Procedure Education
Procedure Educator
It is important to educate the patient on the need for the enema, and to voice if there is any discomfort during the administration. Inform the patient
that the enema is most effective when the solution dwells in the colon for as long as possible (greater than 15 mins), and the feeling of distension is
normal.
Wear PPE
Wearing PPE
PPE will vary with each patient. Standard precautions should always be used. If there is an infection process or any chance of spray, additional PPE
should be used.
Put Patient in Sims Position
Playing The Sims in Sim's Position
Place the patient in a left side-lying Sims’ position. This gives the enema a downward flow into the sigmoid colon, improving retention. If the patient
has poor sphincter tone, place the bedpan under the patient.
Insert Tip
Inserting Head-of-tube
The length of insertion will depend on the patient, typically between 2-4 inches. To prevent trauma to the rectum, insert the tip slowly, and do not
advance if the patient complains of pain.
Start Flow Slowly
Holding low for Slow Flow
A rapid infusion will result in the rectum to contract and push out the infusing enema, and can cause pain to the patient. Raise the height of the enema
bag slowly (12-18 inches above the patient) to allow for a continuous flow. Do not raise the bag above 18 inches as the enema may flow too quickly
causing the patient discomfort.
Stop With Discomfort
Stop-sign with Discomfort
Some discomfort from colon distention is normal. However, if the patient’s discomfort increases, stop the enema immediately by lowering the enema
bag (or clamp the line). Allow the patient to relax, and resume the flow slowly only when the patient permits. Some orders may involve directions,
such as "Continue enema until no fecal matter present, stool is clear, etc." It is important to note that patients may only receive up to 3 consecutive
enemas before danger of fluid and electrolyte imbalance.
Potential for Vagus Response
Vegas-sign bearing down
It is important to remember that stimulation of the vagal nerve can occur with enemas. Vagus stimulation results in a drop in heart rate. In a severe
response, the patient can become dizzy or faint.
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