Enemas
CLINICAL GUIDELINES
A registered nurse (RN), licensed practical nurse (LPN), or trained technician (with healthcare prescriber’s orders) may administer an enema.
An enema shall be administered for the purpose of instilling a solution into the large bowel to do the following:
Soften feces, assist peristalsis, and evacuate the rectum and colon when constipation, or acute fecal impaction is present or when trying to achieve fecal psuedocontinence for a child with spinal bifida or other spinal cord injuries.
Prepare for diagnostic tests or surgical procedures.
Enema use is also employed in reduction of intussusception when prescribed and supervised by a healthcare prescriber.
The type and amount of enema solution to be instilled varies with the age and size of the child and with the reason for the enema (Chart 37-1 and Table 37-1).
Administration of an enema is contraindicated for children with recent colon or rectal surgery, acute abdominal conditions, and/or a bleeding disorder or low platelet count.
CHART 37-1 Types of Enemas
Anthelmintic enema: Used to help destroy intestinal parasites
Carminative enema: Helps to expel flatus from the rectum and relieve distention secondary to flatus
Cleansing enema: Removes feces from the colon
Hypertonic enema: Small-volume cleansing enema
Hypotonic or isotonic enema: Large-volume cleansing enema
Medicated enema: Used to administer a medication rectally
Nutritive enema: Replenishes fluids and nutrition rectally
Oil retention enema: Lubricates the stool and intestinal mucosa, making defecation easier
Return-flow enema (Harris flush): Allows a small amount of solution to be administered and then allowed to return to the solution container. This process is repeated several times. Stimulates peristalsis to aid in expelling flatus.
EQUIPMENT
Mineral oil or normal saline enema solution (amount varies by age and size of child; see Table 37-1) or manufacturer’s prepackaged enema solution
Bag with tubing and rectal catheter
Protective pad
Water-soluble lubricant
Towels
Toilet paper
Bedpan
Nonsterile gloves
TABLE 37-1 Recommended Amount of Solution for Enema Administration | ||||||||||||||||||||||||||||||||
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CHILD AND FAMILY ASSESSMENT AND PREPARATION
Assess the child’s health history and physical findings to determine timeframe and reason for previous enemas.
Assess underlying factors that warrant this procedure (e.g., constipation, preparation for another procedure, or for surgery).
Review the medical record to determine whether colonic evacuation will be followed by laxative therapy.
Enema use is unpleasant and should be approached cautiously as it may exacerbate stool-withholding behavior in children. Research indicates that oral medications can be effectively used in fecal disimpaction. Enema therapy is only indicated if oral medication has not been effective or if rapid emptying of the colon is required.
Assess psychosocial concerns of the child and family in relation to administration of the enema.
Explain the procedure and the expected results to the child and the family. Use age-appropriate terminology.
KidKare An enema is a very private and scary experience for a child. The child’s developmental level should be taken into consideration in regard to explanations of the procedure, parental presence, privacy concerns, and the degree to which the child assists in the procedure. In addition, the child’s cultural needs must be considered to ensure that sensitivity to the cultural values is respected.
Encourage the child to drink one to two glasses of water before the procedure.
Ensure the child’s privacy.
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