No.

NP: 33

Procedure for the Insertion of Enemas & Suppositories

Lead Person: Janice Evans

Date Printed:

March 2003

Date of Review: February 2005

PROCEDURE FOR THE INSERTION OF ENEMAS AND SUPPOSITORIES

Prior to administering an enema or suppository the peri anal region should be checked for abnormalities (Heywood-Jones, 1994; Addison, 1999). A digital examination should be carried out for faecal loading and for abnormalities including blood, pain and obstruction. See Policy for DRE EQUIPMENT PROCEDURE Explain the procedure, checking with the client and any notes for previous ano/rectal surgery or abnormalities. Explain the procedure to the patient and the expected effect of the suppository and then gain consent (Campbell, 1993; Mallet & Bailey, 1996) Give the client an opportunity to urinate (Mallet & Bailey, 1996) Check the prescription chart and assemble the equipment. Ensure that the bed is protected To reduce cross (Campbell, 1993; Heywood-Jones, unnecessary mess. 1994; Mallet & Bailey, 1996) Wash hands and put on apron and gloves. Non sterile gloves Tissue Absorbent pad Lubricating gel Suppositories/Enemas Bed protection RATIONALE To gain co-operation If this is not obtained, the procedure may constitute assault.

infection

and

Position the patient lying on the left side with knees flexed and place an absorbent pad under the hip. It is customary to ask the patient to lie To aid relaxation and minimise in left lateral position. resistance and discomfort on insertion Ask the client to breathe deeply (Campbell, 1993; Heywood-Jones, 1994; Mallet & Bailey, 1996). Insert suppositories about 4cm into the rectum, usually using the index finger (Mallet & Bailey, 1996). Insert enema the length of administration tube. Do not insert a suppository into a As its effect will be only minimal faecal mass. (Campbell, 1993) If the suppository is an evacuant assess the patients ability to reach the toilet prior to administration. Lubricate the blunt end of the suppository with a lubricating gel. Insert the suppository blunt end foremost into the anal canal (Abd-elMaebound et al 1991; Addison et al 2000; Moppett, 2000) This allows the lower edge of the contracting sphincter to close tightly around the anus, also makes it easier for the patient to retain the suppository. (Abd-el-Maebound et al 1991).

Enemas must be at room temperature To minimise shock and prevent bowel or should be warmed. spasms (Heywood-Jones, 1994; Mallet & Bailey, 1996). Lubricate the full-length of the tube The purpose of long tubes is not to with gel. reach higher into the bowel but to allow ease of self-administration (Heywood-Jones, 1994) Ensure that all air is removed from enemas before they are administered (Heywood-Jones, 1994; Mallet & Bailey, 1996). Use gravity, not force, to administer Forcing an enema into the rectum water-based enema could result in bowel spasm, leakage and shock (Mallet & Bailey, 1996).

Phosphate enemas should not be used Harshness, in compromised clients, such as those imbalance who are elderly or debilitated or have advanced malignancy (Sweeney et al 1986). They should not generally be administered to patients with severely impaired renal function, and conditions where there is likely to be increased colonic absorption. Phosphate enemas act within 2-5 minutes.

cause

electrolyte,

Phosphate enemas must be avoided in Phosphate can be absorbed clients with colitis, proctitis, systemically and accumulate (Addison inflammatory bowel conditions, et al 2000). inflamed haemorrhoids or skin tags, acute gastrointestinal conditions, and/or rectal surgical wounds/trauma and those who have had radiotherapy to the lower pelvic area. (Martindale, 1999) Clean the clients peri anal area. Ask the client to retain the suppository. Ensure that assistance is available if client is unable to walk to the toilet. A suppository will take about 20 minutes to dissolve. (Addison et al, 2000) Document that the suppository has been given, monitor the client and record the effects of the rectal medication using the Bristol Stool Scale (see Policy for DRE). Dispose of equipment, remove apron and gloves To prevent cross infection. Some clients may prefer to insert the suppository themselves, if so the nurse should explain the procedure and be available to offer assistance if necessary

REFERENCES

Abd-el-Maebound, KH. Et al (1991) Rectal Suppository: Common Sense and Mode of Insertion. The Mancet. 338(8870): 798-800. Addison, R. (1999) Digital rectal examination 1. Nursing Times; 95:40 Insert: Practical procedures for nurses, 33.1. Campbell, J. (1993) Skills update: suppositories. Community Outlook; 3: 7, 22-23. Addion R, Ness. W, Abulafi. M, Swift.I, Robinson. M (2000) How to Administer Enemas and Suppositories. Nursing Times, ACA Supplement. 96(6): 3-4 Heywood-Jones, I. (1994) Skills update: administration of enemas. Community Outlook; 4:5, 18-19. Mallet, J., Bailey, C. (1996) Bowelcare. In: The Royal Marsden NHS Trust Manual of Clinical Nursing Procedures. London: Blackwell Science. Martindale, (1999), 32nd edition, Drug Reference January Moppett S (2000) Which Way Is Up For A Suppository?: Nursing Times, ACA Supplement. 96(19): 12-13. Sweeney J L et al (1986) Rectal Gangrene: a complication of phosphate enema. The Medical Journal of Australia; 144:7, 374-375