Setting up a medicinal enema

Level of assistance:

• Hospital health care organization.

Description of the clinical situation (variant):

Patient A., 77 years old, is being treated as an inpatient in the gastroenterological department of the central regional hospital with the diagnosis of acute colitis. It is necessary to perform a medicinal enema, following the doctor's instructions.

Training options

• Individual

Training requirements for students

• Knowledge of the algorithm of the manipulation "Setting the cleansing enema". "Setting a medicinal enema".
• Briefing on working with the simulator

INDICATIONS

• inflammatory processes of the lower colon

CONTRAINDICATIONS

• gastrointestinal bleeding
• bleeding hemorrhoids
• rectal tumor in the decay stage

POSSIBLE COMPLICATIONS

•  Damage to the rectum

EQUIPMENT FOR PERFORMING A PRACTICAL SKILL

• phantom buttocks for giving enemas
• manipulation table
• couch
• disposable sterile Janet syringe
• Rectal gas tube sterile disposable
• medicine (decoction of chamomile) as prescribed by the doctor
• Disposable Esmarh mug in sterile packaging
• sterile gauze napkin -1pc.
• sterile tweezers
• basin or vessel
• Kleenex, diaper
• Vaseline
• thermometer to measure water temperature
• "water bath"
• Gown, cap, mask, non-sterile gloves, apron, sleeves
• a tripod to hang the Esmarh mug
• clean rags
• clamp
• padding
• the ship
• boiled water 1.5 - 2.0 l
• Containers with a working solution of chemical disinfectant: 
  • "Disinfection of dressing material, PPE"
  • "Disinfection of syringes and other medical devices"
  • container for the disposal of medical waste:
    
    • "Packaging"

ALGORITHM FOR PERFORMING A PRACTICAL SKILL

Preparatory stage

• Establish contact with the patient, explain the purpose and course of the manipulation, get consent to perform.
• Provide isolation (put a screen in the room) and a comfortable environment for the patient for the procedure
• Wear a change of sanitary clothing, an apron.
• Perform hygienic hand sanitizer
• Put on gloves
• Prepare the equipment
• Give the patient the cleansing enema 20-30 minutes before giving the medicinal enema
• Place the bottle with the medicine in a "water bath" and heat it to 38-40 C.

Main stage

• Place the patient on his left side with his legs bent and pulled up to his stomach, closer to the edge of the bed. Place a cloth under the patient's buttocks and a diaper over it.
• Lubricate the end of the vaseline tube inserted into the rectum with Vaseline oil.
• Bend the tube, clasp its free end between the IV and V fingers of the right hand.
• Take the rounded end as a handle 6-7 cm from the blind end.
• Spread the buttocks I and II fingers of the left hand.
• With the right hand, gently rotate the gas tube into the rectum to a depth of 20-30 cm: the first 3-4 cm in the direction of the navel, the remaining 15-20 cm parallel to the spine.
• Fill the syringe with 50-100 ml of heated medicine (chamomile decoction), let the air out of the syringe
• Attach a Jeanet syringe to the free end of the gas tube
• Slowly inject the medicine by squeezing the outer end of the gas tube
• Disconnect the Janet syringe and place it in a container with a working solution of disinfectant:  "Disinfecting syringes and other medical devices".
• Remove the gas tube and place it in a container: "Disinfecting syringes and other medical devices".
• Clean the anus with a sterile wipe (for women, from front to back)

Final Stage

• Take away the kleenex and the diaper
• Place them in a used laundry bag
• Remove the contaminated gloves and immerse them in a container with a working solution of disinfectant:  "Disinfection of dressing material, PPE"
• Take off your apron, sleeves, mask, gown.
• Remove the screen, make sure the patient has no complaints
• Wash your hands.
• Make a record of the manipulation on the appointment sheet.
• After the procedure, ask the patient to stay in bed for at least 30 minutes, changing body positions for a better effect of the drug on the intestinal mucosa.
• Put the workplace in order (initial condition).