68

ENEMAS

SKILL 28 ADMINISTRATION OF

ENEMAS

SAFETY

1. Never force catheter into anal canal. If a well lubricated

catheter does not advance easily, stop enema.

2. Use only isotonic solutions.
3. Give only the prescribed amount of solution. The

smaller the child the less the amount of fluid that can be
safely given.

4. Give only the number of enemas prescribed.

EQUIPMENT
Prepackaged enema or container for enema solution, solu-

tion, and rectal catheter

Towels
Lubricant
Bath thermometer
Waterproof pad
Bedpan, potty chair, diaper, and so forth
Gloves, nonsterile

PROCEDURE

1. Check physician’s order. Ensures appropriate type of

enema given.

2. Gather equipment. Promotes organization and effi-

ciency.

3. Wash hands. Reduces transmission of microorganisms.
4. Explain procedure to child and family. Enhances cooper-

ation and participation and reduces anxiety and fear.

5. Fill container with prescribed enema solution, unless it

is a prepackaged enema.

6. Warm solution to body temperature or 37.7° C, 100° F.

Prevents cramping and discomfort. Cold fluid can cause
hypothermia in a small child.

7. Provide for child’s privacy.
8. Position waterproof pad under child. Protects bed linens.
9. Position child.

a. Left side, lateral recumbent position with knees up to

chest.

b. On back with legs lifted to expose anal orifice.
c. Left side with right leg thigh flexed about 45° to body

axis (Sims position).

10. Put on nonsterile gloves. Protects nurse from microor-

ganisms in feces.

11. Lubricate rectal catheter/enema tip. Prevents irritation

of mucosal lining of bowel and decreases discomfort.

12. Prime rectal tube or nozzle of prepackaged enema.

Avoid introducing air into rectum.

13. Have child take a deep breath. Introduce catheter past

anal sphincter into anal canal and lower rectum. Relaxes
anal sphincter.

14. Once tip of catheter is in place, elevate bag and instill

fluid slowly or squeeze prepackage enema. Do not ele-
vate container more than 10 cm above rectum. Fluid
pressure increases with height of bag.

15. If child shows signs of distress, e.g., abdominal pain,

shortness of breath, or chest pain, flow should be
stopped.

16. When solution is completely administered or child can-

not hold any more, clamp tube and remove.

17. Clean lubricant and any feces from anus with toilet

paper.

18. Have child try to retain enema for the prescribed

amount of time. May hold buttocks together.

19. After prescribed amount of time, place child on bed

pan, potty chair, toilet, or apply clean diaper.

20. After child expels the enema, cleanse the anal area as

needed. Prevents irritation of skin and mucous mem-
branes of anus.

21. Dispose of equipment in appropriate container.

Consistent with body fluid precautions.

22. Remove gloves. Wash hands. Reduces transmission of

microorganisms.

DOCUMENTATION

1. Procedure, including specific type of enema, and how

child tolerated it.

2. Results of enema.

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Copyright © 2007 by Thomson Delmar Learning, a division of Thomson Learning, Inc. All rights reserved.

SKILL 28

SKILL 28

Administration of Enemas