Enema Administration
Enema administration involves instilling a solution into the rectum and colon. In a retention enema, the patient holds the solution within the rectum or colon for 30 minutes to 1 hour. With a cleansing enema, the patient expels the solution almost completely within 15 minutes. Both types of enema stimulate peristalsis by mechanically distending the colon and stimulating rectal wall nerves.
Enemas are used to clean the lower bowel in preparation for diagnostic or surgical procedures; to relieve distention and promote expulsion of flatus; to lubricate the rectum and colon; and to soften hardened stool for removal. They’re contraindicated, however, after recent colon or rectal surgery or myocardial infarction as well as in the patient who has an acute abdominal condition of unknown origin such as suspected appendicitis. They should be administered cautiously to a patient with an arrhythmia.
Equipment
Prescribed solution ▪ bath (utility) thermometer ▪ enema administration bag with attached rectal tube and clamp ▪ IV pole ▪ gloves ▪ linen-saver pads ▪ bath blanket ▪ two bedpans with covers, or bedside commode ▪ water-soluble lubricant ▪ toilet tissue ▪ plastic bag for equipment ▪ water ▪ gown ▪ stethoscope ▪ washcloth ▪ soap and water ▪ if observing enteric precautions: plastic trash bags, labels ▪ Optional (for patients who can’t retain solution): plastic rectal tube guard, indwelling urinary or rectal catheter with 30-mL balloon and syringe.
Prepackaged disposable enema sets are available, as are small-volume enema solutions in both irrigating and retention types and in pediatric sizes.
Preparation of Equipment
Prepare the prescribed type and amount of solution, as indicated. (See Commonly used enema solutions.) Standard irrigating enema volume is 750 to 1,000 mL for an adult.
Pediatric Alert
Standard irrigating enema volumes for pediatric patients are 500 to 750 mL for a school-age child; 250 to 500 mL for a toddler or preschooler; and 250 mL or less for an infant.
Because some ingredients may be mucosal irritants, make sure the proportions are correct and the agents are thoroughly mixed to avoid localized irritation. Warm the solution to reduce patient discomfort. Administer an adult’s enema at 105° to 110°F (41° to 43°C). Check the temperature with a bath thermometer.
Pediatric Alert
Administer a child’s enema at 100°F (38°C) to avoid burning rectal tissues.
Clamp the tubing and fill the solution bag with the prescribed solution. Unclamp the tubing, flush the solution through the tubing, and then reclamp it. Flushing detects leaks and removes air, which could cause discomfort if introduced into the colon.
Commonly Used Enema Solutions
| Solution | Amount | Action | Time to take effect | Adverse effects |
|---|---|---|---|---|
| Tap water (hypotonic) | 500 to 1,000 mL |
| 15 min | Fluid and electrolyte imbalance, water intoxication |
| Normal saline solution (isotonic) | 500 to 1,000 mL |
| 15 min | Fluid and electrolyte imbalance, sodium retention |
| Soap | 500 to 1,000 mL (concentrate at 3 to 5 mL/1,000 mL of tap water) |
| 10 to 15 min | Rectal mucosa irritation or damage |
| Hypertonic solution | 70 to 130 mL |
| 5 to 10 min | Sodium retention |
| Oil (mineral, olive, or cottonseed oil) | 150 to 200 mL |
| 30 min | Rectal mucosa irritation |
Hang the solution container on the IV pole and take all supplies to the patient’s room. If you’re using an indwelling urinary or rectal catheter, fill the syringe with 30 mL of water.
Implementation
Verify the doctor’s order.
Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.1
Assess the patient, paying special attention to his abdomen. Auscultate for bowel sounds; a cleansing enema will increase peristalsis.
Provide privacy and explain the procedure. If you’re administering an enema to a child, familiarize him with the equipment and allow a parent, another relative, or guardian to remain with him during the procedure to provide reassurance.
Ask the patient if he’s had previous difficulty retaining an enema to determine whether you need to use a rectal tube guard or a catheter.
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