|Fundamentals of Nursing Practice||© Rhodora Cruz|
Types of Enemas
There are three types of cleansing enemas: the large volume enema, the small volume, enema, and the packaged, disposable enema. Normal saline is normally used for a cleansing enema because it is isotonic solution and therefore, does not cause electrolyte imbalance, unlike the tap water. Although a packet of Castille soap comes in the commercial enema equipment set, it is not regularly used.
A. The Large Volume Enema
The purpose of large volume enema is to clean as much of the colon as possible of feces, as an intervention for constipation as well as “bowel prep” before a diagnostic procedure. The amount used is 500-1000 ml and the bag is raised as high as 18 inches above.the anal opening. The patient is instructed to retain and hold the fluid as long as possible to induce peristalsis and cause evacuation of feces.
B. The Small Volume Enema
The small volume enema is used to clean the lower portion of the colon or the sigmoid. This type of cleansing enema is often used for the patient who is constipated but does not need cleansing of the higher colon. The amount used is less than 500 ml and the bag is raised no higher than 12 inches.
C. The Prepackaged Disposable Enema
This is the most common enema used in the hospital. Fleets enema is one of most common brand. This can be used for tests also and for constipation. The enema solutions may contain either biscodyl or sodium phosphate, which are both rectal stimulants. The solution is hypertonic and thus, draws fluid into the bowel, softening and loosening the fecal mass. Hypertonic solution is inappropriate for a dehydrated patient or in a situation where immediate evacuation is desired. These enemas are available in to sizes: 150 ml and 37.
If fecal material is hardened, an oil-retention enema may be given to soften the feces. Commercially packaged enemas contain 90-120 ml solution. The patient should retain the solution to at least one hour for the enema to be effective. This enema is usually followed by a cleansing enema.
A return-flow enema, or Harris flush, is used to remove intestinal gas and stimulate peristalsis. A large volume fluid is used but the fluid is instilled in 100-200 ml increments. Then, the fluid is drawn out by lowering the container below the level of the bowel. This brings the flatus out with the fluid. Repeat this procedure three to five times or until no gas is returned.
Occasionally, an cool fluid enema may be used to lower the body temperature rapidly. This is done only if the temperature is dangerously high. This is not a common procedure. The temperature must be checked, before, during, and after the procedure.
Rectal Instillation of Medication via Enema
Medication can be given in the colon via enema. The purpose for using enema to give medications is to soothe the intestinal mucosa while other medications correct electrolyte imbalances or combat infections. It may be necessary to administer a cleansing enema to clear the colon before the medicated enema is given.
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