Skill 23

Enemas

An enema is the instillation of a solution into the rectum and sigmoid colon to promote defecation by stimulating peristalsis. Cleansing enemas promote complete evacuation of feces from the colon. They act by stimulating peristalsis through infusion of large volumes of solution. Oil-retention enemas act by lubricating the rectum and colon, allowing feces to absorb oil and become softer and easier to pass. Medicated enemas contain pharmacological therapeutic agents. Some are prescribed to reduce dangerously high serum potassium levels (e.g., sodium polystyrene sulfonate [Kayexalate] enema) or to reduce bacteria in the colon before bowel surgery (e.g., neomycin enema).

Delegation Considerations

The skill of enema administration can be delegated to nursing assistive personnel (NAP) unless medication is instilled via an enema. The nurse directs the NAP about:

▪ Properly positioning patients who have mobility restrictions or therapeutic equipment such as drains, IV catheters, or traction.

▪ Informing nurse about patient’s new abdominal pain (exception: a patient reports abdominal cramping) or rectal bleeding.

▪ Informing the nurse immediately about the presence of blood in the stool or around the rectal area, or about any change in the patient’s vital signs.