1.1.1.

Enema
Definition:

 Is an injection of a liquid in to the rectum, to be returned or retained.

 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.

Purpose:

 To cleanse the lower bowel,

 To assist in the evacuation of stool or flatus
 To instill medication
1.1.1.1. Cleansing enema/evacuating enema/
Objectives: - At the end of this lesson, the learner will be able to
1. Define enema
2. To perform cleansing enema
Definition:- an enema is the cleansing of a portion of the bowel by insertion of fluid rectally

Purpose

 To relieve gas, constipation or fecal impaction

 To cleanse the bowel prior to surgery, childbirth, or diagnostic examination.
 To evacuate the bowel in patients with neurologic dysfunction.
 Evacuates feces in clients with hemiplegia, quadriplegia or paraplegia
 Delivers medication
Types of liquid used for cleansing enema

1. Tape water = 5000 to 1000 cc

2. Soap solution= 5000 to 1000 cc
 3. Normal saline - made by mixing one teaspoon of salt in a liter of water usually contains
1000cc of normal saline.
4. Epsom salt 15 gm - 120 gm in 1000 cc of water

Precautions

 No need to use too much soap - this may produce sever irritation of the membrane of the
colon.
 Tap water must be administered consciously for infants or adults who have altered kidney
or cardiac reserve this is to avoid water intoxication.
Contraindications

 Rectal surgery  for a patient with appendicitis

 Rectal /anal/ cancer  Rectal /Ana/ fissure
 Rectal infection
Equipment

1. Container for solution 9. IV pole/stand

2. Solution at temperature for adult 40- 10. Gloves
430c 11. Receiver /kidney dish/
3. Bath thermometer for infant (37.70c) 12. Lubricant
4. Water proof material /mackintosh/ 13. Rectal tube /catheter /
5. Screen, bath blanket, towel 14. Clamp, connector, funnel
6. Enema can with tube
7. Gauze to apply lubricant /swab/
8. Bed pan and toilet tissue
Procedure

1. Check physician's order patient

2. Prepare solution for cleansing enema.
3. Gather equipment
4. Provide privacy
5. Wash your hand
6. Identify correct patient and explain the procedure to the patient.
7. Fill water container with 750 to 100 cc of Luke warm solution
8. Allow solution to run through the tubing so that air is removed
9. Raise bed to high position and lower side rails
10. Place bed protector under patient

11. Place patient on left side /left lateral / in a sim’s position

12. Lubricate the tip of the tubing with water soluble lubricant
13. Gently insert tubing 3 to 4 inch (6-8cm) in to patients rectum pass the external and
internal sphincters
14. Raise the water container to a maximum height of 45cm
15. Allow solutions to flow slowly
16. Hold the tubing in place in the patient's rectum at all times. Keep abed pan near by
17. After you have instilled the solution, gently remove the tubing instruct patient to hold
solution for 10 to 15 minutes.
18. Elevate the head of the bed so that the patient can assume as squatting position on the
bedpan or assist to bathroom.
19. Provide privacy until the patient has expelled the total volume of the instilled solution
20. Removal and cover bed pan
21. Assist patient with perineal care and help patient to assume a comfortable position
22. If the patient is on strict input and out measure returns to make sure total volume of the
solution is expelled.
23. Clean all equipment and replace in both room or appropriate vocation
24. Wash your hands