Enema Administration: Procedure (Nursing)

by Samantha Rhea, MSN, RN

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    00:05 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.

    00:14 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.

    00:24 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.

    00:41 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.

    00:52 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.

    01:13 Now, that we're ready and prepped, we're going to insert the lubricated tubing tip into the rectum here.

    01:20 Now, this is really important, it's only about two to three inches guys.

    01:25 We don't want to go too far and cause trauma to our patient.

    01:30 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.

    01:42 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.

    01:51 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.

    02:09 Now again, don't forget do not force the enema tip into the rectum.

    02:15 This is really delicate tissue, it's really vascular, and we can cause really bad bleeding and trauma to this area.

    02:22 So please be careful and do not force here.

    02:27 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.

    02:40 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.

    02:52 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.

    03:00 Now, here's the hardest part for the patient, so, one of the hardest part.

    03:05 You want to make sure you educate, to tell the patient they've got to retain the solution, for as long as possible.

    03:12 So, the longer for the patient the better.

    03:19 So, once you've prepped that and you put the prescribed enema solution in the bucket, we have this clamped.

    03:27 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.

    03:36 The higher the knees up, the better.

    03:38 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.

    03:56 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.

    04:15 So, if we have an enema cap on here, we’d go ahead and remove that now.

    04:19 So, this is important to make sure also we lubricate this tip.

    04:23 So, I’ve got my lubricant here now.

    04:29 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.

    05:00 Okay, so once I’ve lubricated, again as you can see, I try to maintain privacy for my patient as long as possible.

    05:09 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.

    05:18 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.

    05:33 So, when I do this, with a steady pressure, I want to gently try to insert this, in my patient's rectum.

    05:42 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.

    05:51 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.

    05:59 But just know, be steady, gentle insertion and even a little bit of side to side movement here.

    06:06 Now, also think to point the tip towards the navel, that's a good tip here.

    06:11 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.

    06:23 So, let's take a minute to talk about unclamping the tubing.

    06:27 Now, this is actually an important step and a good FYI.

    06:31 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.

    06:46 That can be pretty uncomfortable, so, here's the tip that I like to do in my practice.

    06:51 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.

    07:02 You can give the patient a few minutes and see how they tolerate it.

    07:06 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.

    07:16 Now, once that's been administered, trash 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.

    07:29 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.

    07:46 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.

    07:56 I’m going to throw this here in my trash.

    08:00 So, now, after I’d administered this, I’m going to go ahead remove my gloves because they're soiled and perform hand hygiene.

    About the Lecture

    The lecture Enema Administration: Procedure (Nursing) by Samantha Rhea, MSN, RN is from the course Enema Administration (Nursing).

    Included Quiz Questions

    1. Forceful insertion can cause rectal trauma and tissue damage.
    2. Forceful insertion can cause the client pain or discomfort.
    3. Forceful insertion pushes the stool further into the rectum, making the enema ineffective.
    4. Forceful insertion causes the client to experience flatulence.
    5. Forceful insertion may break the enema administration tubing.
    1. The client must hold in the enema solution as long as possible.
    2. The client must release the enema solution after five minutes.
    3. The client can immediately release the enema solution.
    4. The client must walk to the bathroom to release the enema solution in the toilet.
    1. The nurse should point the enema tubing towards the navel.
    2. The enema tubing should be positioned side to side
    3. The nurse should point the enema tubing towards the client's buttocks.
    4. The nurse should point the enema tubing towards the ground.
    1. The nurse should close the clamp halfway then slowly release the enema solution based on the client's tolerance.
    2. The nurse should ask the client to intermittently bear down to slow the enema solution.
    3. The nurse should bend the enema tubing to start and stop the administration of the enema solution.
    4. The nurse can fully open the clamp to administer the enema solution as it is more effective.
    1. Left side lying with knees bent
    2. Right side lying with knees bent
    3. Supine
    4. Prone with knees bent under client
    1. 5-7 cm (2-3 in)
    2. 10-13 cm (4-5 in)
    3. Until the nurse feels resistance
    4. 1-3 cm (0.5-1 in)
    1. Use the clamp to slow down the enema solution administration.
    2. Ask the health care provider for a different enema solution.
    3. Move the enema tubing from side to side until the client is comfortable.
    4. Stop the enema solution administration and remove the enema tubing.
    1. Ensure the tip of the enema tubing is generously lubricated.
    2. Choose the correct size of enema tubing for the client.
    3. Add lidocaine into the enema solution.
    4. Position the client prone with their buttocks as elevated as possible.

    Author of lecture Enema Administration: Procedure (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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