NCMA 113 – ADMINISTERING ENEMA AND URINARY
CATHETERIZATION
COVERAGE:
 Administration of Enema
o Definition
o Purposes
o Types
o Materials
o Procedure
 Urinary Catheterization
o Definition
o Purposes
o Types
o Materials
o Procedure
ADMINISTRATION OF ENEMA
- An Enema administration is a technique used to
stimulate stool evacuation.
- It is a liquid treatment most commonly used to
relieve severe constipation.
- The process helps push waste out of the rectum
when you cannot do so on your own. The
administration of Enema requires doctor's
order.
PURPOSES
- Constipation is a common gastrointestinal
condition. It occurs when the colon is unable to
remove waste through the rectum. People with
this condition have three or fewer bowel
movements over a seven-day period. Mild
constipation often occurs when you don’t eat
enough fiber or drink enough water on a regular
basis. Daily exercise also helps to prevent
constipation.
- An enema administration is most commonly
used to clean the lower bowel. However, this is
normally the last resort for constipation
treatment. If diet and exercise are not enough
to keep you regular, your doctor might
recommend a laxative before trying an enema.
In some cases, laxatives are used the night
before an enema administration to encourage
waste flow.
- Enemas may also be used before medical
examinations of the colon. Your doctor may
order an enema prior to an X-ray of the colon to
detect polyps so that they can get a clearer
picture. This procedure may also be done prior
to a colonoscopy.
TYPES
 CLEANSING ENEMA
- Cleansing enemas 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.
 CARMINATIVE ENEMA
- A small volume enema given to release flatus.
Traditionally the enema consisted of two
ounces of glycerin, one ounce of magnesium
sulfate (Epsom salts) and three ounces of water.
The combination of ingredients stimulated
peristalsis resulting in a bowel movement in
which feces and flatus are expelled. The
advantage in times past of using the
carminative enema was that the low volume
made it comfortable for the patient to retain,
and it took little time to administer. The enema
is not in common use today since similar results
can be obtained using pre-packaged small
volume enemas such as the Fleets saline
enema, the Fleets bisacodyl enema or a
bisacodyl suppository. When using the
traditional carminative enema, instruct the
patient to try to retain the enema for five to ten
minutes before expelling.
 RETENTION ENEMA
- A retention enema also stimulates the bowels,
but the solution that is used is intended to be
“held” in the body for 15 minutes or more.
- A retention enema introduces oil or medication
into the rectum and sigmoid colon. The liquid is
retained for a relatively long period (e.g.,1 to 3
hours).
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 NCMA 113 – ADMINISTERING ENEMA AND URINARY
CATHETERIZATION

- An oil retention enema acts to soften the feces 5. Provides privacy to the client throughout the
and to lubricate the rectum and anal canal, thus procedure.
facilitating passage of the feces 6. Places the water proof pad under the client’s
 RETURN-FLOW ENEMA buttocks.
- A return-flow enema, or Harris flush, is used to 7. Positions the client in left Sim’s position.
remove intestinal gas and stimulate peristalsis. 8. Prepares the irrigating can, tubing and
A large volume fluid is used but the fluid is solutions. Hangs the enema can on the IV stand
instilled in 100-200 ml of fluid into and out of about 18-24 inches above the level of the
the rectum and sigmoid colon stimulates patient’s rectum.
peristalsis. Then, the fluid is drawn out by 9. Lubricates the rectal tube and allows a small
lowering the container below the level of the amount of solution to flow through the tubing
bowel. This brings the flatus out with the fluid. into the bedpan.
- This process is repeated five or six times until 10. Dons glove and lift the upper buttocks of the
the flatus is expelled and abdominal distention patient.
is relieved. 11. Inserts the tube slowly and smoothly around 3-
4 inches into the patient’s anus.
MATERIALS 12. Administer the solution slowly. If the patient
o Waterproof Pad complains of fullness or pain, use the clamp to
o IV Pole stop the flow for 30 seconds, and then restart
o Enema Can/Bag the flow at a slower rate.
o Rectal Tube 13. Closes the clamp after all the solutions has been
o Water soluble lubricant administered or when the client cannot hold
o Bedpan anymore and wants to defecate.
o Towel 14. Removes the rectal tube and places it in a
o Clean Gloves disposable towel.
 Rectal Tube Sizes: 15. Encourages the patient to retain the enema
o Adult: Fr. 22-30 solution.
16. Assist the patient to defecate.
o Children: Fr. 14-18
17. Assists the patient with the necessary cleansing.
o Infant: Fr. 12
18. Makes the patient comfortable.
19. After care of the unit and materials used.
20. Document the procedure done. Record the kind
and amount of stool and solution used and the
character of the return flow.

URINARY CATHETERIZATION
- In urinary catheterization, a catheter (hollow tube)
is inserted into the bladder to drain or collect urine.
There are two main types of urinary catheterization:
indwelling catheterization and non-indwelling
catheterization.

PROCEDURES
1. Verify the doctor’s order of administering enema
to the client.
2. Prepares the needed materials and solutions.
3. Performs handwashing before and after the
procedure.
4. Identifies patient and explains the procedure.
PURPOSES
- Relieve urinary retention
- Obtain sterile urine specimen
- Measure residual urine
- Empty the bladder before, during and after
surgery
- Allows accurate measurement of urine output
- Bladder irrigation (Cystoclysis)
- Administration of medication

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 NCMA 113 – ADMINISTERING ENEMA AND URINARY
CATHETERIZATION

TYPES
 INDWELLING CATHETER
- A Foley catheter is a thin, sterile tube inserted
into the bladder to drain urine. Because it can
be left in place in the bladder for a period of
time, it is also called an indwelling catheter. It is
held in place with a balloon at the end, which is
filled with sterile water to prevent the catheter
from being removed from the bladder. The
urine drains through the catheter tube into a
bag, which is emptied when full.
 NON-INDWELLING CATHETER
- A similar type of catheter will be inserted but
will not be left in place. This is used for a one
time evacuation of urine. Often referred to as PROCEDURE
an intermittent catheter.  Female Catheterization
1. Assess the patient’s need for catheterization
MATERIALS and refer patient to the doctor.
 Catheter 2. Verify the doctor’s order for catheterization.
 Betadine 3. Prepare the necessary materials.
 Urine Bag 4. Perform hand washing.
 KY Jelly 5. Identifies the patient and explains the
 Syringe (10mL) procedure.
 Sterile Water 6. Positions the patient properly and ensures
patient’s privacy.
 Forceps
7. Applies aseptic technique during the entire
 Sterile Cotton Balls
procedure.
 Kidney Basin
8. Opens the catheterization kit aseptically.
 Sterile Drape
9. Add materials to the kit ensuring sterility the
 Tape to secure the catheter
whole time.
 Types of Catheters
10. Dons first glove and fills the syringe with
o Single Lumen - used for one time
distilled water.
catheterization.
11. Dons second glove and applies sterile drapes to
o Two - Lumen - also called an indwelling foley or the patient.
retention catheter. 12. With the non-dominant hand, separates the
o Triple - Lumen - used for bladder irrigation or labia minora with the thumb and index finger.
Cystoclysis Never removes fingers until catheter is inserted.
 Size of Catheters 13. With the dominant hand, uses sterile forceps to
o Male Fr. 16 -18 pick up swabs. Cleans first from the meatus
o Female Fr. 12 - 14 downward and then on either side using a new
o Child Fr. 8 - 10 swab for each stroke.
o Infant Fr. 5 - 8 14. Picks up the catheter and places the drainage
 How catheter works end of the catheter in the urine receptacle using
uncontaminated hand.
15. Lubricates the insertion end or tip of the
catheter.
16. Gently inserts the catheter in the direction of
the urethra until urine flows.
17. Connects the catheter to the urine bag and
ensures that emptying base of the bag is closed.

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 NCMA 113 – ADMINISTERING ENEMA AND URINARY
CATHETERIZATION

18. Inflates the balloon by injecting 5-10cc of 22. Accurately records the procedure done.
distilled water and checks the anchor.
19. Tapes the catheter with non-allergenic tape at
the thigh of the patient.
20. Removes drapes and makes the patient
comfortable.
21. Disposes soiled materials properly.
22. Accurately records the procedure done.
 Male Catheterization
1. Assess the patient’s need for catheterization
and refer patient to the doctor.
2. Verify the doctor’s order for catheterization.
3. Prepare the necessary materials.
4. Perform hand washing.
5. Identifies the patient and explains the
procedure.
6. Positions the patient properly and ensures
patient’s privacy.
7. Applies aseptic technique during the entire
procedure.
8. Opens the catheterization kit aseptically.
9. Add materials to the kit ensuring sterility the
whole time.
10. Dons first glove and fills the syringe with
distilled water.
11. Dons second glove and applies sterile drapes to
the patient.
12. Grabs the penis firmly behind the glans with the
non-dominant hand and retracts the foreskin of
the uncircumcised male.
13. With the dominant hand, uses sterile forceps to
pick up swabs. Cleans first from the meatus and
then wipe the tissue surrounding the meatus in
circular motion using a new swab for each
stroke.
14. Picks up the catheter and places the drainage
end of the catheter in the urine receptacle using
uncontaminated hand.
15. Lubricates the insertion end or tip of the
catheter.
16. Lifts the penis to a position at 90 degrees angle
and inserts the catheter until urine flows.
17. Connects the catheter to the urine bag and
ensures that emptying base of the bag is closed.
18. Inflates the balloon by injecting 5-10cc of
distilled water and checks the anchor.
19. Tapes the catheter with non-allergenic tape at
the lower abdomen of the patient.
20. Removes drapes and makes the patient
comfortable.
21. Disposes soiled materials properly.

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