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Enema administration

Essential equipment:

Disposable incontinence pad Disposable apron and gloves Rectal tube and funnel (if not using a commercially prepared pack) Solution required or commercially prepared enema Gauze squares Commode or bedpan if required Lubricating gel

Pre-Procedure:

Action Rationale Explain and discuss the procedure with the To ensure that the patient understands the patient. procedure and gives their valid consent (NMC, 2015) Wash hands. For infection prevention and control Draw curtains around the patient or close the To avoid unnecessary embarrassment and to door to ensure privacy. promote dignified care (NMC, 2015)

Allow patient to empty bladder first if necessary. A full bladder may cause discomfort during the procedure Ensure that a bedpan, commode or toilet is In case the patient feels the need to expel the readily available. enema before the procedure is completed

Procedure:

Action Rationale Warm the enema to room temperature by Heat is an effective stimulant of the nerve plexi immersing in a jug of hot water. in the intestinal mucosa. An enema at room temperature or just above will not damage the intestinal mucosa. The temperature of the environment, the rate of fluid administration and the length of the tubing will all have an effect on the temperature of the fluid in the rectum Assist the patient to lie on the left side, with This allows ease of passage into the rectum by knees well flexed, the upper knee higher than following the natural anatomy of the colon. In the lower one, and with the buttocks near the this position, gravity will aid the flow of the edge of the bed. solution into the colon. Flexing the knees ensures a more comfortable passage of the enema nozzle or rectal tube Place a disposable incontinence pad beneath the To reduce potential infection caused by soiled patient's hips and buttocks. linen. To avoid embarrassing the patient if the fluid is ejected prematurely following administration Elective Care Practice Development v 20 01 2017 Reference: The Royal Marsden NHS Foundation Trust (2015). The Royal Marsden Manual of Clinical Nursing Procedures 9th Edition. Wiley. London.

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Wash hands and put on disposable gloves. For infection prevention and control Place some lubricating gel on gauze square and This prevents trauma to the anal and rectal lubricate the nozzle of the enema or the rectal mucosa which reduces surface friction tube. Expel excessive air from the enema and The introduction of air into the colon causes introduce the nozzle or tube slowly into the anal distension of its walls, resulting in unnecessary canal while separating the buttocks. (A small discomfort for the patient. The slow introduction amount of air may be introduced if bowel of the lubricated tube will minimize spasm of the evacuation is desired.) intestinal wall (evacuation will be more effectively induced due to the increased peristalsis) Slowly introduce the tube or nozzle to a depth of This will bypass the anal canal (2.5–4.0 cm in 10.0–12.5 cm. length) and ensure that the tube or nozzle is in the rectum If a retention enema is used, introduce the fluid To avoid increasing peristalsis. The slower the slowly and leave the patient in bed with the foot rate at which the fluid is introduced, the less of the bed elevated by 45° for as long as pressure is exerted on the intestinal wall. prescribed. Elevating the foot of the bed aids retention of the enema by the force of gravity If an evacuant enema is used, introduce the fluid The faster the rate of flow of the fluid, the slowly by rolling the pack from the bottom to the greater the pressure on the rectal walls. top to prevent backflow, until the pack is empty Distension and irritation of the bowel wall will or the solution is completely finished. produce strong peristalsis which is sufficient to empty the lower bowel If using a funnel and rectal tube, adjust the The forces of gravity will cause the solution to height of the funnel according to the rate of flow flow from the funnel into the rectum. The desired. greater the elevation of the funnel, the faster the flow of fluid Clamp the tubing before all the fluid has run in To avoid air entering the rectum and causing further discomfort. Slowly withdraw the tube or nozzle. To avoid reflex emptying of the rectum. Dry the patient's perineal area using gauze To promote patient comfort and avoid squares. excoriation To promote patient comfort and avoid To enhance the evacuant effect excoriation Ensure that the patient has access to the nurse To enhance patient comfort and safety. To call system, is near to the bedpan, commode or minimize the patient's embarrassment. toilet, and has adequate toilet paper.

Elective Care Practice Development v 20 01 2017 Reference: The Royal Marsden NHS Foundation Trust (2015). The Royal Marsden Manual of Clinical Nursing Procedures 9th Edition. Wiley. London.

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Post Procedure:

Action Rationale Remove and dispose of equipment, gloves and For infection prevention and control apron Wash hands. For infection prevention and control Record in the appropriate documents that the To monitor the patient's bowel function enema has been given, its effects on the patient and its results (colour, consistency, content and amount of faeces produced), using the Bristol Stool Chart Observe patient for any adverse reactions. To monitor the patient for complications

Elective Care Practice Development v 20 01 2017 Reference: The Royal Marsden NHS Foundation Trust (2015). The Royal Marsden Manual of Clinical Nursing Procedures 9th Edition. Wiley. London.