What position should a patient be in to receive an enema

Introduction
Nội dung chính Show
Proper Preparation
Onset of Action
Consult Your Pharmacist: Enema Products: Uses and Cautions

Introduction

It is important to use the exact enema ordered by the physician. Some are often ordered by a physician as part of a method to thoroughly cleanse the system before a medical diagnostic procedure, such as a barium enema, colonoscopy, or proctosigmoidoscopy.
Most enemas for this use contain ingredients known as saline laxatives (containing dibasic and monobasic sodium phosphate) or docusate.
Other enemas contain mineral oil. These help in eliminating hard stool and fecal impactions.
Whichever enema is used, there are certain steps in using the enema that must be followed exactly. Two positions are appropriate for giving the enema. One is the side position, in which the patient lies on the left side with the right knee slightly bent so that it is comfortably resting on the bed. In the knee-chest position, the patient kneels on the bed, with the head and upper chest lowered so that the head is resting on the bed.

Proper Preparation

The following tips can be helpful when using enemas:
1. Remove the protective tip from the bottle. In most cases, the enema nozzle beneath this tip is lubricated with petrolatum.
2. Next, insert the nozzle into the rectum with gentle pressure while the tip is pointing toward the navel. Should insertion cause pain, the procedure should be halted. Also, if insertion is difficult, the enema should not be given.
3. When the nozzle is comfortably and fully inserted, the patient should begin to empty the enema container. Better results are obtained if most of the solution is given. To best accomplish this, the bottle can be squeezed from the bottom to the top, being rolled up like a toothpaste tube. This minimizes the medication in the lower part of the container. The bottle is designed to contain more than the effective dose, so that some fluid will be left in the bottle with normal use.

Onset of Action
A major error in use of enemas is to attempt to evacuate the bowels immediately, once the enema has been given. With products containing monobasic and dibasic sodium phosphate, some time must elapse before the product is effective. During this time, the enema is drawing fluid into the lower bowel to liquefy the stool and ease elimination. Attempting to defecate too rapidly only evacuates the enema solution. Therefore, the manufacturers recommend that the patient wait at least 2-5 minutes until lower abdominal cramping is definitely present, although it may take as long as 15 minutes to acheive such action.

Consult Your Pharmacist: Enema Products: Uses and Cautions

The sodium phosphate enemas are available in adult and pediatric sizes. Neither one should be given to children under 2 years old.
They should not be used in patients with kidney disease.
Do not attempt to create a homemade enema. Tap water, hydrogen peroxide and soapsuds enemas have been found to cause rectal bleeding, severe injury and death. Even though pharmacies often sell enema bulbs, they should not be used unless suggested by a physician.

Never use an enema if abdominal pain is present.

Top

Nurses may have to give an enema as part of their nursing responsibilities. It is important nurses learn how to give an enema properly to prevent too much patient discomfort. Enema administration is virtually painless as long as an experienced nursing professional gives the enema with good nursing skills. The process is important for patients who need to alleviate their bodies of toxins.

What is an Enema?

The process of administering an enema involves inserting fluid into the patient’s rectum to cleanse the lower intestines and colon to remove accumulated toxins and fecal matter. Nurses administer enemas to stimulate bowel movements in most cases, but there are several other reasons, which include colon cleansing, constipation treatment, excessive potassium and ammonia removal, medication delivery, alleviate bowel inflammation, and bowel preparation for surgery. The entire process takes 30 minutes to a couple of hours.

Types of Enema

Cleansing Enema – This type of enema prevent the release of feces while the patient is in surgery. The process prepares the intestines of the patient for a colonoscopy or x-ray. This type of enema can be administered as a small volume or large volume cleansing enema.
Carminative Enema – This type of enema releases tension or swelling in the colon and rectum. When waste builds and sits in the colon, a carminative enema allows the waste and toxins to leave the body.
Retention Enema – This type of enema is used to administer medication and oil into the patient’s rectum. The types of oil and medications include nutritive, antibiotics, and anthelmintics.
Return-Flow Enema – This type of enema provides an alternating flow of enema solutions between 100 and 200 mL into and out of the patient’s colon and rectum to stimulate peristalsis to propel food along the normal process.

Steps on How to Give an Enema

Wash the hands thoroughly with soap and warm water for a minimum of 15 seconds before beginning the procedure.
Gather the needed materials (enema bag or bulb, lubricant, gloves, enema solution, ramp clamp, and a towel).
Warm the solution before placing it into an enema bag or bulb to a temperature between 99 and 106 degrees.
Place a towel under the patient to collect any leakage during the procedure. Lay the patient in a position to receive the enema. The ideal positions for enema administration are the right side position, left side position, knee chest position, and on the back. It is advised that the patient remain in one of these positions to receive the enema for one-third of the time.
Lubricate the tip of the enema applicator before inserting it into the rectum of the patient. Ensure that the entire length of the enema tip is lubricated and that the opening of the tip remains free from clogs so that the solution flows freely when the time comes to administer the enema.
Insert the lubricated enema tip into the patient’s rectum and release the enema tubing clamp.
Monitor the patient for cramping as the enema solutions flows comfortably into the patient’s rectum. Signs of cramping may include abdominal muscle tension. If signs of cramping are notices while monitoring the patient, stop the flow and ask the patient to take several deep breaths. Continue the process once the patient becomes comfortable again.
Gently massage the patient’s abdominal area. Massage down the left portion of the patient’s abdomen then massage from left to right across the lower belly button. Continue to massage up the right portion of the abdomen then massage from right to left under the patient’s rib cage.
Remove the tip of the enema from the patient’s rectum once the device is empty. Ask the patient to remain in the current position until he or she has a strong urge for a bowel movement.
The patient may need assistance with walking to the restroom so the nurse should provide this help if needed. Many patients may have the ability to walk to the restroom on their own while the solution is still in the colon.
Ask the patient to massage the abdomen while the enema is being expelled from the body. Tell the patient to massage the area under the belly button from right to left, starting on the right side and from left to right under the patient’s rib cage. The massaging process helps to loosen fecal matter.
Dispose of the gloves used to administer the enema. Wash hands with soap and water after the process is complete.

Video on Enema Administration

Complications of Enema Administration

Complications from enema administration include muscle tone loss, fluid overflow, bowel irritation, internal hemorrhaging caused by an imbalance of electrolytes. An enema should not be administered to a patient with rectal bleeding, abdominal pain, prolapsed rectal tissue, myocardial infarction, or arrhythmias.

Nurses can learn to execute the simple process that can help their patients remove harmful toxins and fecal matter from their bodies safely and comfortably. Patients rely on the specialized care of nursing professionals to make them as comfortable as possible.