Enemas - Kronfeld PDF

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ENEMAS ●

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Can be delegated, but is a sensitive procedure and patient must be thoroughly assessed prior ○ Do not delegate if the patient is unstable, if patient is in abdominal/pain ○ ASSESS for history of bowel disorders, hemorrhoids, distention, hypoactive bowel sounds that could indicate an obstruction Give enemas for… ○ preparation for colonoscopy- “enema until clear,” give several enemas until clear ○ MD can also prescribe laxatives, order fasting, other amounts of “bowel prep” ○ Constipation- can only work through the rectum, will not be effective for constipation further up the colon DO NOT give enemas : ○ If rectal abnormalities are present like blood or pus, could further damage ○ ICP, glaucoma contraindications for enema ○ Prostate surgery, recent bowel surgery ○ If you try to insert the catheter and meet resistance ○ If patient is combative, uncooperative, has dementia, etc.

IMPACTION necessitates a high colonic or a digital fecal disimpaction. Enema will not work.

ADMINISTERING THE ENEMA 1. Prepare the enema, 1500mL max, tap water, WARMER than room temperature. Rectal temp is typically 1 degree higher than oral temp. Cold water will cause cramping. Make sure to close enema clamp before filling water into bag. 2. Hang the bag no higher than 18” above the patient’s head. The higher the bag, the faster the flow. 3. Ensure patient privacy. Place patient in Sims position to access the descending colon located on the left side. If the patient has poor sphincter control, place patient over a bedpan. 4. For an adult, lubricate with water soluble lubricant, insert the catheter 3-4” into the rectum. 5. If you are inserting the catheter and you meet resistance- STOP. 6. Prime the enema line BEFORE starting flow of enema. 7. Start the enema flowing slowly and assess patient tolerance. Hang the bag, and then use the enema line to control the flow with one hand while you hold the enema line with the other hand. One hand should remain on the enema line the entire procedure. 8. Continuous assessment of patient comfort level by asking how they are tolerating. 9. If cramping occurs, lower the bag/rate of flow, can clamp bag and stop flow if needed. 10. Patient should be instructed to hold the solution for as long as possible....