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Cleansing enemas are procedures used to remove feces from the colon for various purposes, including relieving constipation, preparing for surgeries, detoxifying the system, and providing symptom relief. Risks include overuse leading to dependence, electrolyte imbalances, infection from unsterilized equipment, and potential damage to the colon. The procedure requires careful attention to equipment, patient education, and monitoring during administration to ensure safety and effectiveness.

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ADMINISTERING A LARGE VOLUME CLEANSING ENEMA
What is cleansing enema? • Cleansing enemas are given to remove feces from the colon. • Some of the reasons for administering a cleansing enema include relieving constipation or fecal impaction, preventing involuntary escape of fecal material during surgical procedures, promoting visualization of the intestinal tract by radiographic or instrument examination, and helping to establish regular bowel function during a bowel training program. • Cleansing enemas are classified as either large-volume or small volume.
Purpose of Cleansing Enemas: • Relief from Constipation:Helps expel trapped fecal matter, providing relief from discomfort and bloating. • Bowel Preparation:Essential for preparing the colon before surgeries or diagnostic tests. • Detoxification:Aids in eliminating waste products and toxins from the digestive system. • Symptom Relief for Certain Conditions:Can be used in conditions like irritable bowel syndrome (IBS) or during a period of poor digestion.
Causes for Using a Cleansing Enema • Constipation: To relieve acute or chronic constipation by stimulating bowel movements. • Bowel Preparation: For procedures like colonoscopies or surgeries requiring a clean bowel. • Detoxification: To flush out toxins from the colon, improving digestion and overall health. • Medications: When oral medications are not effective, an enema may be used to administer drugs directly to the colon
What to Watch Out For (Risks & Precautions) • Overuse of Enemas: Can lead to dependence, making bowel movements less frequent or harder to achieve without external aid. • Electrolyte Imbalance: Frequent use of phosphate or saline enemas can cause electrolyte disturbances, leading to dehydration and other health issues. • Infection Risk: If equipment is not properly sterilized, there’s a risk of introducing bacteria into the colon. • Damage to the Colon: Improper insertion of the enema tip or excessive pressure can lead to injury of the colon.
Contraindications for Large Volume Cleansing Enemas: • Cardiovascular Disease • Kidney Disease • Severe Rectal or Colonic Conditions • Recent Bowel Surgery • Aggravating Dehydration • Pregnancy • Neurogenic Bowel Disorders (e.g., Spinal Cord Injury) • Immunocompromised States
Equipment's: • Solution as ordered by the physician at a temperature of 105F to 110F (40C to 43C) for adults in the prescribed amount. (Amount will vary depending on type of solution, patient’s age, and patient’s ability to retain the solution. Average cleansing enema for an adult may range from 750 to 1000 mL. Disposable enema set, which includes a solution container and tubing • Water-soluble lubricant • IV pole • Necessary additives, as ordered • Waterproof pad • Bath thermometer (if available) • Bath blanket • Bedpan and toilet tissue • Disposable gloves • Additional PPE, as indicated • Paper towel • Washcloth, soap, and towel
Kindly bring out your checklist….
ACTIONS RATIONALE 1. Verify the order for the enema. Bring necessary equipment to the bedside stand or overbed table. Verifying the physician’s order is crucial to ensuring that the proper enema is administered to the right patient. Bringing everything to the bedside conserves time and energy. Arranging items nearby is convenient, saves time, and avoids unnecessary stretching and twisting of muscles on the part of the nurse. 2. Perform hand hygiene and put on PPE, if indicated. Hand hygiene and PPE prevent the spread of microorganisms. PPE is required based on transmission precautions. 3. Identify the patient. Identifying the patient ensures the right patient receives the intervention and helps prevent errors.
ACTIONS RATIONALE 4. Close curtains around the bed and close the door to the room, if possible. Explain what you are going to do and why you are going to do it to the patient. Discuss where the patient will defecate. Have a bedpan, commode, or nearby bathroom ready for use. This ensures the patient’s privacy. Explanation relieves anxiety and facilitates cooperation. The patient is better able to relax and cooperate if he or she is familiar with the procedure and knows everything is in readiness when the urge to defecate is felt. Defecation usually occurs within 5 to 15 minutes. 5. Warm solution in amount ordered, and check temperature with a bath thermometer, if available. If bath thermometer is not available, warm to room temperature or slightly higher, and test on inner wrist. If tap water is used, adjust temperature as it flows from faucet (Figure 1). Warming the solution prevents chilling the patient, adding to the discomfort of the procedure. Cold solution could cause cramping; a too-warm solution could cause trauma to intestinal mucosa. 6. Add enema solution to container. Release clamp and allow fluid to progress through tube before reclamping. This causes any air to be expelled from the tubing. Although allowing air to enter the intestine is not harmful, it may further distend the intestine.
ACTIONS RATIONALE 7. Adjust bed to comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009). Position the patient on the left side (Sims’ position), as dictated by patient comfort and condition. Fold top linen back just enough to allow access to the patient’s rectal area. Place a waterproof pad under the patient’s hip. Having the bed at the proper height prevents back and muscle strain. Sims’ position facilitates flow of solution via gravity into the rectum and colon, optimizing solution retention. Folding back the linen in this manner minimizes unnecessary exposure and promotes the patient’s comfort and warmth. The waterproof pad will protect the bed. 8. Put on nonsterile gloves. Gloves prevent contact with contaminants and body fluids. 9. Elevate solution so that it is no higher than 18 inches (45 cm) above level of anus (Figure 2). Plan to give the solution slowly over a period of 5 to 10 minutes. Hang the container on an IV pole or hold it at the proper height. Gravity forces the solution to enter the intestine. The amount of pressure determines the rate of flow and pressure exerted on the intestinal wall. Giving the solution too quickly causes rapid distention and pressure, poor defecation, or damage to the mucous membrane.
ACTIONS RATIONALE 10. Generously lubricate end of rectal tube 2 to 3 inches (5 to 7 cm). A disposable enema set may have a prelubricated rectal tube. This causes any air to be expelled from the tubing. Although allowing air to enter the intestine is not harmful, it may further distend the intestine. Gloves prevent contact with contaminants and body fluids. Lubrication facilitates passage of the rectal tube through the anal sphincter and prevents injury to the mucosa. 10. Generously lubricate end of rectal tube 2 to 3 inches (5 to 7 cm). A disposable enema set may have a prelubricated rectal tube. This causes any air to be expelled from the tubing. Although allowing air to enter the intestine is not harmful, it may further distend the intestine. Gloves prevent contact with contaminants and body fluids. Lubrication facilitates passage of the rectal tube through the anal sphincter and prevents injury to the mucosa. 11. Lift buttock to expose anus. Slowly and gently insert the enema tube 3 to 4 inches (7 to 10 cm) for an adult. Direct it at an angle pointing toward the umbilicus, not bladder (Figure 3). Ask patient to take several deep breaths. Good visualization of the anus helps prevent injury to tissues. The anal canal is about 1 to 2 inches (2.5–5 cm) long. The tube should be inserted past the external and internal sphincters, but further insertion may damage intestinal mucous membrane. The suggested angle follows the normal intestinal contour and thus will help to prevent perforation of the bowel. Slow insertion of the tube minimizes spasms of the intestinal wall and sphincters. Deep breathing helps relax the anal sphincters. 12. If resistance is met while inserting tube, permit a small amount of solution to enter, withdraw tube slightly, and then continue to insert it. Do not force entry of the tube. Ask patient to take several deep breaths. Resistance may be due to spasms of the intestine or failure of the internal sphincter to open. The solution may help to reduce spasms and relax the sphincter, thus making continued insertion of the tube safe. Forcing a tube may injure the intestinal mucosa wall. Taking deep breaths helps relax the anal sphincter.
ACTIONS RATIONALE 13. Introduce solution slowly over a period of 5 to 10 minutes. Hold tubing all the time that solution is being instilled. Introducing the solution slowly helps prevent rapid distention of the intestine and a desire to defecate. 14. Clamp tubing or lower container if patient has desire to defecate or cramping occurs (Figure 4). Instruct the patient to take small, fast breaths or to pant. These techniques help relax muscles and prevent premature expulsion of the solution. 15. After solution has been given, clamp tubing and remove tube. Have paper towel ready to receive tube as it is withdrawn. Wrapping tube in paper towel prevents dripping of solution. 16. Return the patient to a comfortable position. Encourage the patient to hold the solution until the urge to defecate is strong, usually in about 5 to 15 minutes. Make sure the linens under the patient are dry. Remove your gloves and ensure that the patient is covered. This amount of time usually allows muscle contractions to become sufficient to produce good results. Promotes patient comfort. Removing contaminated gloves prevents spread of microorganisms.
ACTIONS RATIONALE 17. Raise side rail. Lower bed height and adjust head of bed to a comfortable position. Promotes patient safety. 18. Remove additional PPE, if used. Perform hand hygiene. Removing PPE properly reduces the risk for infection transmission and contamination of other items. Hand hygiene prevents the spread of microorganisms. 19. When patient has a strong urge to defecate, place him or her in a sitting position on a bedpan or assist to commode or bathroom (Figure 6). Offer toilet tissues, if not in patient’s reach. Stay with patient or have call bell readily accessible. 20. Remind patient not to flush the commode before you inspect The sitting position is most natural and facilitates defecation. Fall prevention is a high priority due to the urgency of reaching the commode. 20. Remind patient not to flush the commode before you inspect results of enema. The results need to be observed and recorded. Additional enemas may be necessary if physician has ordered enemas “until clear.”
ACTIONS RATIONALE 21. Put on gloves and assist patient, if necessary, with cleaning of anal area. Offer washcloths, soap, and water for handwashing. Remove gloves. Cleaning the anal area and proper hygiene deter the spread of microorganisms. Gloves prevent contact with contaminants and body fluids. 22. Leave the patient clean and comfortable. Care for equipment properly. Bacteria that grow in the intestine can be spread to others if equipment is not properly cleaned. Hand hygiene deters the spread of microorganisms. 23. Perform hand hygiene. Hand hygiene deters the spread of microorganisms.
• Thank you…