Mosby: Mosby's Nursing Video Skills Procedural Guidelines for Administering a Cleansing Enema 1. 2. 3. 4. Gather all needed supplies. Perform hand hygiene. Introduce yourself to the patient and family, if present. Note the patient’s name, type of enema ordered and time of administration. Compare the record against the label on the enema. 5. If the enema is medicated, check the accuracy and completeness of each medication administration record (MAR) with the health care provider’s written order. Check the patient’s name, type of enema, and time of administration. Compare the MAR with the label on the enema solution. 6. Identify the patient using two identifiers, such as name and date of birth or name and account number, according to agency policy. Compare these identifiers with the information on the patient’s identification bracelet. 7. Provide for the patient’s privacy by drawing the bedside curtain or closing the door. Raise the bed to an appropriate working height; raise the side rail on the patient’s left side. Lower the side rail closest to you. 8. Help the patient into a left side-lying or Sims’ position with the right knee flexed. Encourage the patient to remain in this position until the procedure is complete. Cover the patient with a bath blanket, making sure that only the rectal and anal area is exposed. 9. Apply clean gloves. 10. Place a bedpan or bedside commode in an easily accessible position. If the patient will be expelling the contents of the enema into the toilet, ensure that the toilet is available and place the patient’s slippers and bathrobe in an easily accessible position. (If leaving the patient to do this step, raise the rail on your side). 11. Place a waterproof pad, absorbent side up, under the patient’s hips and buttocks. 12. To administer a prepackaged disposable enema: A. Remove the plastic cap from the tip of the container. The tip may already be lubricated. Apply more water-soluble lubricant as needed. B. Separate the patient’s buttocks and examine the perianal region for abnormalities, including hemorrhoids, anal fissures, and rectal prolapse. C. Gently separate the patient’s buttocks and locate the anus. Instruct the patient to relax by breathing in and out slowly through the mouth. D. Expel any air from the enema container. E. Gently insert the lubricated tip of the container gently into the patient’s anal canal in the direction of the umbilicus: Adjust insertion depth based on the patient’s age. Adult: 7.5 to 10 cm (3 to 4 inches) F. Do not force the tip if you feel resistance. Stop the procedure, and notify the health care provider. G. Once properly inserted to proper depth, roll the plastic bottle from the bottom to the tip until all of the solution has entered the patient’s rectum and colon. H. To remove the enema, place toilet tissue around the rectal tube and anus and Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved. 2 gently withdraw the tube and tip. Discard into proper waste receptacle. I. Instruct the patient to retain the solution until the urge to defecate occurs, usually 2 to 5 minutes. Instruct the patient again to remain in this position. 13. To administer an enema using a standard enema bag: A. Warm the tap water as it flows from the faucet. Add the warmed solution to the enema bag. If saline is ordered, place the container of saline in a basin of warm water before adding it to the enema bag, and check the temperature of the solution by pouring a small amount of it over your inner wrist. The water should be warm, not hot. B. If a soap suds enema is ordered, add castile soap after the water is placed in the enema bag. C. Raise the container, release the clamp, and allow the solution to fill the tubing. This removes the air from the tubing. D. Reclamp the tubing. Prepare the patient in the proper position and draping as done above. E. Lubricate 6 to 8 cm (2.5 to 3 inches) of the tip of the rectal tube with lubricating gel. F. Gently separate the patient’s buttocks and locate the anus. Instruct the patient to relax by breathing in and out slowly through the mouth. Then touch the patient’s skin next to the anus with the tip of the rectal tube. G. Insert the tip of the rectal tube slowly by pointing the tip in the direction of the patient’s umbilicus. The length of insertion varies based on patient’s age: Adult: 7.5 to 10 cm (3 to 4 inches) H. Holding the tubing in the rectum, open the regulating clamp and allow the solution to enter slowly, keeping the container at the level of the patient’s hips. This prevents the solution from flowing out of the bag too rapidly. I. Constantly hold the tube in place until all the solution has been instilled. J. Gradually raise the height of the enema container slowly to the appropriate level above the anus. The amount of time needed to instill the solution will vary with the volume of solution to be administered: 30 to 45 cm (12 to 18 inches) for a high enema 30 cm (12 inches) for a regular enema 7.5 cm (3 inches) for a low enema 14. Once the flow of the fluid has been established, you may use an IV pole to hang the enema bag. A. Lower the container or clamp the tubing if the patient complains of cramping or if fluid escapes around the rectal tube. B. Instill all of the solution, and clamp the tubing. Tell the patient that you’ve completed the procedure and that you’ll be removing the tubing. 15. Place layers of toilet tissue around the tube at the anus, and gently withdraw the rectal tube and the tip. 16. Explain to the patient that some distention and abdominal cramping afterward is normal. While continuing to lie on their left side, ask the patient to retain the solution for as long as possible until the urge to defecate occurs. This usually takes a few minutes. Stay at the bedside. Have the patient lie quietly in bed if possible. Discard the enema container and tubing in the proper receptacle. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved. 3 17. Help the patient to the bathroom or commode if possible. If using a bedpan, help the patient assume as near the normal position for evacuation as possible. 18. Observe the character of the patient’s stool and solution. Caution the patient not to flush the toilet before you have a chance to inspect the patient’s stool. 19. Assist the patient as needed with washing the anal area with warm soap and water. If you will be providing such care, remember to wear gloves. 20. Remove and discard your gloves. Perform hand hygiene. 21. Assess the patient’s abdomen for distention. 22. To ensure the patient’s safety, raise the appropriate number of side rails and lower the bed to the lowest position. 23. Help the patient into a comfortable position, and place toiletries and personal items within reach. 24. Place the call light within reach, and make sure the patient knows how to use it to summon assistance. 25. Document and report the patient’s response and expected or unexpected outcomes. Also document the type and volume of enema, time of administration and characteristics of stool. Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.