Goal: The patient expels feces and reports a decrease in pain and discomfort.
1. Verify the order for the enema. Bring necessary equipment to the bedside stand or overbed table. Warm the solution to body temperature in a bowl of warm water.
2. Perform hand hygiene and put on PPE, if indicated.
3. Identify the patient.
4. Close curtains around 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. 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.
6. Put on nonsterile gloves.
7. Remove the cap and generously lubricate end of rectal tube 2 to 3 inches (5 to 7 cm).
8. Lift buttock to expose anus. Slowly and gently insert the rectal tube 3 to 4 inches (7 to 10 cm) for an adult. Direct it at an angle pointing toward the umbilicus, not bladder. Do not force entry of the tube. Ask patient to take several deep breaths.
9. Compress the container with your hands. Roll the end up on itself, toward the rectal tip. Administer all the solution in the container.
10. After solution has been given, remove tube, keeping the container compressed. Have paper towel ready to receive tube as it is withdrawn. Encourage the patient to hold the solution until the urge to defecate is strong, usually in about 5 to 15 minutes.
11. Remove gloves. Return the patient to a comfortable position. Make sure the linens under the patient are dry. Ensure that the patient is covered.
12. Raise side rail. Lower bed height and adjust head of bed to a comfortable position.
13. Remove additional PPE, if used. Perform hand hygiene.
14. 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. Stay with patient or have call bell readily accessible.
15. Remind patient not to flush the commode before you inspect the results of the enema.
16. Put on gloves and assist patient, if necessary, with cleaning of anal area. Offer washcloths, soap, and water for handwashing. Remove gloves.
17. Leave the patient clean and comfortable. Care for equipment properly.
18. Perform hand hygiene.
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