Constipation is a common problem and a variety of X-rays and other diagnostic films are also common. Enemas may be required for either situation.
Remember when you begin, the patient is ideally on his left side or knee-chest position (I have yet to have a patient volunteer that position). The idea is to let gravity allow the fluid to flow into the sigmoid colon and further if possible.
Cleansing: Soapsuds enema is used as a safe irritant to the colon as long as castile soap is used rather than some detergent based soap. Make sure the water is comfortably warm, about 105 degrees.
Instill the fluid until the bag is empty or the patient is unable to tolerate any more. The faster you go, the more cramping and more difficulty the patient will have.
Older folks may not have adequate sphincter control, so have plenty of chux under the patient and on hand with this enema administration.
An adult can take up to 750-1000 ml of fluid.
High Colonic: is one type of enema administration that I have never personally seen in traditional medicine. It is used by alternative medicine to flush large quantities of water into the entire colon vs just the lower portion.
I would think that 2 or 3 normal soapsuds enemas would produce the same results since peristalsis would bring any remaining stool to the descending colon and expelled.
Chemical: such as Fleets brand is a much smaller volume of fluid. That is because it depends on the colon bringing fluid into the colon which expands the colon enough to stimulate peristalsis.
I always tell my patients to drink adequate fluids the day of enema administration in order to avoid dehydration or electrolyte imbalance. While most average healthy adults have no problems with this sodium phosphate mixture, the older patient can experience problems.
This study abstract was utilizing about 50 mls. more per dose than the Fleets bottle but is nevertheless an indication that caution and good assessment of your patient post procedure is necessary.
When administering a Fleets (or store brand variety of sodium phosphate enema), it is good to administer as much of the fluid as possible but it is not necessary to empty the bottle completely.
During the enema administration, make sure the bottle is tipped to avoid injecting air into the patient and slowly squeeze the bottle until almost empty. Then roll the end up like a toothpaste tube. The tip is pre-lubricated so you shouldn’t have to apply anything before inserting if you don’t want to.
Usually a maximum of 3 at one time can be performed.
A Return or Harris Flush: is where you instill a small amount of fluid then allowing the fluid to return into the tube and container by lowering the container and allowing gravity to let it flow. This stimulates peristalsis as well and usually relieves flatus by allowing the gas to be expelled.
Oil retention: softens hard stool so it can be passed easier. The patient should hold the oil as long as possible, up to an hour or more.
Medicated: are not common but are occasionally used to treat local colonic problems such as inflammation. It is similar to a retention enema since it requires the patient to hold the fluid in the colon as long as possible.
Barium: for X-rays of the colon. After totally cleaning out the bowels with a cleansing enema “until clear”, the patient goes to X-ray where a tech instills a white liquid with barium in it. This “contrast” film helps to visualize the colon and abnormalities.
The tube has an inflatable bulb at the tip so the tube remains in the patient during the procedure and the bulb prevents the barium from leaking out. (Oh, joy!)
Obviously, abdominal cramping can be a side effect.
After a barium is instilled, it is important for the patient to clear the bowels of barium since it can cause constipation. Barium is white and so the patient will know when all of it has been passed.
While you wouldn’t think that many normal adults would get so constipated that they needed assistance, you will be surprised how common it is and how often you perform this nursing skill.
Pain meds, poor fluid intake resulting in dehydration, diets with little or no fiber to aid in bowel function and memory loss where the patient cannot recall the last BM can all lead to needing this procedure.