Cleansing enema procedure

1. High enema
• Is given to clean as much of the colon as possible
• The solution container should be 30-45 cm about the rectum

2. Low enema
• Is administered to clean the rectum and sigmoid colon only

Guidelines
Enema for adults are usually given at 40-43oc and for children at 37.7 oc
Hot – cause injury to the bowel mucous
Cold – uncomfortable and may trigger a spasm of the sphincter muscles

The amount of solution to be administered depends on:
• Kind of enema
• The age of the person and
• The persons ability to retain the solution

Age          Amount
18 month         50-200 ml
18 mon-5 yrs 200-300 ml
5-12 yrs         300-500 ml
12 yrs and older 500-1,000 ml

The rectal tube should be appropriate: is measured in French scale

Age          Size
Infants/small child   10-12 fr
Toddler         14-16 fr
School age child 16-18 fr
Adults 22-30 fr

Purpose
• To stimulate peristalsis and remove feces or flatus (for constipation)
• To soften feces and lubricate the rectum and colon
• To clean the rectum and colon in preparation for an examination. E.g. Colonoscopy
• To remove feces prior to a surgical procedure or a delivery
• For incontinent patients to keep the colon empty
• For diagnostic test
E.g. before certain x-ray exam – barium enema Before giving stool specimen for certain parasites

Procedure
• Inform the patient about the procedure
• Put bed side screen for privacy
• Attach rubber tube with enema can with nozzle and stop cock or clamp
• Place the patient in the lateral position with the Rt. leg flexed, for adequate exposure of the anus (facilitates the flow of solution by gravity into the sigmoid and descending color, which are on the side
• Fill the enema can which 1000 cc of solution for adults
• Lubricate about 5 cm of the rectal tube – facilities insertion through the sphincter and minimizes trauma
• Hung the can = 45 cm from bed or 30 cm from patient on the stand
• Place a piece of mackintosh under the bed
• Make the tube air free by releasing the clamp and allowing the fluid to run down little to the bed pan and clamp open – prevents unnecessary distention
• Lift the upper buttock to visualize the answer
• Insert the tube
♦ 7-10 cm in an adult smoothly and slowly
♦ 5-7.5 cm in the child
♦ 2.5-3.75 cm in an infant

• Raise the solution container and open the clamp to allow fluid to flow
• Administer the fluid slowly if client complains of fullness or pain stop the flow for 30” and restart the flow at a slower rate – decreases intestinal spasm and premature ejection of the solution
• Do not allow all the fluid to go as there is a possibility of air entering the rectum or when the client can not hold anymore and wants to defecate, close the clamp and remove the rectal tube from the anus and offer the bed pan.
• Remove bed pan and clean the rectal tube

Note: if resistance is encountered at the internal sphincter, ask the clients to take a deep breath, then run a small amount of solution (relaxes the internal anus sphincter)