ENEMA
Enema (Clysis) is defined as a introduction of the fluid into the rectum.
An enema is an introduction of fluid into the lower bowel through the rectum for the purpose of cleansing or to introduce nourishment.
An enema is an introduction of fluid into the lower bowel through the rectum for the purpose cleaning, medicinal, diagnostic or such other purpose.
Purpose
1.To remove fecal matter.
2.To relieve flatulence.
3.To relieve constipation.
4.Toprevent involuntary defecation during surgery.
5.To reduce temperature, e.g. cold enema.
6.To check diarrhea, e.g. starch opium enema.
7.Tostimulate peristalsis, e.g. purgative enema.
8.To make diagnosis, e.g. barium enema.
9.To cleanse the bowel before x-ray studies.
10.To induce anesthesia, e.g. anesthetic enema.
11.To administer medications.
12.To destroy intestinal parasites, e.g. antihelminthic enema.
13.To administer fluids and nutrients.
14.Torelieve inflammation.
15.To establish regular bowel functions during bowel training program.
Classification of Enema
Soap water enema:- It is otherwise called saline enema. In this normal saline (sodium chloride 1 teaspoon) to half liter of water.
The amount of solution used for adult 500 to 1000 ml. Children 250 to 500 ml. And infants 250ml or less.The temperature of the solution in adult 105 to 110 degree F and Children 100 degree F.
Oil enema: It is given to soften fecal matter in cases of serve constipation. The enema must be retained 1/2 or 1 hour to soften the feces.
The solutions used are olive oil ginger oil, castor oil and olive oil 1:2 the amount of solution used is 115 to 175 ml the temperature of the solution is 100 degree F (37.7 degree C)
Carminative enema: It is also called antispasmodic enema. It is given to relieve gaseous distension of abdomen by increasing peristalsis and expulsion of flatus, the solution used is 8 to 16 ml of turpentine mixed thoroughly with 600 to 1200 ml of soap solution. Milk and molasses 90 to 230 ml well mixed with equal quantity of warm milk.
Antihelminthic enema: It is given to destroy and expel worms from the intestine cleansing enema must be given prior to antihelminthic enema so that the drug comes in direct contact with worms and the lining of intestine.
The solution used is infusion of quassia 15 gm of chips to 600ml of water or Hypertonic saline solution sodium chloride 60ml with 600ml of water. The amount of solution given is 250ml.
Cold enema: Cold enema or ice water enema is given to reduce body temperature in Hyperpyrexia and heat stroke. It is given in the form of colonic irrigations. The temperature of the solution is 80 to 90degree F (27 to 32 degree C).
Glycerin enema: Glycerin enema is given to children to fever patients and postoperative patient. Pure glycerin and water 1:2 are used.
Astringent enema: Astringent enema contracts the tissues and blood vessels checks bleeding and inflammation lessens the amount of mucus discharge and gives a temporary relief in the inflamed area. It is usually given in colitis and dysentery.
The solutions used are tannic acid 25gm to 600ml waster, alum 30 gm to 600ml of water and silver nitrate 2 percent (silver nitrate is dissolved in the distilled water).
Sedative enema: Sedative enema contains an anesthetic drug to produce anesthesia in the patient. The commonly used drugs are paraldehyde and over thin. Dose is given as per doctor’s order.
Stimulant enema: Stimulant enema is given in the treatment of shock and collapse. Coffee enema is given in case of opium poisoning. Solutions used are black coffee- 1 tables spoon coffee powder to 300ml of water and 15ml of brandy added to 120 to 180ml of glucose saline. The amount of solution used is 180 to 240ml and the temperature of solution is 108 to 110 degree F (42 to 43 degree C).
Emollient enema:
Emollient enema or starch enema is given in case of diarrhea to relieve irritation in an inflamed mucus membrane. The solution used is starch and opium Tr. Opium 1 to 2 ml added to 120 to 180ml of starch mucilage or rice water. The temperature of the solution is 100 to 105degree F (37.8 to 40.5degree C).
Nutrient enema: It is given to supply food and fluid to the body. Selection of the fluids depends upon the ability of the colon to absorb it. Nutrient enema is particularly useful in conditions like hemophilia.
The solution used is normal saline, glucose saline 250ml. 5% peptonized milk 120ml. The amount of solution used is 110 to 1700ml. In 24 hours or 180 to 270ml at 4 hourly intervals. The temperature of solution is 100degree (37.8degree C).
Methods of Giving Enemas
1. Enema can and tube method- When large amounts of fluids are to be given, this method is used, e.g. soap and water enema.
2. Funnel and catheter method- When a small quantity of fluids is to be given, this method is used, e.g. oil enema.
3. Glycerin syringe and catheter method- Even a small quantity of fluid is to be given, this method is used, e.g. purgative enema.
4. Rectal drip method- When the fluid is to be administered very slowly in order to aid in its absorption e.g. nutrient enema.
General Instruction
1. The appropriate size of rectal catheter or rectal tube of cleansing enema is 22 French for adults, 12 French for and infant and 14 to 18 French for children (School age child).
2. The rectal tube need to he smooth the flexible.
3. The rectal tube is lubricated with a water-soluble lubricant or Vaseline to facilitate insertion and to decrease irritation of the rectal mucosa.
4. The temperature of the solution needs to be adjusted according to the purpose of the enema.
5. The amount of the solution to be administered depends up on the type of enema and the age and size of the person.
6. The patient usually placed in left lateral position, when an enema is administered. In this position sigmoid colon is below the rectum, thus facilitating instillation of the fluid.
7. The distance to which the tube is inserted depends upon the age and the size of the patient. For an adult it is normally inserted 7.5 to 10 cm (3 to 4 inches), for children it is 2.5 to 3.75 cm (into 1½ inches).
8. The height of the enema can should not be above 18 inches (20cm) from the anus.
9. The length of time that the enema solution is retained will depend up on the purpose of enema oil retention enema are usually retained for 2 to 3 hours. Other cleansing enemas are normally retained 5 to 10 minutes.
10. Prepared enema will have their own instruction which need to be followed.
11. Prevent air from entering into rectum, by expelling air from the tube.
12. If the rectum is impacted, attempt to remove the fecal matter with a gloved finger.
13. Make sure the whole apparatus use for the administration of enemas is in a good working condition.
14. Regulate the flow of fluid according to the type of enema.
15. Listen to the complaints of the patient and should not ignore any discomfort however small they are.
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