptic solution


• Wet cotton balls or rag pieces in a container


• Gauze or rag pieces in a container


• A paper bag


• Clean linen ( personal & bed linen), pads, dressings etc as needed, a soap dish, a towel &  wash cloth (if the patient is able to do himself )


• A bed pan with cover


• A Towel or small pillow

PROCEDURE

S.NO	STEPS OF PROCEDURE	RATIONAL
1.	Wash hands and wear gloves.	To prevent cross infection
2.	Attach the tubing to the enema can and clamp the tube	To prepare the tube and be ready for administration
	Pour 750ml of water into the can. Test the temperature of the solution at the inner aspect of the wrist.	Temperature above 43 may injure tissues and temperature below 21may produce severe cramping
4.	Hang the can with the solution on the stand and adjust the height at 45 cm. from the anus.	The rate of the flow and the pressure of the fluid will increase according to the height of the can.
5.	Attach the rectal tube to the tubing. Loosen the clamp and let a small amount of fluid to run into the kidney tray. Regulate the flow of the solution by adjusting the clamp. Pinch the tubing with the fingers. Read the level of   fluid in the enema can.	Running the fluid through the tube will help to expel the air from the tubing. Reading the level of fluid can help us to calculate the amount of fluid introduced into the rectum.
6.	Lubricate the tip of the tube about 2 to 4 inch from the xylocaine jelly.	Lubrication of the tube will prevent cross infection.
	Separate the patient’s buttocks to visualise the anus with the help of gauss and insert the tip 8 to 10 cm. gently while the patient inhales.	Forceful insertion of the rectal tube may injure the anal or rectal tissue.
	Hold the enema tube in place while releasing the pressure on the tube and let the fluid run in. Read the level of the fluid and make sure that it is flowing.	Holding the tube throughout the procedure will prevent the displacement of the tube.
	During the administration of the fluid ask the patient to take panting breaths.	Breathing with open mouth relaxes the abdominal muscles, decreases the pressure on the colon. Also distract the patient enough to relax the abdominal muscles.
	Temporarily stop the administration of the solution if the patient has an urge to defecate or has abdominal cramps or if the solution level is rising in the enema can.	Temporary stoppage of the fluid will relax the bowels as the peristaltic movement is passed off,
	Continue the fluid administration to give about 750 to 1000 ml of solution. Stop the procedure if the patient feels any discomfort.	Large amount of faeces in the colon decreases the volume of the solution retained comfortably.
	Clamp the tubing. Gently remove the rectal tube by pulling it through 3 to 4 layers of rag pieces. Hold the rag pieces. Hold the rag piece around the tube and firmly  against the anus.	Holding the rag piece around the tube cleanses the tube by removing the faeces from the tube. The pressure applied on the anus will help the patient to maintain the control over anal sphincter.
	Discard the rag pieces in the paper bag. Detach the rectal tube and place it in the kidney tray.	Avoid the contamination of the articles and the environment, with the soiled articles.

AFTER CARE OF THE PATIENT AND ARTICLES

• Assist the patient to the bathroom or help positioning him/ her.


• Observe characteristics of feces return flow.


• Record & report


• Type & volume of enema given


• Size & type of catheter


• Color, amount & consistency of fecal return.


• Ask whether the patient is comfortable.


• Any other observation.


• Dismantle all articles & ensure effective housekeeping after disinfection.

AFTER CARE OF THE BED PAN

• Rinse with cold water under force after evacuating its content.


• Wash with soap & water using a brush.


• Use vim to remove stains & rinse well.


• For disinfection soak bedpans in Lysol 1:40 for one hour or they can be sterilized in sterilizer.


• Direct sunning of bedpans for a few hours to deodorize & disinfect them as advisable.


• Keep them dry for next use.