ENEMA
Definition:
An enema is the introduction of fluid into the rectum for cleansing, medicinal or
diagnostic or any other purpose.
Classification:
Retension enema (Retaining enema)
Non retension enema (Returning enema)
General purpose of enema:
1. To stimulate evacuation and cleansing the large bowel.
2. To relieve flatulence.
3. To check diarrhea.
4. To supply fluids and nutrients.
5. To soften hard faecal matter.
6. To stimulate peristalsis.
7. To stimulate a patient in shock.
8. To reduce temperature.
9. To make diagnosis.
10. To cleanse the bowels before X-ray studies.
11. To induce anaesthesia-anaesthetic enema.
Returning enema:
Large enema / soap-water enema-
Purpose:
1. To stimulate defaecation and treat constipation of two to three days.
2. To cleanse the bowel before surgery and child birth.
3. To soften faecal matter.
4. To relieve retension of urine by stimulating reflex action of the
bladder.
5. To relieve retension of urine by stimulating reflex action of the
bladder.
6. To cleanse the bowel before any type of retension enema.
Articles needed:
A tray containing-
1. Enema can, rubber tubing, glass connection, screw clamp,
2. Mackintosh and draw sheet,
3. A sterile catheter in bowl no 8 or 12
4. Lubricant
5. Hot water in a jug
6. Pint measure
7. Soap jelly in a bottle
8. I.V stand
9. Toilet tray
10. Bed pan-2.
Solutions used:-
Soap water- soap jelly 50 ml to1 litre of water.
Amount of solution:-
Infants-250ml or less
Children-250ml to 500ml
Adults-500 ml to 1000ml
Temperature of solution:-
Children-100ºf (37ºc)
Adults-105 to 110ºf(40.5 to 43ºc)
Precautions:-
1. See that the whole apparatus is in working condition.
2. The catheter or rectal tube must be soft and flexible to avoid injury to
the mucus membrane of the rectum.
3. The catheter should be lubricated to avoid friction.
4. The amount of should be depended upon the age and size of the
person.
5. While giving enema, left lateral position is given so that sigmoid
colon is below rectum, so that instillation of fluid becomes easy.
6. The catheter should be inserted 3 to 4 inches in adults, and 1 to 1.5 in
children.
7. Regulate the flow of fluid.
8. Don’t allow the air to enter into the rectum so-
Remove the froth from the solution
Expell air from the tube
Clamp the tube before emptying the can completely.
9. Listen to the complaints of the patient and don’t ignore any
Discomfort however small it is.
Procedure:-
1. Attach rubber tubing to the can, apply clamp and close it.
2. Pour 1000ml of soap solution in the enema can at a temperature at
107ºf.
3. Apply Vaseline on the tube/catheter and hang the can on the stand
45cm above the bed or 30cm from the body.
4. Keep the articles on the bedside locker.
5. Explain the procedure to the patient.
6. Screen the patient.
7. Assist the patient to turn to left lateral position because the colon
descends on left side,there fore flow of solution is better. Bring
patients hip toward edge of bed.
8. Turn top bedding down while covering the patient with bath blanket.
Place the mackintosh and drawsheet under patients buttocks.
9. Arrange bath blanket so that the anus is exposed.
10. Wash hands to prevent cross infection.
11. Expel air from the tubing by allowing small amount of solution to
flow into kidney tray and close it again, this also expels air.
12. Separate the buttocks so that anus can be seen easily.
13. Instruct the patient to breathe deeply through his mouth.
14. Insert gently catheter 3-5 inches, then open enema clamp and gently
let water run in.
15. Continue the fluid administration to give about 500-1000ml of
solution. If the patient develops discomfort, stop the procedure.
16. Clamp the tubing before emptying the can completely so that the air
will not enter into the tubing and getting to patient.
17. Slowly withdraw the catheter, cover it with gauze pieces and place it
in the kidney tray.
18. Place the bedpan under the patients buttocks,or assist the patient to
bathroom if possible.
After care of patient and articles:-
1. Remove all articles while patient is on the bedpan clean it with soap and
water,clean,dry and place to their usual places.
2. Remove patients bedpan.
3. Assist the patient for perineal care.
4. Give patient soap and water to wash hands, dry the patient, put on the
garments,change the linen if wet,make the patient comfortable.
5. Observe the enema results,noting the colour,consistency and the
amount,obtain specimen if required, wash hands.
Recording and reporting:-
1. Record the type of enema,the result,the untowards results observed if
any,with date and time on the patients chart and on the nurses record and
sign.
2. Send the specimen if any to the laboratory.
#Cleansing enema:
It is given to cleanse the bowel before x-ray studies, surgery and retension
enema. Normal saline 1tsp to half litre of water or soda bi carb solution is
used for it.
#Carminative enema:
It is given to relieve gaseous distension of the abdomen, by increasing
peristalsis and expulsion of flatus.8-16ml of turpentine is mixed with 500-
1000 of soap solution.Also known as antispasmodic enema.
#Anthelmintic enema:
It is given to destroy and expel worms from the intestines.Hypertonic saline
60ml with 600ml of eater is mainly used for enema.Amount should
be 250ml.
#Ice water enema:
This is given to reduce body temperature in hyperpyrexia and heat stroke.It
is given by drip method.The temperature of the solution should be 65-75ºf.
#Small enema:
In this type the amount of solution is 500ml or less than that so it is called
as small enema.The sub types are as follows:-
* Glycerine enema
It is given especially in children and fever patients.The quantity of the
solution depends upon the age of the patient.
- Pure glycerine 2-4 g is given with rubber catheter & glycerine
syringe.
- 2 ounce water and one 1 ounce glycerine 2:1.
- Pure glycerine can be used.
Purpose:
1. When there is a constipation in children.
2. When there is 7-8days constipation,the stool has become hard.
3. Patient’s with fever.
Articles:
1. Screen
2. In a tray:-
- Pure glycerine or mixture of glycerine & water.
- Keep the bowl in hot eater.
- Glycerine syringe.
- Catheter.
- Kidney tray.
- Mackintosh and draw sheet.
- Bed pan-2
- Toilet tray.
* Oil enema:
Oil enema is given to soften faecal matter in cases of severe constipation
and after operation on the rectum and perineum.It is given to avoid
straining and injury to the sutures and wounds.The enema must be
retained for half to one hour to soften the faeces.
Olive oil or sweet oil is used for the enema.
Retention enema:
1.Retetion enemas are given slowly with small rectol catheter and funnel.
2. Usually are given for retention and absorption.
3. Amount is usually 6-8 ounces (150-200ml).
4. Temperature is usually at body temperature except stimulating enema
which is given at 107-110ºf.
* Nutrient enema:
It is given to supply nutrients to the body.Normal saline,glucose
saline,glucose 5%,10%,peptonised milk 120ml etc.
The amount of solution is taken about 110ml to 1700ml in 24 hrs or 180-
200ml every 4 hrly.
The temperature of the solution should be 100ºf.
* Sedative enema:
This type of enema contain a sedative drug and is given to induce sleep,
paraldehyde, chloral hydrate,potassium bromide are used to give sedative
enema. The dose is according to the patients condition and physician’s
order.
Purpose:
1. To check diarrhea.
2. To relieve irritated mucous membrane and pain.
Articles:
1. Screen
2. Articles for cleansing enema.
3. Articles for retaining enema-can,rubber tubing,Murphys drip,tubing
clip,glass connection catheter,
4. Adhesive tape
5. Bed blocks
6. 1 tsp starch
7. 180ml of boiling water spoon
8. 15-30min.Tr opium can be used in cases of pain and irritation of
intestine.
Procedure:
1. Dissolve 1tsp starch in small amount of cold water.
2. Add 200ml of boiling water to this.
3. Stir rapidly to prevent lumping.
4. Boil it for 1-2min.It should be thin enough to pass through the enema
tube
5. Allow solution to cool at 99ºf.
6. Give cleansing enema before starch enema.
7. Follow the procedure as for small retention enema.
