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Administering an EnemaEQUIPMENTPrepackaged enema or enema containerDisposable glovesWater-soluble jellyWaterproof padBath blanketBedpan or commodeWashcloth and towelBasin Toilet tissuePROCEDURE
Nursing ActionRationalePreparatory phase
1.Assess the patient's bowel habits (lastbowel movement, laxative usage, bowelpatterns) and physical condition(hemorrhoids, mobility, external sphinctercontrol).1.Enema should not be givenif there is a suspicion of appendicitis or bowelobstruction.2.Provide for privacy, and explain procedureto patient.2.Provides comfort.
Performance phase
1.Wash hands.1.Promotes hygiene.2.Place patient on left side with right kneeflexed (Sims' position). Place waterproof padunderneath patient, and cover with bathblanket.2.Allows for enema solution toflow by gravity along thenatural curve of the sigmoidcolon and rectum.3.Place bedpan or bedside commode inposition for patients who cannot ambulateto the toilet or who may have difficulty withsphincter control.3.Allows for easy accessibility.4.Remove plastic cover over tubing, andlubricate tip of enema tubing 3-4 inches(7.5-10 cm) unless prepackaged (tip isalready lubricated). Even prepackagedenema may need more lubricant.4.Prevents trauma and easesapplication.5.Apply disposable gloves.6.Separate buttocks, and locate rectum.7.Instruct patient that you will be insertingtubing and to take slow, deep breaths.7.Allows for patient relaxationand readiness.8.Insert tubing 3-4 inches for adult patients.8.Prevents tissue trauma of rectum.9.Slowly instill the solution using a clamp andthe height of the container to adjust flow9.Rapid infusion can causecolon distention and
 
rate if using an enema bag and tubing. Forhigh enemas, raise enema container 12-18inches (30.5-45.5 cm) above anus; for lowenemas, 12 inches. If using a prepackagedenema, slowly squeeze the container untilall solution is instilled.cramping. Containerelevated past 12-18 inchesand controller on tubing notregulated contribute to rapidinfusion.10.Lower container or clamp tubing if patientcomplains of cramping. 11.Withdraw rectal tubing after all enemasolution has been instilled or until clear(usually not more than three enemas).11.“Until clearâ€
meansuntil results do not containfecal matter and are clear.12.Instruct patient to hold solution as long aspossible and that a feeling of distentionmay be felt.12.Promotes better results.13.Discard supplies in the appropriate trashreceptacle.13.Maintains hygiene,minimizes patientembarrassment.14.Assist patient on the bedpan or to thebedside commode or toilet when urge todefecate occurs.14.Prompt action will preventsoiling.15.Observe enema return for amount, fecalcontent. Instruct patient not to flush toiletuntil the nurse has seen the results.15.If enema has not hadsufficient time to absorb,result may be mostly clearwith little fecal material.
NURSING ALERT Enemas should not be given routinely to treatconstipation because they disrupt normal defecation reflexes andthe patient becomes dependent.Follow-up phase
1.Document the type of enema given,volume, and results on the appropriatechart forms. 2.Assess and document presence or absenceof abdominal distention after enema wasgiven.2.Relief of abdominaldistention indicates successof gas relief.3.Assist the patient with washing perineumand rectal area, if indicated; may also needa clean gown or linen change.3.Fecal soiling may result,especially in bedriddenpatients.Purposes of Enema Administration
Bowel preparation for diagnostic tests or surgery to empty the bowel of fecal content
Delivery of medication into the colon (such as enemas containingneomycin to decrease the bowel's bacteria count or a kayexalateenema to decrease the serum potassium level)
 To soften the stool (oil-retention enemas)
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