Cleansing enema

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• simulator for the cleansing enema 
• medical portable manipulation table
• couch
• enema set
  • enema bag (Esmarch's mug)
  • enema tips
  • enema tubing (hose) with an adjustable pinch clamp
  • hook
• basin
• waterproof sheet
• absorbent sheet
• vaseline oil
• thermometer for water
• PPE: medical gown, hat, mask, non-sterile gloves, apron, sleeve protectors
• skin antiseptic
• stand (tripod)
• clean wipes
• clamp
• tweezers
• boiled water 1.5 - 2.0 l
• waste containers:
  • "Disinfection of dressings, PPE"
  • "Disinfection of syringes and other medical items"
  • "Packaging"

Clinical situation:

• Patient A., 65 years old, was admitted to the surgical department of the central district hospital for a planned operation. It is necessary to prepare the patient for surgery
• Сarry out a cleansing enema.

Order of the skill performance:

Preparatory stage:

• Inform the patient about the procedure, get verbal consent to giving it
• Provide isolation and conditions comfortable for the patient
• Put on PPE: medical gown, hat, mask, apron, sleeve protectors, non-sterile gloves
• Open the package with the enema set, connect the enema tubing, enema tip and Esmarch's mug (if it necessary)
• Close the adjustable pinch clamp
• Pour water into the Esmarch's mug - 1.5-2 liters of room temperature (24-26 ºС)‚ check the temperature with a water thermometer
• Hang the  Esmarch's mug on a tripod at a height of 1 m from the couch level
• Open the clamp and drain some water through the tip
• Close the clamp 
• lubricate the tip with vaseline oil
• Cover the couch with waterproof and absorbent sheets
• Ask the patient to take the required position (on his left side with his/her legs bent at the knees and brought to his stomach).

Maine stage:

• Spread the patient's buttocks with the first and second fingers of the non-dominant hand
• Insert carefully the tip into the anus with a dominant hand by translational-rotational movements 3-4 cm towards the navel, then 7-8 cm parallel to the spine (total 10-12 cm)
• Open the clamp, adjust the flow of water into the intestines with not very high speed (if water does not enter, change the position of the tip)
• Ask the patient to relax and to breathe deeply.
• If the patient has spastic pain, close the clapm and wait until the pain stops, then continue the procedure
• Leave a small amount of water at the bottom of the mug (for prevention  from entering of air to the intestine) and close the clamp
• Remove carefully the tip out of the anus by compressing together the buttocks cheeks with the fingers of your non dominant hand
• Ask the patient to hold water in the rectum for 5-10 minutes
• Disconnect the tip from Esmarch's mug with tweezers
• Put the Esmarch's mug and the tip into the container “Disinfection of syringes and other medical items”

Final stage:

• 5-10 minutes after the end of the procedure, take the patient to the toilet room or give him a bedpan
• check the effectiveness of the procedure (abcence the feces into the bedpan or toilet)
• Clean and disinfect the couch
• Remove and discard personal protective equipment
• Wash your hands
• Record the procedure in the medical records (journal)
• Put the workplace in order (initial condition)