The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [201]
12 Slowly introduce the tube or nozzle to a depth of 10.0–12.5 cm. This will bypass the anal canal (2.5–4.0 cm in length) and ensure that the tube or nozzle is in the rectum. C
13 If a retention enema is used, introduce the fluid slowly and leave the patient in bed with the foot of the bed elevated by 45° for as long as prescribed. To avoid increasing peristalsis. The slower the rate at which the fluid is introduced, the less pressure is exerted on the intestinal wall. Elevating the foot of the bed aids in retention of the enema by the force of gravity. C
14 If an evacuant enema is used, introduce the fluid slowly by rolling the pack from the bottom to the top to prevent backflow, until the pack is empty or the solution is completely finished. The faster the rate of flow of the fluid, the greater the pressure on the rectal walls. Distension and irritation of the bowel wall will produce strong peristalsis which is sufficient to empty the lower bowel (Higgins 2006, E).
15 If using a funnel and rectal tube, adjust the height of the funnel according to the rate of flow desired. The forces of gravity will cause the solution to flow from the funnel into the rectum. The greater the elevation of the funnel, the faster the flow of fluid. E
16 Clamp the tubing before all the fluid has run in. To avoid air entering the rectum and causing further discomfort. E
17 Slowly withdraw the tube or nozzle. To avoid reflex emptying of the rectum. E
18 Dry the patient’s perineal area with a gauze swab. To promote patient comfort and avoid excoriation. P
19 Ask the patient to retain the enema for 10–15 minutes before evacuating the bowel. To enhance the evacuant effect. C
20 Ensure that the patient has access to the nurse call system, is near to the bedpan, commode or toilet, and has adequate toilet paper. To enhance patient comfort and safety. To minimize the patient’s embarrassment. P
Postprocedure
21 Remove and dispose of equipment.
22 Wash hands. For infection prevention and control (Fraise and Bradley 2009, E).
23 Record in the appropriate documents that the enema has been given, its effects on the patient and its results (colour, consistency, content and amount of faeces produced), using the Bristol Stool Form Chart (see Figure 6.2). To monitor the patient’s bowel function (Gill 1999, C).
24 Observe patient for any adverse reactions. To monitor the patient for complications (Peate 2003, C).
Problem-solving table 6.4 Prevention and resolution (Procedure guideline 6.10)
Suppositories
Definition
A suppository is a medicated solid formulation that melts at body temperature when inserted into the rectum (Moppett and Parker 1999).
Evidence-based approaches
Rationale
Indications
The use of suppositories is indicated under the following circumstances.
To empty the bowel prior to certain types of surgery and investigations.
To empty the bowel to relieve acute constipation or when other treatments for constipation have failed.
To empty the bowel before endoscopic examination.
To introduce medication into the system.
To soothe and treat haemorrhoids or anal pruritus.
Contraindications
The use of suppositories is contraindicated when one or more of the following pertain.
Chronic constipation, which would require repetitive use.
Paralytic ileus.
Colonic obstruction.
Malignancy of the perianal region.
Low platelet count.
Following gastrointestinal or gynaecological operations, unless on the specific instructions of the doctor.
Methods of administration of suppositories
The use of suppositories dates back to about 460 BC. Hippocrates recommended the use of cylindrical suppositories of honey smeared with ox gall (Hurst 1970). The torpedo-shaped suppositories commonly used today came into being in 1893, when it was recommended that they were inserted apex (pointed end)