1. Enema – when the Prep didn’t work!

2. When the Prep didn’t work!
Upon admission of patient…
 Ask them to describe what their
stool looked like the very last time
they had a bowel movement.
 Don’t ask them if their stool was
clear… most will just agree and say
“Yes”.

3. TWO Types of People….
Those who look
And those
who don’t!

4. When is an enema is needed??
When your patient says….
 Their stool was any variation of brown
 Had formed stool
 Isn’t sure if they were clear but cannot have another
bowel movement
 The patient has an ostomy and is having a
colonoscopy prior to a “take down”. This patient
will require a small (approx. 100 – 200 ml) “rinse” of
their rectum if they did not do a fleets enema at
home.

5. It could always be worse….

6. When patients are reluctant
 No patient wants to have an enema.
 It is humiliating.
 Explain that if they are not clean the physician will
not be able to visualize and properly inspect colon
and polyps or lesions may be missed.
 It could result in the procedure being aborted and
the patient will have to prep again. Make them
understand why it’s important to be “clean”.
 Give them a choice to reschedule but discourage it.
Patients may not come back.

7. Preparing for “the ENEMA”

8. Choose the correct PPE

9. Required PPE…..
 Gown
 Do not wear it outside of the area that the enema was given
 In between administration of the enema hang it on the pole
 Gloves
 Eye protection
 Shoe covers (especially if patient is not continent)
Room 4 is stocked with all needed PPE

10. Respect Patient Privacy
 Use prep room 4, if available
 Nurse needs to ask patient if
they are comfortable with
them giving the enema or
would they prefer a different
staff member give it
 Keep patient covered as
much as possible during
enema administration
 Make sure patient is covered
and not on toilet when door is
opened

11. Respect Patient Modesty

12. Patient Positioning….
Left side lying (Sims) –
bottom leg straight, top bent
Left side (fetal position) –
both knees drawn up

13. This is the incorrect way…….

14. Preparing needed items….
 Enema bag with tubing
 Tap water enema using luke
warm water, unless
otherwise directed by
physician. Test the water to
make sure it isn’t toocold or
hot.
 Be sure to clamp the tubing
about two feet from the
insertion tip.
 Blue pads
 Towels
 Lubricating jelly
 Generously lubricate
insertion tip of enema
 IV pole

15. Tips to Make and Enema Easier…
 Be sure to lubricate the insertion tip with plenty of
jelly.
 Lubricate your finger and tell the patient that you are
going to insert your finger into their rectum.



Using a lubricated finger, find the anal entrance
Lubricate anal entrance with jelly
In some patients (esp. obese patients), finding the anal
entrance can be difficult.
 Using your finger as a guide, insert the tip of tubing.
Doing this will help reduce anal canal trauma.

16. Tips to Make and Enema Easier…
 Do not force the tubing into the anal cavity. If you




have to force it, it probably isn’t in correctly. It
should be easy to slide in
Insert tubing a couple of inches or until you feel
resistance (most enema tubing is marked with a line)
Unclamp tubing and start fluid flow. When fluid is
flowing, gently insert catheter until resistance is felt.
Don’t open the flow completely. Slower is better
tolerated
Instruct patient to tell you if they hurt

17. This position is helpful for the incontinent patient

18. Colon Anatomy
Normal Colon
Example redundant colon

19. Are they clean enough?
 Ideally, the stool (bowel movement) is clear.
Ask yourself, “Can I see through the liquid to
the bottom of the toilet”?
 Minimal flakes and sediment are okay
 Water color or tint is okay if you can see
through it
 Can the patient tolerate more, if needed?
After 4000 ml of enema, if they still are not
clear a re-evaluation may need to be done.

20. IT’S STILL NOT CLEAR???? Seriously?
 Due to mega colon, redundant colon, constrictions, or
masses, some colons may be impossible to clean.
 The right side (descending) may be clean and results
show clear but after a few minutes….. BAM! More dark
stool! This is because the stool is moving from the left
side (ascending) or transverse.
 Ask your patient to retain the fluid for at least 5 minutes,
if possible. This allows the fluid to travel into descending
colon.
 KNOW HOW MUCH YOUR PATIENT CAN
TOLERATE! THEY ARE TIRED AND
DEHYDRATED.

21. Not sure? Get a second opinion…

22. Safety
 Give patient privacy after
administering enema but
keep safety in mind….
 Lower bed to lowest
position
 For elderly, move bed close
to toilet and have any of
their walking aids nearby.
 Give patient nurse call light
 Instruct patient to call if
they need assistance
 Point out hand rails next to
toilet.

23. Man Returned Used Enemas To CVS
Regularly: Cops
The Huffington Post | By Lauren Feldman Posted: 07/03/2012 2:05
pm Updated: 07/03/2012 2:05 pm
 A Florida man found his choice of rectal-cleaning
product pretty crappy, cops said.
 Sheriffs launched an investigation after personnel from
a CVS in Jacksonville alleged that a man
was repeatedly returning used enema saline laxatives
to the store, according to a Jacksonville Sheriff's Office
news release.
 The suspect returned the six-pack containers of
enemas between April and June, according to the
release. CVS employees told police they had initially
re-shelved the items during this period, not realizing
they had been used.

24. THE END

25. Developed by
Sandy McLellan, RN, CGRN