An enema is a procedure in which fluid is introduced into the lower segment of the large intestine for diagnostic or therapeutic purposes. A cleansing enema is prescribed to liquefy and remove the contents of the lower sections of the large intestine, cleaning it from feces and gases.

 

Before considering the algorithm for setting a cleansing enema , let us remind ourselves of the indications for its use:

• constipation;
• stool retention of various origins;
• removal of toxic substances in case of poisoning;
• preparation of patients for operations and childbirth;
• preparation for endoscopic and X-ray studies of the large intestine;
• preparation for the use of medicinal enemas.

Algorithm for setting a cleansing enema

Preparation for the procedure

• We establish a trusting and confidential relationship with the patient. We provide isolation and comfortable conditions for the patient for the procedure.
• In the enema room we put on special clothes: a bathrobe, change of shoes, oilcloth apron.
• We wash our hands and put on rubber gloves.
• We assemble the system, attach a sterile tip to it.
• Pour water into Esmarch's mug - 1.5-2 liters. The temperature of the water will depend on the cause of the stool retention. With normal constipation - 20 degrees, with anatomical - 12-20 degrees, and with spastic - 37-40 (up to 42) degrees. The temperature is checked with a water thermometer.
• We hang Esmarch's mug on a tripod at a height of 1 meter from the floor level, but not higher than 30 cm from the patient's level.
• We fill the system so that part of the water passes through the tip.
• We put next to the couch or bed, where the procedure will be performed, a basin with a small amount of disinfectant.
• We put an oilcloth on the couch or bed at the level of the patient's buttocks so that the edge hangs into the pelvis. We lay a diaper on top of the oilcloth.
• We lay the patient on the left side with knees bent and legs brought to the stomach.

Performing a procedure

• Lubricate the tip with sterile Vaseline.
• We spread the patient's buttocks with the first and second fingers of the left hand, gently insert the tip into the anus with the right hand: 3-4 cm towards the navel, then 8-10 cm parallel to the spine. At the same time, we take into account the individual features of the structure of the rectum.
• We open the valve of the system, regulate the flow of fluid into the intestines. If water does not flow, change the position of the tip. We ask the patient to relax and breathe deeply into the abdomen. If the patient experiences spastic pain, close the valve and wait until the pain stops, after which we continue the procedure. If the pain does not stop, inform the attending physician or the doctor on duty.

End of procedure

• After the Esmarch mug is completely empty, close the valve and carefully remove the tip.
• Ask the patient to hold water for 5-10 minutes.
• We remove the handpiece from the system, immerse it in a container with a disinfectant for disinfection.
• We change gloves by immersing the used ones in a special container with a disinfectant.
• 5-10 minutes after the end of the procedure, we escort the patient to the toilet room or give him a vessel.
• We are convinced of the effectiveness of the procedure (we examine the contents of the vessel, ask the patient if the feces have come out).
• We wash the weakened patient after the end of defecation.
• We disassemble the system, immerse it in containers for disinfection, remove gloves, change overalls.

Contraindications for a cleansing enema:

• acute inflammatory processes in the lower intestines;
• malignant neoplasms of the rectum;
• stomach and intestinal bleeding;
• bleeding hemorrhoids;
• the first days after surgery on the abdominal organs;
• abdominal pain of unknown origin.