Enema 59na

E N E M A

What is Enema? ENEMA is a solution introduced into the rectum and large intestine. The action of an enema is to distend the intestine and sometimes to irritate the intestinal mucosa, thereby increasing peristalsis and the excretion of feces and flatus.

TYPES OF ENEMAS A. CLEANSING ENEMA = are intended to remove feces. They are given chiefly to: 1. Prevent the escape of feces during surgery.

2. Prepare the intestine for certain diagnostic tests such as x –ray or visualization tests ( e.g. colonoscopy ) 3. Remove feces in instances of constipation or impaction.

Cleansing Enema uses a variety of solution : SOLUTION

CONSTITUENTS

ACTION

TIME TO EFFECT

ADVERSE EFFECTS

Hypertonic

90-120ml of solution e.g. sodium phosphate

Draws water into the colon

5-10 mins.

Retention of sodium

Hypotonic

500-1,000 ml of tap water

Distends colon, stimulates peristalsis and softens feces

15-20 mins.

Fluid and electrolyte imbalance, water intoxication

Isotonic

500-1,000 ml of normal saline ( 9 ml to 1,000 ml water)

Distends colon, stimulates peristalsis and softens feces

15-20 mins.

Possible sodium retention

Soapsuds

500-1,000 ml soap to 1,000 ml water

Irritates mucosa, distends colon

10 – 15 mins.

Irritates and may damage mucosa.

Common solution for cleansing enemas

 Tap water

 Normal saline solution  Soapsuds solution  Hypertonic solution

B. CARMINATIVE ENEMA = is given primarily to expel flatus. The solution instilled into the rectum releases gas, which in turn distends the rectum and the colon, thus stimulating peristalsis. For an adult 60 to 80 ml. of fluid is instilled.

C. RETENTION ENEMA = introduces oil or medication into the rectum and sigmoid colon. The liquid is retained for a relatively long period. An oil retention enema acts to soften the feces and to lubricate the rectum and anal canal, thus facilitating age of the feces. Antibiotic enemas are used to treat infections locally, antihelmintic enemas to kill helminths such as worms and intestinal parasites and nutritive enemas to ister fluids and nutrients to the rectum.

D. RETURN – FLOW ENEMA = is used occasionally to expel flatus. Alternating flow of 100 to 200 ml of fluid into and out of the rectum and sigmoid colon stimulates peristalsis. This process is repeated five or six times until the flatus is expelled and abdominal distention is relieved.

Purpose Enemas may be given for the following purposes:  to remove feces when an individual is constipated or impacted,  to remove feces and cleanse the rectum in preparation for an examination,  to remove feces prior to a surgical procedure to prevent contamination of the surgical area,  to ister drugs or anesthetic agents.

 water enemas can cause cardiovascular overload and

electrolyte imbalance. Similarly, repeated saline enemas can cause increased absorption of fluid and electrolytes into the bloodstream, resulting in overload. Individuals receiving frequent enemas should be observed for over-load symptoms that include: dizziness, sweating, or vomiting

 Soap suds and saline used for cleansing enemas can cause

irritation of the lining of the bowel, with repeated use or a solution that is too strong. Only white soap should be used; the bar should not have been previously used, to prevent infusing undesirable organisms into the individual receiving the enema. Common household detergents are considered too strong for the rectum and bowel. The commercially prepared soap is preferred, and should be used in concentration no greater than 5 cc soap to 1, 000 cc of water.

Description  Cleansing enemas act by stimulation of bowel activity through irritation of the lower bowel, and by distention with the volume of fluid instilled. When the enema is istered, the individual is usually lying on the left side, which places the sigmoid colon (lower portion of bowel) below the rectum and facilitates infusion of fluid. The length of time it takes to ister an enema depends on the amount of fluid to be infused. The amount of fluid istered will vary depending on the age and size of the person receiving the enema, however general guidelines would be:

 Infant: 250 cc or less  Toddler and preschooler: 500 cc or less  School-aged child: 500–1, 000 cc  Adult: 750–1, 000 cc

 Some may differentiate between high and low enemas.

A high enema, given to cleanse as much of the large bowel as possible, is usually istered at higher pressure and with larger volume (1, 000 cc), and the individual changes position several times in order for the fluid to flow up into the bowel. 2. A low enema, intended to cleanse only the lower bowel, is istered at lower pressure, using about 500 cc of fluid. 1.

 Oil retention enemas serve to lubricate the rectum

and lower bowel, and soften the stool. For adults, about 150–200 cc of oil is instilled, while in small children, 75–150 cc of oil is considered adequate. Salad oil or liquid petrolatum are commonly used at a temperature of 91°F (32.8°C). There are also commercially prepared oil retention enemas. The oil is usually retained for one to three hours before it is expelled.

 The rectal tube used for infusion of the solution, usually made

of rubber or plastic, has two or more openings at the end through which the solution can flow into the bowel. The distance to which the tube must be inserted is dependent upon the age and size of the patient.  For adult, insertion is usually 3–4 in (7.5–10 cm);  for children, approximately 2–3 in (5–7.5 cm); and  for infants, only 1–1.5 in (2.5–3.75 cm). The rectal tube is lubricated before insertion with a water soluble lubricant to ease insertion and decrease irritation to the rectal tissues.

 The higher the container of solution is placed, the

greater the force in which the fluid flows into the patient. Routinely, the container should be no higher than 12 in (30 cm) above the level of the bed; for a high cleansing enema, the container may be 12–18 in (30–45 cm) above the bed level, because the fluid is to be instilled higher into the bowel.

Preparation  The solution used in the procedure is measured, mixed, add warmed before istration of enema

Aftercare  If necessary, a specimen will be collected for diagnostic evaluation. If the enema was given to alleviate constipation, the better approach to combating constipation in the future is with a high fiber diet (five to six servings of whole grain foods) and adequate fluid intake (seven to eight glasses of water per day). Regular exercise and going to the bathroom when necessary will also help. If constipation is a chronic problem, medical help should be consulted to determine if there is underlying disorder.

Risks  Habitual use of enemas as a means to combat constipation can make the problem even more severe when their use is discontinued. Enemas should be used only as a last resort for treatment of constipation and with a doctor's recommendation. Enemas should not be istered to individuals who have recently had colon or rectal surgery, a heart attack, irregular heart beat.

Can I do an enema if I am pregnant or nursing a baby?

 Both pregnant women and nursing women have safely

done enemas. Many of them. No known risks are associated with clean water enema, but if you are pregnant, you should avoid enema containing herbs

What do I need to do an enema? Enema bag/bucket must contain:  enema bag (or enema bucket)  enema tube (connecting enema bag with enema nozzle)  tube clamp or stop cock - used for clamping the tube.  enema nozzle or tip (thin plastic, silicone, glass or stainless steel tube that will be inserted into anus). Nozzle is usually 5 - 8 cm long (2 - 3 in), and it is as thick as pencil. You are not suppose to insert the whole length!  enema liquid

ASSEMBLE THE MATERIALS NEEDED

POSITION THE CLIENT IN THE LEFT LATERAL POSITION WITH THE RIGHT LEG SHARPLY FLEXED

PLACE SOLUTION INTO THE BUCKET AND ADD WATER AS NEEDED

LUBRICATE 2 INCHES OF THE RECTAL TUBE WITH LUBRICANT

GENTLY AND SMOOTHLY INSERT THE RECTAL TUBE INTO THE RECTUM

RAISE THE CONTAINER 12 TO 18 INCHES ABOVE THE RECTUM AND INSTILL 200 CC OF SOLUTION

LOWER THE CONTAINER 12 TO 18 INCHES BELOW THE CLIENT’S RECTUM. OBSERVE FOR AIR BUBBLES AS THE SOLUTION RETURNS.

CLEAN THE ANAL AREA TO REMOVE EXCESS LUBRICANT

A COMMERCIAL ENEMA

POSITION THE CLIENT IN THE LEFT LATERAL POSITION WITH THE RIGHT LEG SHARPLY FLEXED

ALTERNATIVELY, YOU MAY POSITION THE CLIENT IN THE KNEE CHEST POSITION

AFTER INSERTING THE NOZZLE INTO THE ANUS, SQUEEZE THE CONTAINER UNTIL ALL THE SOLUTION IS INSTILLED

REMOVE THE NOZZLE AND CONTAINER AND HAVE THE CLIENT CONTINUE TO LIE ON THE LEFT SIDE FOR THE PRESCRIBED LENGTH OF TIME. DISPOSE OF THE EMPTY CONTAINER IN THE TRASH RECEPTACLE