The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [200]
Dioctyl sodium sulphosuccinate 0.1% and sorbitol 25% in single-dose disposable packs are used to soften impacted faeces.
Sodium citrate 450 mg, sodium alkylsulphoacetate 45 mg and ascorbic acid 5 mg in single-dose disposable packs.
Retention enemas
A retention enema is a solution introduced into the rectum or lower colon with the intention of being retained for a specified period of time. Two types of retention enema are in common use.
Arachis oil (may be obtained in a single-dose disposable pack). This needs to be used cautiously as it is contraindicated in patients with peanut allergies (Day 2001).
Prednisolone.
Enemas containing arachis oil enhance the lubricating process, as well as softening impacted faeces (Butler 1998). These work by penetrating faeces, increasing the bulk and softness of stools. They work most effectively when warmed to body temperature and retained for as long as possible (Clarke 1988).
All types of enemas need to be prescribed and checked against the prescription before administration. It is essential that the implications and procedure are fully explained to the patient, so as to relieve anxiety and embarrassment.
Legal and professional issues
Administration requires skill and knowledge from the practitioner and adherence to the Nursing and Midwifery Council’s (NMC 2008c) Standards for Medicines Management.
Procedure guideline 6.10 Enema administration
Essential equipment
Disposable incontinence pad
Disposable gloves
Topical swabs
Lubricating jelly
Rectal tube and funnel (if not using a commercially prepared pack)
Solution required or commercially prepared enema
Preprocedure
Action Rationale
1 Explain and discuss the procedure with the patient. To ensure that the patient understands the procedure and gives their valid consent (NMC 2008a, C).
2 Wash hands. For infection prevention and control (Fraise and Bradley 2009, E).
3 Ensure privacy. To avoid unnecessary embarrassment and to promote dignified care (NMC 2008b, C).
4 Allow patient to empty bladder first if necessary. A full bladder may cause discomfort during the procedure (Higgins 2006, E).
5 Ensure that a bedpan, commode or toilet is readily available. In case the patient feels the need to expel the enema before the procedure is completed. P
Procedure
6 Warm the enema to room temperature by immersing in a jug of hot water. Heat is an effective stimulant of the nerve plexi in the intestinal mucosa. An enema at room temperature or just above will not damage the intestinal mucosa. The temperature of the environment, the rate of fluid administration and the length of the tubing will all have an effect on the temperature of the fluid in the rectum (Higgins 2006, E).
7 Assist the patient to lie on the left side, with knees well flexed, the upper higher than the lower one, and with the buttocks near the edge of the bed. This allows ease of passage into the rectum by following the natural anatomy of the colon. In this position gravity will aid the flow of the solution into the colon. Flexing the knees ensures a more comfortable passage of the enema nozzle or rectal tube (Higgins 2006, E).
8 Place a disposable incontinence pad beneath the patient’s hips and buttocks. To reduce potential infection caused by soiled linen. To avoid embarrassing the patient if the fluid is ejected prematurely following administration. P
9 Wash hands and put on disposable gloves. For infection prevention and control (Fraise and Bradley 2009, E).
10 Place some lubricating jelly on a topical swab and lubricate the nozzle of the enema or the rectal tube. This prevents trauma to the anal and rectal mucosa which reduces surface friction (Higgins 2006, E).
11 Expel excessive air from enema and introduce the nozzle or tube slowly into the anal canal while separating the buttocks. (A small amount of air may be introduced if bowel evacuation is desired.) The introduction of air into the colon causes