ENEMA

DEFINITION:
Enema is the instillation of solution into the large intestines for the purpose of cleaning, softening
feces, assisting peristalsis, administering medications, and nutrition.

Enema is the administration of fluid into the lower bowel through the rectum for the purpose of
cleaning or to introduce medication is known as enema.

PURPOSE:

 To stimulate defecation
 To treat constipation.
 To administer medication.
 To destroy intestinal parasite
 To relieve gaseous distension.
 To administer fluids.
 To introduce peristalsis
 To reduce temperature

TYPES OF ENEMA:

 CLEANSING ENEMA: removes feces from the colon

 HYPOTONIC OR ISOTONIC ENEMA: Large volume cleansing enema.
 HYPERTONIC ENEMA: small volume cleansing enema.
 OIL RETENTION ENEMA: lubricates the stool and internal mucosa, making defecation easier.
 CARMINATIVE ENEMA: helps to expel flatus from the rectum and helps to relieve distension
due to flatus.
 MEDICATED ENEMA: To administer medication rectally.
 NUTRITIVE ENEMA: to supply nutrition and fluids rectally.

GENERAL INSTRUCTION:

 The appropriate size catheter or rectal tube need to be used. (12Fr for an infant and 14 Fr
for school age child)
 The rectal tube needs to be smooth and flexible.
 It should be lubricated with a water soluble lubricant.
 The temperature of the solutions needs to be adjusted according to the purpose of enema.
 The amount of solution to be administered depends upon the type of enema, and the age
and size of the person. For giving evacuant enema 250-500ml for a child and 250 ml or less
for an infant can be used.
 When an enema is administered the patient usually assumes a left lateral position.
 The distance to which the tube is inserted depends upon the age and size of the patient. For
children 2.5-3.75cm.
 Height of enema can should be adjusted to regulate the flow of solution.
 To retain the solution, the nurse can press the baby’s buttocks together.
 Prevent air from entering the rectum.
ARTICLES REQUIRED:

A tray containing:

ARTICLES RATIONALE
Enema can, tubing and screw For administering enema
Ordered solution For administering enema
Rectal catheter To provide enema
Mackintosh and towel To prevent bed linen from wetting
Kidney tray and paper bag To discard the waste
Bed pan Used in case client is unable to retain enema solution.
I/V stand To hang the enema can
Screen To provide privacy
Gloves To prevent cross infection
Gauze piece To remove the rectal tube after enema administration

PRELIMINARY ASSESMENT

1. Check the diagnosis

2. Check the date and time of surgery
3. Check the nature of enema ordered
4. Check for any lesions in rectal or perineal area

PROCEDURE:
S.NO. STEPS RATIONALE

1. Explain the procedure to the child according to An explanation will soothe the patient
his level of understanding if old enough if not, and build his/ her trust on nurse.
then to parents
2. Put on the curtains/ screen. To provide privacy to the patient.

3. Place mackintosh and towel under patient’s
buttock
4. Keep bed pan under the bed
5. Position:
a) Older child, have him lie on his left side
with his upper leg flexed.
b) Infant, place infant in a supine position,
with a pillow under his head and back
and a small bedpan under his buttocks,
gentle restraints may be needed.
6. Hang the enema can no higher than 30-45cm
above infant’s hips with tubing and loosen the
screw clamp and let a small amount of fluid to
run into kidney tray.
7. Perform hand hygiene. Wear gloves
To prevent bed linen from wetting
Can be used in case client is unable to
retain enema solution.
This position places the descending colon
at the lowest point.
Infants cannot retain enema fluid.
Pillows provide the body alignment.
This allows the solution to run slowly
with minimum pressure. And running
small amount of fluid into kidney tray
makes sure the patency of tube as well
as removes air from tubing.
Prevents cross infection.

8. Separate the patient’s buttocks to visualize the Allows smooth insertion of tube without
anus clearly and Insert lubricated rectal tube causing injury or irritation.
(lubricate 2-4 inch) 3.7-10 cm into the rectum
just within the anal sphincter.
 9. Release the clamp and let the fluid run in. Do not Fluid volume varies depending upon the
administer more than 300 ml of solution to size of the child:
infant unless otherwise ordered a) Birth to three months: 30-100ml
b) Infants: 150-250 ml
c) Child: 200-500 ml
d) Older children: 500-1000ml
10. Stop the procedure if patient feels The gentle massage will help relax the
uncomfortable. Clamp the tubing; gently remove infant and assist in expelling the solution.
the rectal tube by pulling it through 3 to 4 layers
of gauze piece. Once the rectal tube is removed,
the abdomen can be gently massaged; if there
are no contraindications.
11. Discard the gauze piece in the paper bag. Detach Reduces transmission of microorganism.
the rectal tube and discard it.
12. Provide the patient with bedpan. If the child is Child will feel comfortable to defecate in
old enough to go to bathroom, assist him/her natural position.
onto bathroom.
13. When a retention enema is administered, the To assist retention of fluid.
buttocks may be held or taped together to assist
retention of fluid.
14. Remove and discard the gloves. And perform Reduces transmission of microorganism.
hand hygiene.

AFTER CARE:

 Take all the articles to the utility room and discard the waste, clean the articles and store it
in proper place.
 Wash hands.
 Return to patient and evaluate patient’s condition.
 Send the specimen if any to the laboratory.

RECORDING AND REPORTING:

 Record the type of enema given, time of administration and characteristics of results.
 Report if the patient fails to defecate to the physician.
REFERENCE:

 Dr. B.T. Basvanthappa (2006) “Pediatric / Child Health Nursing” First Edition, Ahuja
Publishing House, Bangalore, Page No. 543-544.
 Raman Kalia (2012) “Pediatric Nursing Procedures” First Edition, Jaypee Brothers Medical
Publishers, New Delhi, Page No. 58-61.
 Soumya Kurian (2016) “Textbook Of Pediatric Nursing” First Edition, EMMESS Medical
Publishers, Bangalore, Page No. 54-56.
 Annamma Jacob (2010) “Clinical Nursing Procedures; The Art Of Nursing Practice” second
edition, Jaypee Brothers Medical Publishers, New Delhi, page no : 177-178.
 Parul Datta (2009) “Pediatric Nursing” Second Editon, Jaypee Brothers Medical Publishers,
New Delhi, Page No.164.