Goal: The patient expels feces and is free from injury with minimal discomfort.
1. Verify the order for the enema. Bring necessary equipment to the bedside stand or overbed table.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around the bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Discuss where the patient will defecate. Have a bedpan, commode, or nearby bathroom ready for use.
5. Warm solution in amount ordered, and check temperature with a bath thermometer, if available. If bath thermometer is not available, warm to room temperature or slightly higher, and test on inner wrist. If tap water is used, adjust temperature as it flows from faucet.
6. Add enema solution to container. Release clamp and allow fluid to progress through tube before reclamping.
7. Adjust bed to comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Position the patient on the left side (Sims’ position), as dictated by patient comfort and condition. Fold top linen back just enough to allow access to the patient’s rectal area. Place a waterproof pad under the patient’s hip.
8. Put on nonsterile gloves.
9. Elevate solution so that it is no higher than 18 inches (45 cm) above level of anus. Plan to give the solution slowly over a period of 5 to 10 minutes. Hang the
container on an IV pole or hold it at the proper height.
10. Generously lubricate end of rectal tube 2 to 3 inches (5 to 7 cm). A disposable enema set may have a prelubricated rectal tube.
11. Lift buttock to expose anus. Slowly and gently insert the enema tube 3 to 4 inches (7 to 10 cm) for an adult. Direct it at an angle pointing toward the umbilicus, not bladder. Ask patient to take several deep breaths.
12. If resistance is met while inserting tube, permit a small amount of solution to enter, withdraw tube slightly, and then continue to insert it. Do not force entry of the tube. Ask patient to take several deep breaths.
13. Introduce solution slowly over a period of 5 to 10 minutes. Hold tubing all the time that solution is being instilled.
14. Clamp tubing or lower container if patient has desire to defecate or cramping occurs. Instruct the patient to take small, fast breaths or to pant.
15. After solution has been given, clamp tubing and remove tube. Have paper towel ready to receive tube as it is withdrawn.
16. Return the patient to a comfortable position. Encourage the patient to hold the solution until the urge to defecate is strong, usually in about 5 to 15 minutes. Make sure the linens under the patient are dry. Remove your gloves and ensure that the patient is covered.
17. Raise side rail. Lower bed height and adjust head of bed to a comfortable position.
18. Remove additional PPE, if used. Perform hand hygiene.
19. When patient has a strong urge to defecate, place him or her in a sitting position on a bedpan or assist to commode or bathroom. Offer toilet tissues, if not in patient’s reach. Stay with patient or have call bell readily accessible.
20. Remind patient not to flush the commode before you inspect results of enema.
21. Put on gloves and assist patient, if necessary, with cleaning of anal area. Offer washcloths, soap, and water for handwashing. Remove gloves.
22. Leave the patient clean and comfortable. Care for equipment properly.
23. Perform hand hygiene.
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2 comments:
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