ENEMA

ADMINISTRATION

By:

Jose Byron Dadulla-Evardone RN

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 ENEMA
• Enema – the process of instilling fluid
through the anal sphincter into the rectum
& lower intestine for a therapeutic
purpose.
• Is performed using a flexible plastic rectal
tube with several large holes in the tip.
• This is connected to the tubing from a
solution bag or container.

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 ENEMA
• An enema can also be performed using a
prepackaged solution that comes in a soft
plastic bottle with a pre-lubricated rectal tip
attached.
• Enema solutions are prepared using plain
tap water or saline, soapsuds solutions, oil
solutions, or various medication solutions.

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 MECHANISM OF ENEMA
• The most common purpose for
administering an enema is to stimulate
peristalsis (involuntary contraction) and to
evacuate stool from the rectum.

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 PURPOSE OF ENEMA
Enemas are used to treat:
• Constipation
• Cleanse the bowel before a bowel exam or
before bowel surgery.
• Deliver medication directly onto the rectal
mucous membranes to be absorbed into
the bloodstream.

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 TYPES OF ENEMA
1. Tap water or soapsuds enema dilates the
bowel, stimulates peristalsis, and lubricates the
stool to encourage a bowel movement.
• These types of enemas are instilled and held for
five to 10 minutes, as tolerated.

2. Oil retention enema is prepared in a smaller

volume and is retained in the bowel for 30-60
minutes.
• The purpose is to soften the hardened stool and
allow normal elimination.
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 TYPES OF ENEMA
3. Steroid enema solutions can be
administered to alleviate bowel
inflammation in patients with ulcerative
colitis.
colitis
4. Antibiotic enema solutions can be
administered to treat localized bacterial
infections.

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 TYPES OF ENEMA
5. Medicated hypertonic enema solutions
can be used to pull excessive potassium or
ammonia from the bloodstream through the
rectal wall.
• These substances are then eliminated with
the stool.

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 PRECAUTIONS
• Enemas should not be used as a first-line
treatment for constipation.
• Frequent use of enemas can lead to fluid
overload, bowel irritation,
irritation and loss of
muscle tone of the bowel and anal
sphincter.
• Never deliver more than three consecutive
enemas to treat a patient.

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 PRECAUTIONS
• A patient with diarrhea may not be able to
hold an enema.
• Must be used with caution in cardiac
patients who have arrhythmias or have had
a recent myocardial infarction.
infarction
• Insertion of the enema tube and solution
can stimulate the vagus nerve which may
trigger an arrythmias such as
bradycardia.
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 PRECAUTIONS
• Enemas should not be given to patients
with undiagnosed abdominal pain
because the peristalsis of the bowel can
cause an inflamed appendix to rupture.
• Should be used cautiously in patients who
have had recent surgery on the rectum,
bowel, or prostate gland.
• If the patient has rectal bleeding or
prolapse of rectal tissue from the rectal
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 PRECAUTIONS
opening, cancel the enema and consult with
the physician before proceeding.
• Do not force the enema catheter into the
rectum against resistance. This can cause
trauma to the rectal tissue.
• Use only mild castile soap for soapsuds
enemas because other soap preparations are
too harsh and irritate the rectal tissue.

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 Equipments

• Disposable • Lubricant Jelly

incontinent pad • Enema
• Disposable gloves • Bath
• Swabs Thermometer

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 PREPARATION
• Before administering an enema, ensure the
patient’s privacy by closing the room door.
• The patient should be encouraged to empty
both bladder and bowels before the
procedure.
• Have the patient undress completely from
the waist down.
• Position the patient on the bed on his or her
left side with the top knee bent and
pulled slightly upward toward the chin.
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• Place a waterproof pad under the
patient’s hips to protect the bedding and
drape a sheet over the patient covering the
entire body except the buttocks.
• Place a bedpan and toilet paper within quick
access.
• Explain the procedure to the patient.
• Emphasize the importance of breathing
slowly through the mouth to encourage
relaxation of the rectal sphincter and to
avoid oppositional pressure.
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• Let the patient know that while he or she
may feel the urge to defecate, most enemas
need time to work and he or she should try
to hold the fluid for at least 5 to 10
minutes after instillation (30-60 minutes
for retention enemas and longer for some
medicated enema solutions).
• Check the medication label if it is a
medicated solution to avoid medication
errors.
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• Be sure it is the right medicine, the right
dose (strength), the right time, the right
person, and the right method.
• Verify the expiration date on the label. Do
not use outdated medicine.
medicine
• Wash hands thoroughly and put on gloves.
• To prepare for premixed disposable enema
instillations, follow the directions on the
package.
• Most premixed disposable enemas come
with the tip already lubricated.
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Inflatable Silicone Balloon Tip
Enema Nozzles

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• Shake the solution bottle.
• Remove the cap from the tip and expel
excess air from the apparatus before use.
• To prepare solutions to be administered
using an enema bag, heat the solution to
105`F (40.6`C).
40.6`C
• Adult solutions are generally 750-1000cc
of solution for a non-retention enema and
150-200cc of fluid for a retention enema.

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Enema Additives

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• Children’s solutions are 250-500cc of
solution for a non-retention enema and 75-
150cc of solution for a retention enema.
• Infant’s solutions are 150-250cc of solution
for a non-retention enema.
• If preparing a medicated solution, follow
the physician’s orders.
• Select a rectal tube appropriate to the pt’s
size (#14-30 French rectal tube for an
adult, #12-18 for a child, #12 for an
infant) and connect it to the tubing from the
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 Rectal Inflation Nozzle with
Syringe (working tip inflated)
•

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• Fill the enema bag with the solution and
open the tubing.
• Run the solution through the tubing to the
tip of the rectal tube to clear air from the
line.
• Clamp the tubing and adjust the bag on an
IV pole so that it will hang at the patient’s
hipline.
• Put water soluble lubricant on a clean 4x4
gauze pad and roll the tip of the rectal tube
in the lubricant.
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Retention Enema Bag System

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• Coat all of the rectal tube that will be
inserted into the rectum to avoid
traumatizing the rectal tissue [3-4 inches
(7.3-10 cm)
cm for an adult, 2-3 inches (5-7.5
cm)
cm for a child, 1-1 ½ inches (2.5-4 cm)cm
for an infant].

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 PROCEDURE
• To administer an enema solution, the
clinician should have the patient lie down
on the left side, knees bent. Lift the upper
buttock so that the rectal opening can be
visualized.
• Place the lubricated tip of the enema
catheter at the anal opening, and gently
advance the catheter through the anal
sphincter into the rectum toward the
umbilicus (navel), 3-4 in (7.5-10 cm) for an
adult.
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• Insert the tubing 2 in (5 cm) for a child < 6
yrs and 1 in (2.5 cm) for an infant.
• After alerting the patient, open the enema
tubing to allow solution to flow or squeeze
premixed enema solutions slowly into the
rectum.
• If the patient complains of cramping, slow
or stop the enema flow and have the
patient breathe slowly through the mouth to
encourage relaxation.
• When giving fluid through an enema bag,
start with the bag suspended from an IV
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 pole at the patient’s hip level.
• As the tubing is opened, slowly raise the IV
pole to promote fluid flow until the bag is
12 inches (30.5 cm) above the hip for an
adult.
• Continue to hold the rectal tube in place
throughout the procedure or it will be
expelled from the rectum.
• If the fluid will not flow in, gently rotate
the tubing within the rectum to clear the
holes of the tubing from the wall of the
bowel or the impacted stool that may be
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 occluding the flow.
• If ordered to give a high enema, slowly
raise the bag no more than 18 in (46 cm)
above the adult patient’s hip;
hip 12 in (30.5
cm) above a child’s hip and 6 in (15 cm)
above an infant’s hip.
hip This will increase
the water pressure to deliver the fluid higher
into the bowel.
• When all of the solution has been
administered, clamp the tubing, remove the
enema catheter, and release the buttock.
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The Enema Tank

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 AFTERCARE
• After administering an enema, remain near
the patient in case he or she needs
assistance with the bedpan or to get to the
bathroom.
• Medicated enemas that are expelled
immediately may need to be repeated,
using fresh solution.
• Follow the directions or consult with the
physician.
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• To assist the patient with retaining an
enema after instillation, apply gentle
pressure to the rectal opening using a 4X4
gauze pad or squeeze the buttocks together.
• Tuck a 4X4 gauze pad between the buttocks
to collect seepage. This maneuver may help
the patient feel more secure.
• Cover the patient after the procedure and
instruct him or her to lie still for 5 to 10
minutes or longer if a medicated solution
or retention enema is administered. This
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 will allow time for the sol’n to take effect.
• Wash items that might be reused, such as
non-disposable enema bags and tubing, in
warm soapy water. Rinse and allow them to
air dry.
• Place disposable items, gauze pads, &
gloves in a trash bag, then seal & discard it.
• Assist the patient to the bathroom or with
the bedpan after he or she has held the
enema solution for the correct amount of
time.
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• Hands should be washed after performing
the procedure.
• Note the results of the enema (color,
consistency, content and amount of feces
produced).

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 COMPLICATIONS
• Complications of enema administration are
not common but can include irritation,
swelling, redness, bleeding, or prolapse of
the rectal tissue.
tissue
• If any of these symptoms are apparent, or if
the patient complains of pain or burning
during enema instillation, stop the
procedure and notify the physician.
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The End!

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