Setting up a siphonic enema

Level of assistance:

• Hospital Health Organization

Description of the clinical situation (variant):

Patient A., 77 years old, is being treated as an inpatient at the central regional hospital in preparation for a large intestine operation. It is necessary to prepare the patient for the operation by following the doctor's instructions.

Training options

• Individual

Training requirements for trainees

• Knowledge of the algorithm of manipulation "Siphonic enema"
• Briefing on working with the simulator

 INDICATIONS

• Suspicion of intestinal obstruction
• Preparation for surgery on the large intestine
• Poisonings
• No effect of the enema

 CONTRINDICATIONS

• erosions and ulcers of the mucosa of the large intestine
• unclear abdominal pain
• colorectal tumors
• first days after gastrointestinal surgery
• bleeding hemorrhoids
  

POSSIBLE COMPICATIONS

• Rectal damage

EQUIPMENT FOR PERFORMING A PRACTICAL SKILL

• phantom buttocks for giving enemas
• manipulation table
• couch
• sterile tray
• sterile siphon enema system
• thick gastric tube
• rubber tube of the same diameter as the probe
• glass connecting tube
• sterile tweezers
• 1-1.5 liter funnel
• basin or bucket
• kleenex, diaper
• vaseline oil
• thermometer to measure water temperature
• Gown, cap, mask, non-sterile gloves, apron, sleeves
• antiseptic
• individually wrapped sterile gauze wipes
• 10 liters of water at 37 ˚C
• ship
• jug
• Containers with a working solution of chemical disinfectant: 
  • "Disinfection of dressing material, PPE"
  • "Disinfection of syringes and other medical devices"
• Container for medical waste disposal: "Packaging"

ALGORITHM FOR PERFORMING A PRACTICAL SKILL

Preparatory stage:

• Establish a trusting and confidential relationship with the patient
• Explain the purpose and the course of the manipulation, get consent
• Provide isolation and comfortable conditions for the patient for the procedure (in the enema room)
• Wear OPP, apron.
• Prepare the necessary equipment
• Hygiene hand sanitizer
• Wear non-sterile gloves
• On the sheet covering the couch, lay the plastic sheet so that it hangs down into the basin, over it lay a diaper
• Ask or help the patient to lie on the couch on the left side with the legs bent and pulled up to the abdomen, closer to the edge of the couch
  
• Lubricate the blind end of the gastric tube with Vaseline oil
  

Main stage:

• spread buttocks with the first and second fingers of your left hand
• with the right hand, insert the rounded end of the probe into the intestine and move it to a depth of 30-40 cm: the first 3-4 cm - in the direction of the navel, then - parallel to the spine
• if the probe does not enter the rectum, clean the rectal ampulla' make sure the tube does not curl up in the rectal ampulla
  
• attach a funnel to the free end of the probe
• hold the funnel slightly inclined at the level of the patient's buttocks and pour 1 liter of water from a pitcher into it
• slowly raise the funnel to a height of 1 m
• invite the patient to breathe deeply
• as soon as the water reaches the mouth of the funnel, lower it below buttock level without pouring water out of it until the funnel is completely filled
• drain the water into a prepared container
• fill the funnel with water again and repeat the flushing using 10 liters of water until "clear flush water"
• when the rinsing is finished, disconnect the adapter from the probe
• immerse adapter, rubber tube and funnel in container: "Disinfection of syringes and other medical devices".
• leave the probe in the intestine for 10-20 minutes, dipping it into a container of flushing water so that the remaining fluid comes out
• with slow reciprocating movements, remove the probe from the intestine, passing it through a gauze napkin
• dip the probe into the container "Disinfection of syringes and other medical devices
• dry the skin around the anus with a sterile gauze tissue.
• dip the wipe into the container "Disinfection of dressing material, PPE"
• wash the patient if necessary.

Final Stage:

• Ask about the patient's well-being after the manipulation, ensure that the patient is transported to his room
• pour dry bleach 1:5 for 20 minutes, then flush it down the toilet
• Remove the diaper, put it in a bag for used linen; Kleenex, apron, wipe with a clean cloth (rag) moistened with a chemical emergency disinfectant or treat it by irrigation
• remove the OPP in the correct order
• Remove contaminated gloves
• Immerse them in a container with a working solution of chemical disinfectant:  "Disinfection of dressing material, PPE"
• wash your hands
• Record the manipulation in the medical records
• Put the workplace in order (initial condition).