Cleansing Enema Level III

Purpose The purpose of this procedure is to promote defecation.

Preparation 1. Verify that there is a physician’s order for this procedure. 2. Review the resident’s care plan to assess for any special needs of the resident. 3. Assemble the equipment and supplies as needed.

General Guidelines 1. Should a regular-sized bedpan be uncomfortable to the resident or if the resident’s medical condition requires, use a fracture pan for the procedure. 2. Report any complaints the resident may have to your supervisor before beginning the procedure. 3. Should the resident complain of cramps after you have started the enema, stop the flow of solution until the pain has subsided. 4. When administering the solution, do not raise the enema container more than eighteen (18) inches above the mattress, or more than twelve (12) inches above the buttocks. 5. Prepare cleansing enema solutions as follows: 6. Soapsuds: Mix one (1) package of enema soap to 1,000 ccs of warm water. Stir the solution gently with the tip of the tubing to prevent the forming of suds. 7. Saline: Mix two (2) teaspoons of salt to 1,000 ccs of warm water. 8. Tap Water: Use 1,000 ccs of warm tap water. Do not add anything to the water.

Equipment and The following equipment and supplies will be necessary when performing this procedure. Supplies 1. Enema tray (container, tubing, clamp, and lubricant); 2. Tray cover; 3. Solution (as prescribed); 4. Toilet tissue; 5. Wash basin; 6. Soap; 7. Towel; 8. Wash cloth; 9. Graduated pitcher (if enema container not marked); 10. Bath thermometer; 11. Bedpan; 12. Paper towels; 13. Bed protector (disposable or plastic); 14. Bath blanket/sheet, etc.; 15. Urinal (as necessary); and 16. Personal protective equipment (e.g., gowns, gloves, mask, etc., as needed).

Steps in the 1. Place the clean equipment on the bedside stand. Arrange the supplies so they can be Procedure easily reached. 2. Wash and dry your hands thoroughly. 3. Put on disposable gloves. 4. Adjust the resident’s clothing to expose the buttocks. Cover the resident to limit exposure and provide privacy.

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Revison date: 5/11/2012 Steps in the 5. Place the bed protector under the resident’s buttocks. Procedure 6. Assist the resident to turn on his/her left side. Bend the right knee toward his/her chest, unless contraindicated by the resident’s medical condition. (This is the Left (continued) Sims Position or Enema Position.) 7. Place the bedpan at the foot of the bed. Be sure that it is in easy reach. 8. Close the clamp on the enema tubing. 9. Fill the graduated container with 1,000 ccs of warm water (105°F or 40.5°C). Test the water with the bath thermometer. 10. Pour the water into the enema container. Mix solutions as prescribed. 11. Hold the tubing over the bedpan. Open the clamp on the enema container. Let a small amount of the solution run through the tubing into the bedpan to eliminate any air in the tubing. Close the clamp. 12. Lubricate the tip of the tubing about 3 to 4 inches. Be sure the tube is well lubricated. Check the opening of the tube to be sure that it is not plugged. 13. Expose the buttocks. (Note: Grasp the privacy cover at the anal area. Lift it up and fold over the buttocks.) 14. Separate the buttocks so that you can see the anal area. 15. Grasp the tubing about 5 to 6 inches from the end. Gently insert the enema tip 3 to 4 inches through the anus into the rectum. (Note: If you feel resistance or if the resident complains of pain, stop the procedure and summon the staff/charge nurse.) 16. Raise the enema container about twelve (12) inches above the buttocks. (Note: Do not raise the container more than eighteen [18] inches.) 17. Open the clamp and let the solution run in slowly. Instruct the resident to breathe slowly through his/her mouth. (Note: This will help relax the resident.) If the resident complains of cramping, you may need to lower the container or clamp the tubing for a moment until the discomfort eases. 18. When the solution has finished running into the rectum, clamp the tubing. 19. Slowly withdraw the rectal tubing. 20. To prevent contamination, wrap the end of the tubing in a paper towel. Place the tubing into the enema container. Place the enema container on a paper towel. 21. Encourage the resident to hold the solution as long as possible. 22. Assist the resident onto the bedpan. (Note: If the resident is unable to hold the solution, put the bedpan underneath the resident before giving the enema.) 23. Discard gloves into the designated container. Wash and dry your hands thoroughly. 24. Unless otherwise instructed, raise the back of the bed so that the resident will be in a near sitting position. 25. Place the toilet tissue within easy reach of the resident. 26. Provide the resident with as much privacy as possible. Place the call light within easy reach of the resident. Assure the resident that you will be near should he/she need assistance. 27. Remove the enema equipment while the resident is on the bedpan. Discard disposable items into the designated container. Clean and sanitize any reusable equipment and place in the designated storage area. Discard gloves into the designated container. Wash and dry your hands thoroughly. 28. If the resident is having trouble expelling the solution, notify your supervisor. 29. When you return to the resident, wash and dry your hands thoroughly and put on gloves. 30. When the resident has expelled the solution, remove the bedpan. Check the results of the enema. Look for color, consistency, odor, amount, etc. 31. Collect a specimen, if ordered. 32. Empty the solution into the commode. Flush the commode. Clean and store the bedpan in accordance with facility protocols. 33. Fill the wash basin one-half (1/2) full of warm water. Take to the bedside. Inspect the resident’s buttocks. Wash, rinse, and dry as necessary. Assist resident in washing his/her hands. 34. Remove the bed protector. Discard as indicated.

Revison date: 5/11/2012 35. Remove the bath blanket. Fold and store, or discard into the soiled linen container. Steps in the 36. Return gown or pajamas to the appropriate position. Pull top covers back over resident. Procedure 37. Change linen as necessary. Discard dirty linen into designated container. Discard (continued) gloves into designated container. Wash and dry your hands thoroughly. 38. Discard disposable items into designated containers. 39. Remove gloves and discard into designated container. Wash and dry your hands thoroughly. 40. Reposition the bed covers. Make the resident comfortable. 41. Place the call light within easy reach of the resident. 42. Clean wash basin and return to designated storage area. 43. Clean the bedside stand. 44. Wash and dry your hands thoroughly. 45. If the resident desires, return the door and curtains to the open position and if visitors are waiting, tell them that they may now enter the room.

Documentation The following information should be recorded in the resident’s medical record:

1. The date and time the enema was administered. 2. The name and title of the individual who administered the enema. 3. The type of enema and the amount of solution used. 4. The type of solution used (i.e., soapsuds, saline, or tap water). 5. All assessment data obtained during the procedure. 6. Results of enema (i.e., color, odor, blood, soft, hard, large or small amounts, if gas was expelled, etc.). 7. If a specimen was collected. 8. How the resident tolerated the procedure. 9. If the resident refused the procedure, the reason(s) why. 10. The signature and title of the person recording the data.

Reporting 1. Notify the supervisor if the resident refuses the enema. 2. Report other information in accordance with facility policy and professional standards of practice.

References MDS (RAPs) H2b; H3h; (14) Survey Tag Numbers F309 Related Documents Risk of Exposure Blood–Body Fluids–Infectious Diseases Date:______By:______

Procedure Date:______By:______Revised Date:______By:______Date:______By:______

Revison date: 5/11/2012