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Giving an enema to someone is a simple
procedure!
Administering an enema to somebody requires gentleness, kindness and
sensitivity.
Most of all communication between the recipient and the administrator.
TECHNIQUES
The basic aspects of enema administration are
proper positioning of
the recipient, optimal volume of enema solution, infusion
rate, and experience needed by the person giving the enema. Due to the
anatomical situation of the
rectum and
sigmoid colon area, the
left lateral position
is usually the best position. A digital
rectal examination is needed to check for stool and
determine if the patient has fecal impaction,
hemorrhoids, polyps,
fistulas,
rectal prolapse or any other abnormal problems. Special consideration must be
given to anyone having any of these problems.
digital rectal examination also allows
lubrication of the anal area.
ENEMA SAFETY
This procedure is considered easy enough to delegate
almost anybody with
very little training or the recipients themselves, There have been very few traumatic
or dangerous side effects . These can include
inflammation, electrolyte imbalance, and perforation rectal lining. Nursing
texts contain little or no information about these risks and the precaution to the
administrator can take to prevent their occurrence.
The recipient has a passive role in enema administration the recipients
cooperation is a must. Strategies for gaining co-operation include honesty,
asking about prior experience with enemas, describing expected sensations,
warning about discomfort, showing the recipient the
equipment, and teaching
relaxation techniques. Lubrication is a key factor, and it is almost never
enough
(
Vaseline,
K. Y. Jelly
). Give
the recipient some control by stopping the flow of the enema solution when requested and
restart the flow when the recipient is ready.
Privacy and a close-by toilet facility are obvious while the availability
of supportive help should be considered for the eventful situations.
It is difficult to specify the amount of
solution, solution temperature, depth
of
rectal tube insertion, speed of administration, and retention time. While some
studies suggest between 750 to 2000mls, it should really depend on the
recipients health and ability to retain the amount of solution. Physiologically,
the temperature of the solution should be warm,
around 103°F, not cold, cold
or ice water solutions
are not effective for retention and can cause massive cramping. The rectal tube should be inserted
inline with a digit and therefore should also stop at the level reached or felt
during anal lubrication 3 to 4 in. is usually sufficient. The fluid should be
left to inflow at low gravity pressure, the container being not more than
18 in. to
2 ft. above the recipients rectum. The more the solution is retained the
more the positive effect.
A Well Administered Enema
Knowledge, experience and practice increase proficiency but not
perfection. No hard rules exist, but practical suggestions, which are intended
to alleviate pain and discomfort for the recipient. Enemas are intended to be
curative not painful. You should feel proud for being entrusted with carrying
such important and delicate practice, and this perspective can be applied to
other tasks.
Enema administration is a basic nursing skill; An
administrator should recognize when an enema is needed or required.
For The Person Receiving the enema:
- Pick a
position.
Be sure you are comfortable and can relax.
Make sure you can clean up if an
accident occurs.
Make sure the administrator
has clear access to your anus.
- Lubricate the
anus.
Have the administrator massage
lubricant inside your anus and
rectum. This will help
your sphincter to
relax when the nozzle is
inserted. You might want to take a couple of deep breaths as it passes
your anal sphincter. You want your anus to admit it easily so that you can relax.
- Relax, as the administrator turns on the flow, mentally picture yourself
receiving the enema. A good
administrator will stop or slow the flow if you experience any
cramping. Many problems occur if you panic, try to relax, everything
will be fine. If cramps do occur (and they
sometimes do during your first
enema) have the
administrator slow or stop the flow, Take several deep
breaths, and try massaging
your stomach area in a clockwise rotation then
restart the flow.
- If you feel the need to evacuate, ask the administrator to stop the flow.
Relax, the desire should pass as your colon relaxes as
the enema flows deeper into the intestine.
- You will probably feel your stomach expanding. Let it. Try to hold the enema
for a few minutes. (five to 10 minutes is usually
long enough for the enema to produce excellent results)
- When it is time to evacuate, take yourself (with the tube still in
place) to the toilet. Wait until you are in a position to evacuate
before you remove the nozzle.
- After you evacuate, take a several deep breaths and feel
lightness and euphoria that commonly follows a
good enema cleansing.
The Person
Administering the enema
:
The administrator
of the enema has a great deal of responsibility.
The enema recipient is
usually embarrassed
and in a delicate position. You should respect their
modesty in everything that
you do. The following advice should make the process go as smoothly as
possible.
- Lubricate the recipients
anal area. A finger
works great for this purpose.Apply a liberal
amount of lubricant to your finger tip and to the outside of
the recipients
anus. Next, press the tip of your finger into the center of
the recipients anus. Use about enough pressure to break an egg shell. Applying
constant pressure for a second will allow the anus to receive your
finger. Apply the lubricant liberally working it in and out. Assuming
your partner reacts positively to anal stimulation, I'm sure they won't
mind.
- Suspend the enema bag about 1 foot to 18 inches above the anus.
Hanging the bag higher will produce more pressure and flow, lower will
produce less pressure and flow. Dropping the bag below the anus can
result in back-flow into the enema bag during the procedure.
Open clamp and allow air to escape
tubing before inserting nozzle into the anus
Insert the nozzle,
Learn from
the experience with your finger.
You should know how much pressure will be required. The nozzle should
slide right in. ( Never force anything into the rectum.)
Open the clamp slowly. Don't try to give the entire enema at once.
It can take as long as 15 minutes to administer
a good enema. If the receiver has a full colon (hasn't recently
defecated) they
may not be able to receive as much solution. It is a good idea to have them evacuate.
Then start the procedure again. This procedure can be repeated until the recipient can take a
complete filling without having to evacuate.
While filling the recipient, watch for signs of cramping. If this
occurs you should slow or stop the flow until the recipient can relax
and allow the cramping to pass.
You might want to massage the recipients stomach to encourage
the solution further into the colon.
When the recipient
needs to evacuate you need
to stop the flow and encourage the recipient to retain the enema as long
as possible.
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