Now, is a great time to prepare your patient,
So, you want to of course provide privacy,
and again, forewarn kind of the steps
of this procedure for your patient.
You want them in a side-lying position,
with the knees bent as close
to the chest as possible,
for easy access to the rectum in visualization.
Now, before you administer it,
make sure you're really conscious
about putting absorbent pads,
beneath a patient's buttocks,
because again when you give all that enema fluid,
it's going to spill out and
soil their linens as well,
so, make sure you place your absorbent pads.
Now, once we're ready,
we have a little cap that's usually
protecting the catheter itself,
the end of the tubing,
we can go ahead and remove that cap here.
Now, this is really important,
sometimes that cap when you
remove it may have lubrication,
but go ahead and bring lubricant anyway,
because again, when you're inserting
the catheter in the mucosa,
we don't want to cause trauma,
so, this is a great time to go ahead
and apply the lubricant to the tip of the tubing.
Now, that we're ready and prepped,
we're going to insert the lubricated
tubing tip into the rectum here.
Now, this is really important, it's
only about two to three inches guys.
We don't want to go too far and
cause trauma to our patient.
Also, just know on insertion, this
is the biggest piece of this skill,
you want to give steady gentle pressure,
when you're inserting the enema tip in the rectum.
It's also a great idea to kind of
do a wiggle side to side movement
and you're going to point
the tip towards the navel.
So again, on insertion gentle
steady insertion with pressure,
that tips, going towards the navel of the patient
is where you're going to direct it,
and you may need to give it a
little side to side gentle movement
to help ease of insertion of the tip.
Now again, don't forget do not
force the enema tip into the rectum.
This is really delicate
tissue, it's really vascular,
and we can cause really bad
bleeding and trauma to this area.
So please be careful and do not force here.
Now, that we've got the tip inserted,
this is the time we can unclamp the enema tubing
and this solution is going to
flow all the way from the bucket,
through the tubing and slowly into the rectum.
Now, here's the key point here,
once the solution starts to flow,
talk to your patient, let them
know the fluid is starting
and coach them through that.
Now, once that solution all
the way has been administered,
this is when we go ahead and clamp that tubing and
withdraw the catheter itself.
Now, here's the hardest part for the patient,
so, one of the hardest part.
You want to make sure you educate,
to tell the patient they've
got to retain the solution,
for as long as possible.
So, the longer for the patient the better.
So, once you've prepped that and you put the
prescribed enema solution in the bucket,
we have this clamped.
Now, clearly, we were working
with a mannequin here today,
but if I had my patient in the room,
I would want them in a side lying
position with their knees bent.
The higher the knees up, the better.
And again, a left lying position is great,
but, sometimes the patient
can't lay on their sides,
you may need them to lay face
down or their chest down,
with their knees bent up,
so, whatever is going to give
you easy access to the rectum.
So, we're going to need to assess our patient,
and it's important when you
do enema administration,
to make sure you have plenty of absorbent pads,
because as you can imagine,
when we administer this,
there's going to be a lot of
the enema fluid spilling out
and hopefully some productive
results from our patient.
So, if we have an enema cap on here,
we’d go ahead and remove that now.
So, this is important to make
sure also we lubricate this tip.
So, I’ve got my lubricant here now.
So, when we're talking about lubricant,
there's usually a lubricant that
actually comes with the kit itself
or that sterile surgical
lubricating jelly is great,
and a lot of times, if I can get this open,
I like to just dip the catheter in itself,
and lubricate the tip and lubrication is key,
make sure you are nice to your
patient and lubricate it really well.
Okay, so once I’ve lubricated,
again as you can see,
I try to maintain privacy for
my patient as long as possible.
So now, once the tip is lubricated,
I can go ahead and insert
this in the patient's rectum,
about two to three inches,
so, I’m going to go ahead
and expose the patient now.
And again, during this time I
would be talking to my patient,
letting them know, “Okay we're
about to insert the tubing now,
so, I want you to relax as much as possible.”
Let me go ahead and expose my patient.
So, when I do this, with a steady pressure,
I want to gently try to insert
this, in my patient's rectum.
It's also helpful, to kind of move
side-to side here, when I do this,
this is going to help for ease of insertion.
And when you're talking about
a human patient and GI mucosa,
it actually slides in really pretty gently,
a lot better than it does here obviously.
But just know, be steady, gentle insertion
and even a little bit of
side to side movement here.
Now, also think to point
the tip towards the navel,
that's a good tip here.
Now, of course, we talked about
gentle side to side movement,
I want to stress, DO NOT force
the enema tip into the rectum,
you really can cause some
damage to the delicate tissue.
So, let's take a minute to talk
about unclamping the tubing.
Now, this is actually an
important step and a good FYI.
So, as you can imagine with most clamps on tubing,
it's going to control how fast that fluid goes,
so, if I open this up all the way,
you can imagine all this fluid is
going to free flow into our patient.
That can be pretty uncomfortable,
so, here's the tip that I
like to do in my practice.
I like to go about, oh you can even hear it,
halfway clicked or about halfway clamped,
the reason being this will slowly
administer some of the fluid.
You can give the patient a few
minutes and see how they tolerate it.
Now, if they do really well, you
may be able to open up the clamp,
just a little bit more to increase
the speed of the solution.
Now, once that's been administered,
and the patient's gotten all of the medication,
we can clamp that tubing again and then
withdraw it from the tip of the rectum,
so, I’m going to go ahead and clamp now.
So, once I’ve done that,
I’m going to slowly withdraw
that tip again from the rectum,
and then this is where I’m
going to tell my patient,
to try to retain that solution,
as much as possible within the
rectum, for as long as they can,
and I’m going to go ahead and provide privacy.
So, once I’ve removed this,
I’m going to go ahead and
try to get rid of this here,
and dispose of my supplies.
I’m going to throw this here in my trash.
So, now, after I’d administered this,
I’m going to go ahead remove my
gloves because they're soiled
and perform hand hygiene.