SKILL 6:
- In general, enemas are not harmful.
CLEANSING ENEMA
OBJECTIVES:
1. To be able to define what is Cleansing enema.
2. To be able to know the purpose and
contraindications of cleansing enema.
3. Demonstration of skill# 6 and discuss the
rationale per action done.
4. To be able to determine what is the Nursing
Responsibilities in this type of procedure.
What is ENEMA?
- An enema is a liquid preparation that is
introduced into the body via the rectum for the
purposes of producing a bowel movement or
administering medication.
- are water-based and meant to be held in the
rectum for a short time to flush your colon.
Once injected, they're retained for a few
minutes until your body rids itself of the fluid,
along with loose matter and impacted stool in
your bowel.
Take note
- An enema is only an occasional remedy
- Procedure such enemas requires a doctor’s full
knowledge and has a complete written order
for his/her patients.
TYPES of ENEMA:
 SOAP SUDS ENEMA
- A soap-suds enema can be used but only
when pure castile soap is used
 BARIUM ENEMA
- an X-ray machine takes pictures of the colon
while an enema tube inserted in the rectum
delivers liquid barium.. The procedure is
also called a colon X-ray.
 FLEET ENEMA
- a saline laxative that provides reliable relief
from occasional constipation without pain
or spasm.
Purpose of Cleansing Enema
 treat constipation
 can be either large- or small-volume enemas
which are designed to irritate the colon to
produce peristalsis and encourage evacuation
of the rectum and large intestines.
 is to ensure a clean colon. A clean colon is essential
for good diagnostic radiographs and adequate
colonoscopic examination.
CONTRAINDICATION
However, there are some individuals who
should not use enemas, particularly
medicated enemas; if you have severe
kidney disease, congestive heart failure,
obstruction in your stomach or intestines,
paralytic ileus, megacolon or active
inflammatory bowel disease. If you are
dehydrated, you should also not use an
enema.
The harmful side effects on the colon:
- The weakening of the intestinal motility of the
colon
- Violation of intestinal microflora
Are cleansing enemas safe?
- An incorrectly administered enema can damage
tissue in your rectum/colon, cause bowel
perforation and, if the device is not sterile,
infections. Long-term, regular use of enemas
can cause electrolyte imbalances. Temporary
side effects of enemas can include bloating and
cramping.
Nursing Responsibilities
- Encourage the patient to empty bladder as fluid
entering the rectum may cause discomfort to an
already full bladder.
- Ensure the patient has privacy.
- Make sure that a commode or toilet is nearby
because inserting an enema often gives the
patient urgency to defecate.
Health Education:
- Diet
- Physical Activity
- Routine in Bowel movement
IMPLEMENTATION: 11. Holds tubing in rectum constantly until end of
1. Explains the procedure to the client. fluid instillation.
- Nurse are health educators; patient & 12. Clamps tubing or lowers container if client
significant others will gain knowledge complains of fullness or cramping; to stop the
- ease to get consent (invasive procedure) flow for 30 seconds and then restarts the flow
- patient will be comfortable and will at a slower rate.
cooperate 13. Closes the clamp after all the solution has been
- patient will trust the nurse all throughout instilled or when the client cannot hold
her care/ management/treatment anymore and feels the desires to defecate (urge
2. Washes hands. to defecate usually indicates that sufficient fluid
- cleans hands and prevents spread of has been administered).
microorganism 14. Removes the enema tube from the anus and
3. Assembles the equipment: rubber protector, places the enema tube in a disposable towel
lubricant, warm enema solution, irrigator 15. Assists client onto bedpan or bedside commode
can/container, rubber tubing (24 inches), or nearby bathroom. Asks the client to retain
glass/plastic connecting tube, IV stand, rectal the solution for 5 – 10 minutes.
tube Fr. 22-24, bedpan/bedside commode, 16. Assists client back to bed if using the bathroom.
kidney basin and forceps/clamp, tissue 17. Removes bed protector and removes gloves.
paper/paper towel, clean disposable gloves, and 18. Discards disposable equipment. Cleanses non
blanket. disposable equipment. Washes hands.
- all materials must be at reach 19. Documents: character, consistency, amount,
- there will be no interruption of the color, odor of stool, client’s response to enema.
procedure
- ease flow of the procedure
4. Provides for client’s privacy.
- It is a Right: Right to PRIVACY Prepare the following materials for return demonstration:
- respects the need for patient 1. Enema bag (improvise)
confidentiality. 2. Enema tube (improvise)
3. Rectal tube (straw)
- maintains patient’s dignity
4. Tissue/Paper towel
5. Assists the client to the left lateral position and 5. Rubber sheet (improvise)
flex the right leg. Spreads the rubber protector 6. 2 pairs of disposable gloves
under the buttocks. 7. 2pcs Blanket
- Proper positioning based on anatomical 6. Lubricant (improvise)
position 7. IV pole (improvise)
- Prevents leaks and spoiled linen 8. Patient (improvise)
6. Puts on gloves. (Clean disposable gloves)
- PPE
7. Lubricates the last 3-4 inches (7 – 10 cm) of the
rectal tube, being careful not to plug opening.
- reduce friction/rubbing that will cause abrasion
- prevent perforation of organ
8. Gently separates buttocks and locates anus.
Instructs the client to relax by breathing out
slowly through mouth.
9. Inserts slowly and gently the rectal tube 3 – 4
inches directing it at an angle pointing toward
the umbilicus. If resistance is encountered at
the internal sphincter, ask the client to take a
deep breath, then run a small amount of
solution through the tube.
10. Raises the solution container and opens the
clamp to allow fluid to flow slowly hang solution
not higher than 12 inches (30 cm above the
rectum).