sign in sign up
<<
Home , Enema, Rectal administration

ADMINISTRATION

PURPOSE Procedure for administering an enema. POLICY STATEMENTS In children with renal dysfunction or bowel dysfunction, phosphate (e.g. Fleet®) may lead to ADVERSE EVENTS. Even in normal children, phosphate enemas should not be used in children under 2 years of age and only with extreme caution between 2 and 5 years of age. Give phosphate enema (e.g. Fleet®) only once. If a second enema is required, a enema may be administered to reduce exposure to . Performing an enema requires a prescriber's order which specifies the name or type, volume, indication, route and frequency of administration. Pediatric Dosing for phosphate enema (Fleet®): Children 2-4 years: one half pediatric enema = 30 mL X 1 dose only Children 5-11 years: pediatric enema = 60 mL X 1 dose only Children ≥12 years and Adolescents: adult enema = 120 mL X 1 dose only SITE APPLICABILITY All inpatient areas. PRACTICE LEVEL/COMPETENCIES Administering an enema is a foundational nursing competency. EQUIPMENT o commercially prepared enema (e.g. Fleet®) or appropriate container ( or bag) with ordered solution (e.g. 0.9% NaCl) at body temperature (approximately 37.8°) and tubing if required for bag administration o appropriate sized rectal tube or as appropriate (size 12 F for infants; size 14F-18F for children and adolescents) o water soluble lubricant o incontinence pads o bedpan/commode o clean gloves PROCEDURE Rationale 1. ASSESS patient for presence of any condition that Identifies contraindications to the procedure. may contraindicate enema administration and DISCUSS concerns with prescriber: o renal dysfunction/renal failure o abnormal serum electrolytes o low calcium, hyperphosphatemia, or hypernatremia o dehydration o heart (recent cardiac , congestive heart failure, , history of QT prolongation) o hypertension o (or symptoms of appendicitis: , , fever or ) o GI obstruction CC.12.35 BC Children’s Hospital Child & Youth Health Policy and Procedure Manual Page 1 of 4

ENEMA ADMINISTRATION

o recent or past bowel surgery o o paralytic o ulcerative o anorectal malformations o rectal o rectal fissures o o increased intracranial pressure o glaucoma o thrombocytopenia o neutropenia o seizure risk 2. ASSESS patient for abdominal distention, pain, Establishes a baseline assessment for determining and presence of bowel sounds. efficacy of the enema. 3. IDENTIFY patient and EXPLAIN procedure. Failure to correctly identify patients prior to procedures may result in errors. Reduces child and family’s anxiety. Evaluates and reinforces understanding of previously taught information and confirms consent for procedure. 4. PROVIDE for privacy. Shows respect for child; promotes cooperation and decreases anxiety. 5. PERFORM hand hygiene and DON clean gloves. Routine control practices; reduces transmission of microorganisms. 6. PLACE incontinence pad under patient and Provides easy passage of the solution by following POSITION the patient on the left side with knees the natural curve of the sigmoid colon and . flexed or in the knee-chest position.

7. ATTACH rectal tube to syringe or solution tubing Instillation of air into the GI tract can cause and prime entire length of tubing with solution to abdominal distention and discomfort. remove air. NOTE: If administering only 30 mL Fleet enema from 60 mL bottle, prepare bottle by expelling 30 mL of , then replace cap and administer as usual. 8. LUBRICATE tip of rectal tube or remove cap from Facilitates insertion and promotes comfort. commercial enema. 9. SEPARATE the buttocks and locate the anus. Good visibility and positioning aid in ease of procedure. 10. Gently INSERT rectal tube or tip of commercial Prevents irritation or trauma to the rectal mucosa or enema into the patient's rectum to recommended rectum. depth per chart below with the tip directed towards the umbilicus.

CC.12.35 BC Children’s Hospital Child & Youth Health Policy and Procedure Manual Page 2 of 4

ENEMA ADMINISTRATION

Insertion Age distance infant 2.5 cm (1") 2-4 years 5 cm (2") 4-10 years 7.5 cm (3") 11 and over 10 cm (4")

11. If using container and tubing: ELEVATE the Promotes continuous slow instillation of solution, container no more than 30-45 cm (12-18") above with minimization of complications. Too rapid the rectum. RELEASE clamp and allow the administration can cause painful distention of the solution to flow for 10-15 minutes. Hold tubing in colon. High pressure could rupture the bowel of an place with one hand. Lower the height of the infant. container if the child has pain or if fluid leaks around the catheter. If using syringe: gently PUSH on syringe plunger until solution has been administered. For prepackaged enemas, SQUEEZE bottle until all the solution has been administered. 12. After instilling the solution, gently REMOVE the Prevents leakage of fluid around the tubing. rectal tube or bottle tip. 13. MAINTAIN patient in side-lying position until urge Longer retention of the solution promotes more to have a bowel movement is felt (2-15 minutes). effective stimulation, peristalsis, and . 14. POSITION and SUPPORT patient on bedpan/commode or ASSIST to the bathroom. 15. PROVIDE routine perineal care. Promotes comfort and prevents skin breakdown. 16. MEASURE the amount and quality of returned Evaluates efficacy of the procedure. solution. Assesses for return of all infused fluid. 17. REMOVE equipment and supplies and DISPOSE Routine infection control practices; reduces of appropriately. PERFORM hand hygiene. transmission of microorganisms.

DOCUMENTATION DOCUMENT on appropriate record(s): o date and time o abdominal assessment before and after enema o type, route, volume of fluid/solution administered o length of time enema retained o colour, consistency, amount of stool and fluid returned o abnormal findings, such as bloody stool or presence of mucous o individual administering enema o patient's response to procedure, including changes in vital signs o patient/family education o unexpected outcomes and related treatment o any other pertinent actions or observations REFERENCES Blackmer, A.B. and Farrington, E.A. (2010). in the Pediatric Patient: An Overview and Pharmacologic Considerations. Journal of Pediatric Healthcare, 24(6):385-99. Fleet Enema Manufacturer’s Monograph. Retrieved August 22, 2013 from http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-

CC.12.35 BC Children’s Hospital Child & Youth Health Policy and Procedure Manual Page 3 of 4

ENEMA ADMINISTRATION

%20(General%20Monographs-%20F)/FLEET%20ENEMA.html Harrington, L. and Schuh, S. (1997). Complications of Fleet enema administration and suggested guidelines for use in the pediatric . Pediatric Emergency Care, 13(3):225-6. Lexicomp Drug Information: Sodium Phosphates. Retrieved August 22, 2013. Marraffa, J.M., Hui, A., and Stork, C.M. (2004). Severe hyperphosphatemia and hypocalcemia following the of a phosphate-containing Fleet pediatric enema. Pediatric Emergency Care, 20(7):453-6. Mason, D., Tobias, N., Lutkenhoff, M., Stoops, M. and Ferguson, D. (2004). The APN's Guide to Pediatric Constipation Management. The Nurse Practitioner, 29(7):13-21 Mauricio, R. (2008). Bowel Irrigation. In Trivits, V.J. and Lebet, R.M., (Ed). AACN Procedure Manual for Pediatric Acute and Critical Care (pp. 678-684). St Louis, Missouri: Saunders Elsevier. Mendoza, J., Legido, J., Rubio, S. and Gisbert, J.P. (2007). Systematic Review: the Adverse Effects of Sodium Phosphate Enema. Alimentary Pharmacology and Therapeutics, 26(1):9-20. National Institute for Health and Clinical Excellence. (2010). Constipation in Children and Young People. Clinical Guideline No. 99. NICE, London. Rogers, J. (2012). Assessment, prevention and treatment of constipation in children. Nursing Standard. 26(29):46-52.

CC.12.35 BC Children’s Hospital Child & Youth Health Policy and Procedure Manual Page 4 of 4