Name: ___________________________________Date:_________ Section/Group: _______

Administering a Cleansing Enema

CHECKLIST
Legend:
3-Very Satisfactory 0- Did not perform the procedure
2- Satisfactory 1- Needs Improvement

Goal: To introduce solution into the large intestine to promote expulsion of feces.
PROCEDURES 3 2 1 0

1 Assemble necessary equipment. Warm the solution in amount ordered

and checks temperature with bath thermometer, if available. If tap water
is used, adjust temperature as it flows from the tap.

2. Explain the procedure to the patient and plan where he or she will
defecate. Have bedpan, commode, or nearby bathroom ready for his or
her use.

3. Perform hand hygiene.

4. Add enema solution to container. Release clamp and allow fluid to

progress through tube before re-clamping.

5. Position waterproof pad under patient.

6. Provide privacy. Position and drape patient on the left side (Sim’s
position) with anus exposed or on back, as dictated by patient comfort
and condition.

7. Put on disposable gloves.

8. Elevate solution so it is 45 cm (18 inches) above level of patient’s

anus. Plan to administer solution slowly over a period of 5-10 minutes.
Container may be hung on IV pole or held in the nurse’s hands at the
proper height.

9. Generously lubricate the last 5-7 cm (2-3 inches) of the rectal tube. A
disposable enema set may have a pre-lubricated rectal tube.

10. Lift buttock to expose anus. Slowly and gently insert rectal tube 7-10
cm (3-4 inches). Direct it in an angle pointing toward the umbilicus.

11. If the tube meet resistance while inserting it, permit a small amount
of solution to enter, withdraw tube slightly, then continue to insert it. Do
not force tube entry. Ask pt to take several deep breaths.

12. Introduce solution slowly over a period of 5-10 minutes. Hold tubing
all the time solution being instilled.

13. Clamp tubing or lower container if patient has the desire to defecate
or cramping occurs. Patient also may be instructed to take small fast
breaths or to pant.

14. After solution has been given, clamp tubing and remove tube. Have
paper towel ready to receive tube as it is withdrawn. Have patient retain
solution until the urge to defecate becomes strong, usually in about 5-15
minutes.

15. Remove disposable gloves from inside out and discard.

16. When patient has a strong urge to defecate, place him or her in
sitting position on bedpan or assist to commode or bathroom.

17. Record character of the stool and patient’s response to the enema,
remind patient not to flush commode before nurse inspects results of
enema.

18. Assist patient, if necessary, with cleaning of anal area. Offer

washcloth, soap, and water to wash his or her hands.
 19. Leave patient clean and comfortable. Care for equipment properly.

20. Perform hand hygiene.

For the next items, evaluate the students in general according to the criteria. (5 as the
highest score)
5 4 3 2 1

Mastery

Orderliness

Proper attitude in assessing the client followed.

Ability to answer questions

Proper reporting observed.

Student’s Name and Signature: _____________________________________ Evaluator’s

Name and Signature: _____________________________________

Comments:________________________________________________________________
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