Enema – when the prep didn’t work!

1. Enema – when the Prep didn’t work!

2. When the Prep didn’t work! Upon admission of patient… Ask them to describe what their stool looked like the very last time they had a bowel movement. Don’t ask them if their stool was clear… most will just agree and say “Yes”.

3. Those who look And those who don’t! TWO Types of People….

4. When is an enema is needed?? When your patient says…. Their stool was any variation of brown Had formed stool Isn’t sure if they were clear but cannot have another bowel movement The patient has an ostomy and is having a colonoscopy prior to a “take down”. This patient will require a small (approx. 100 – 200 ml) “rinse” of their rectum if they did not do a fleets enema at home.

5. It could always be worse….

6. When patients are reluctant No patient wants to have an enema. It is humiliating. Explain that if they are not clean the physician will not be able to see and properly inspect colon and they may miss polyps or lesions. It result in the procedure being aborted and the patient will have to prep again. Make them understand why it’s important to be “clean”. Give them a choice to reschedule but discourage it. Patients may not come back.

7. Preparing for “the ENEMA”

8. Choose the correct PPE

9. Required PPE….. Gown do not wear outside the room In between administration of the enema hang it on the pole Gloves Eye protection Shoe covers (especially if patient is not continent) Room 4 is stocked with all needed PPE

10. Respect Patient Privacy Use prep room 4, if available Nurse needs to ask patient if they are comfortable with them giving the enema or would they prefer a different staff member give it Keep patient covered as much as possible during enema administration Make sure patient is covered and not on toilet when door is opened

11. Respect Patient Modesty

12. Left side lying (Sims ) – bottom leg straight, top bent Left side (fetal position) – both knees drawn up Patient Positioning….

13. This is the incorrect way…….

14. Preparing needed items…. Enema bag with tubing Tap water enema using luke warm water, unless otherwise directed by physician. Test the water to make sure it isn’t cold or hot. Be sure to clamp the tubing about two feet from the insertion tip. Blue pads Towels Lubricating jelly Generously lubricate insertion tip of enema IV pole

15. Tips to Make and Enema Easier… Be sure to lubricate the insertion tip with plenty of jelly. Lubricate your finger and tell the patient that you are going to insert your finger into their rectum. Using a lubricated finger, find the anal entrance Lubricate anal entrance with jelly In some patients (esp. obese patients), finding the anal entrance can be difficult. Using your finger as a guide, insert the tip of tubing.

16. Tips to Make and Enema Easier… Do not force the tubing into the anal cavity. If you have to force it, it probably isn’t in correctly. It should be easy to slide in Insert tubing a couple of inches or until you feel resistance (most enema tubing is marked with a line) Unclamp tubing and start fluid flow. When fluid is flowing, gently insert catheter until resistance is felt. Don’t open the flow completely. Slower is better tolerated Instruct patient to tell you if they hurt

17. This position is helpful for the incontinent patient

18. Normal Colon Example redundant colon Colon Anatomy

19. Are they clean enough? Ideally, the stool (bowel movement) is clear. Ask yourself, “Can I see through the liquid to the bottom of the toilet”? Minimal flakes and sediment are okay Water color or tint is okay if you can see through it Can the patient tolerate more, if needed? After 4000 ml of enema, if they still are not clear a re-evaluation may need to be done.

20. IT’S STILL NOT CLEAR???? Seriously? Due to mega colon, redundant colon, constrictions, or masses, some colons may be impossible to clean. The right side (descending) may be clean and results show clear but after a few minutes….. BAM! More dark stool! This is because the stool is moving from the left side (ascending) or transverse. Ask your patient to retain the fluid for at least 5 minutes, if possible. This allows the fluid to travel into descending colon . KNOW HOW MUCH YOUR PATIENT CAN TOLERATE! THEY ARE TIRED AND DEHYDRATED.

21. Not sure? Get a second opinion…

22. Safety Give patient privacy after administering enema but keep safety in mind…. Lower bed to lowest position For elderly, move bed close to toilet and have any of their walking aids nearby. Give patient nurse call light Instruct patient to call if they need assistance Point out hand rails next to toilet.

23. Man Returned Used Enemas To CVS Regularly: Cops The Huffington Post   |  By  Lauren Feldman  Posted: 07/03/2012 2:05 pm Updated: 07/03/2012 2:05 pm A Florida man found his choice of rectal-cleaning product pretty crappy, cops said. Sheriffs launched an investigation after personnel from a CVS in Jacksonville alleged that a man was  repeatedly returning used enema  saline laxatives to the store, according to a Jacksonville Sheriff's Office news release. The suspect returned the six-pack containers of enemas between April and June, according to the release. CVS employees told police they had initially re-shelved the items during this period, not realizing they had been used.

24. THE END

25. Developed by Sandy McLellan, RN, CGRN