ENEMA

by:
Prof. Rodeo R. Aguilar RN
 ENEMA
• Procedure in which a solution is introduced
into the rectum and sigmoid colon to remove
feces and/or flatus.
Types of Enema Purpose Solution Amount
Stimulates peristalsis by SOAP SUDS SOLUTION adults - 1000ml
Cleansing irritating the colon and
Enema through distention by
volume.
- 5ml of castile soap in
1000ml of H2O
infants - ≤ 250ml

a. High Flow 1000ml of solution is

- 1 bar of “Perla” soap in
delivered at a higher
1000ml of H2O then
pressure; patient
autoclave
assumes (L) lateral
recumbent, then dorsal
- tap H2O (adults)
recumbent, then (R)
lateral recumbent so the
- NSS
fluid can flow through the
large intestine.

b. Low Flow 500ml of solution is

delivered at a lower
pressure; to clean only
the rectum and the
sigmoid colon
 Cleansing Enema
1. High Flow (large volume)
✓ Given to clean as much of the colon
✓ Often used before diagnostic test
✓ For adult about 1,000 ml is administered
✓ Client change position from left lateral position to dorsal recumbent and to right
lateral position during the procedure so that fluid can follow large intestine
✓ Fluid is administered at higher pressure
✓ Container of solution is held higher
✓ Height of enema can: 12-18 inches
 Cleansing Enema
2. Low Flow (small volume)
o Given to clean the rectum and sigmoid only
o About 500 ml is administered to an adult
o Client maintains the left sidelying (sims)
• Position during its administration
1. Carminative: given primarily to expel flatus for adult instill 60-180 ml of fluid
2. Retention: introduces oil into rectum and sigmoid oil is retained for 1-3 hours it acts to soften the feces and lubricate the canal return
3. Flow/Harris Flush/Colonic Irrigation: is used to expel flatus alternating flow of 100-200 ml of fluid into and out of the colon – siphoning
after
4. Cleansing: stimulates peristalsis by irritating the colon distends the colon with the volume of fluid introduced

o Height of enema can: 12 inches

Types of Enema Purpose Solution Amount
Carminative To expel flatus by - 1-2-3 enema 180 - 240ml
Enema releasing the gas - Milk and molasses
that distends the enema
sigmoid colon and - Mayo enema
the rectum

Oil Enema or To lubricate the - Mineral oil Adults = 150-

Retention Enema colon and the - Olive oil 200ml
rectum; to soften - Cottonseed oil
the feces Small children =
The oil is retained 75-150ml
for 1 to 3 hrs.
Types of Enema Purpose Solution Amount

▪ Return Flow To expel flatus Adult

Enema 100-200ml
▪ Harris Flush
Enema Total - 1000ml
▪ Colonic Irrigation

▪ Medicated To administer
Enema medication

▪ Cooling Enema To lower the body

temperature (33-
35˚C / 91-95˚F)
 Types of Solu tion s
Tap H2O:
- Should not be used for infants because of the danger of electrolyte
imbalance colon absorbs water and repeated enemas can result in
cardiovascular overload.

- S/Sx of cardiovascular overload: dizziness, pallor, sweating, vomiting

 Types of Solu tion s
Soap Suds:
- stimulates peristalsis through irritation and distention.
- only bland, white soap & previously unused (e.g. castile soap)
- strength should not be greater than 5ml/1000ml H2O.
 Types of Solu tion s
Hypertonic solution:
- distends and irritates.
- 120ml of solution is left for 5-7mins before defecating.
- contraindicated in dehydrated patients because this type of solution
draws fluid from the circulation to the bowel.
 Types of Solu tion s
NSS:

- stimulates peristalsis through distention by volume.

- problem: fluids and electrolytes are absorbed into the bloodstream
- to make: add 9ml NaCl to 1000ml H2O or add 1 tsp salt to 500ml H2O.
Salad Oil or Liquid Petrolatum:
- at 33˚C / 91˚F, for oil retention enemas.
 Ty p e s o f S o l u t i o n s
For Carminative Enema:
• 1-2-3 enema
✓ 30 ml (1oz.) magnesium sulfate
✓ 60 ml (2oz.) glycerine
✓ 90 ml (3oz.) warm H2O
• Milk and Molasses Enema
✓ Milk + Molasses in equal parts totaling 180-240 ml
• Mayo enema
✓ 240 ml H2O
✓ 60 ml white sugar
✓ 30 ml sodium bicarbonate (sodium bicarbonate - added just before introducing the enema so the solution will be
bubbly
 Nursing Considerations
ENEMA
1. Place the client in a left lateral position with the right knee flexed.
• (Sims position) to promote flow of the enema into the colon.
2. Hang the enema bag no more than 12 in (30 cm) above the rectum to avoid overly
rapid administration.
3. Lubricate the enema tubing tip and gently insert 3-4 in (7.6-10 cm) into the
rectum. Appropriate sizes:
• Adult- Fr. 22-32
• Child – Fr. 14-18
• Infant – Fr 12
 Nursing Considerations
ENEMA
4. Direct the tubing tip toward the umbilicus during insertion to prevent intestinal
perforation.
5. Encourage the client to retain the enema for as long as possible (5 - 10 minutes).
6. Open the roller clamp on the tubing to allow the solution to flow in by gravity. If the
client reports abdominal cramping, use the roller clamp to slow the rate of
administration or lower the enema container.
7. Stop as desired or client cant hold it anymore.
8. Remove the catheter and clean the anus.
9. Assist client to eliminate and assess feces.