Nursing Interventions for Enema Administration

  1. Check the doctor’s order.
  2. Provide privacy. To prevent feeling of embarrassment.
  3. Promote relaxation. To relax anal sphincter and facilitate insertion of rectal tube.
  4. Position the client:
    • Adult – left lateral position.
    • Infant/Small children – dorsal recumbent position.
  5. Sizes of rectal tube to be used are as follows:
    • Adult – Fr. 22-32
    • Children – Fr. 14-18
    • Infant – Fr. 12
  6. Lubricate 5 cm (2 in) of the rectal tube.
  7. Allow solution to flow through the connecting tubing and rectal tube to expel air before insertion of rectal tube. This prevents introduction of air into the colon.
  8. Inset 7-10 cm (3-4 in) of rectal tube gently in rotating motion. To prevent irritation of anal and rectal tissues.
  9. Introduce solution slowly. To prevent sudden stimulation of peristalsis, and the client can better tolerate introduction of solution.
  10. Change the position to distribute solution well in the colon (high enema); if low enema, remain in left lateral position.
  11. If the order is cleansing enema:
    • Give the enema 3 times.
    • Alternate hypotonic solution with isotonic solution to prevent water intoxication or hypoosmolar fluid imbalance.
  12. If abdominal cramps occur during introduction of solution, temporarily stop the flow of solution by clamping the tube until peristalsis relaxes.
  13. After introduction of the solution, press buttocks together to inhibit the urge to defecate.
  14. Ask the client who is using the toilet not to flush it. The nurse must observe the return flow.
  15. Do perianal care.
  16. Make relevant documentation.

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