an enema can be used to treat constipation or to prepare the bowel for certain procedures before you administer an enema introduce yourself to the patient note the patient's name the type of enema ordered and the time of administration compare the record against the label on the enema solution or package if the enema is medicated check the accuracy and completeness of the medication administration record against the health care provider's order then identify the patient using two identifiers all right if you could state your name for me please juana hankins and your birthday 7470 okay i'm going to close the curtain for privacy for us provide privacy by drawing the bedside curtain or closing the door raise the bed to a comfortable working height ensure that the side rail on her left side is raised then i'd like to assist you on your left side please okay help her into the left side lying or sims position with her right knee flexed explain to her that she'll need to stay in this position until the procedure is complete cover her with a bath blanket making sure that only the anal area is exposed next apply clean gloves place a bedpan or bedside commode in an easily accessible position if the patient will be using the toilet to expel the contents of the enema make sure the bathroom remains unoccupied and keep the patients slippers and robe handy to administer a pre-packaged disposable enema remove the plastic cap if necessary apply a little more water-soluble gel to the pre-lubricated tip ensure that there is a waterproof pad absorbent side up under the patient's hips and buttocks now separate the buttocks and inspect the perianal area for abnormalities such as hemorrhoids anal fissures and rectal prolapse gently separate the patient's buttocks and locate the anus help her relax by coaching her to breathe slowly in and out through her mouth after expelling any air from the enema container gently insert the lubricated tip into the anal canal angling it toward the umbilicus adjust the insertion depth based on the patient's age in any patient don't force the tip if you feel resistance stop the procedure and notify the health care provider once you've inserted the lubricated tip to the proper depth roll the plastic bottle from the bottom to the tip until all the solution has been instilled into the patient's rectum and colon when you're finished press a few layers of toilet tissue around the rectal tube at the anus and gently withdraw the tube and tip discard the enema container in the proper receptacle instruct the patient to retain the solution until she has the urge to defecate which usually occurs in two to five minutes to administer an enema using an enema bag fill the bag with warm water from the faucet as prescribed if saline has been ordered warm the container of saline in a basin of water before you add it to the water in the enema bag then check the temperature of the solution by pouring a few drops on your wrist the water should be warm but not hot if a soap suds enema has been ordered add castile soap after the water is placed in the enema bag next raise the bag release the clamp and let the solution flow just until it fills the tubing to push the air out of it then re-clamp the tubing when the enema and the patient have been prepared you may apply a little more water-soluble gel to the pre-lubricated tip then gently separate the patient's buttocks and locate the anus you can help him relax by reminding him to take deep slow breaths through his mouth can you take a few deep slow breaths through your mouth touch the skin next to the patient's anus with the tip of the rectal tube then gradually insert it into the anal canal angling it toward the patient's umbilicus as you would for a prepackaged enema adjust the insertion depth based on the patient's age but don't force it as you hold the tube in place open the regulating clamp and allow the solution to enter keep the enema container at the level of the patient's hips to prevent the solution from flowing out of the bag too quickly gradually raise the container above the anus for a high enema raise it 12 to 18 inches or 30 to 45 centimeters for a regular enema raise it 12 inches or about 30 centimeters and for a low enema raise it 3 inches or 7.5 centimeters once the flow of the fluid has been established you may hang the enema bag from an iv pole if the patient has cramping or a fluid escapes around the rectal tube lower the container or close the clamp when all the solution has been instilled clamp the tube tell your patient that you've completed the procedure place toilet tissue around the tube at the anus and gently withdraw the rectal tube and tip for either type of enema explain that mild bloating and abdominal cramping afterward is normal [Music] ask her to retain the solution for as long as possible while lying on her side in bed stay at the bedside and when the patient is ready help her onto the commode or bedpan or accompany her to the bathroom observe the characteristics of the stool and solution remind the patient not to flush the toilet before you've had a chance to inspect the character of her stool if the patient needs your help washing her anal area with soap and water remember to wear gloves next remove and discard your gloves and perform hand hygiene assess the patient's abdomen for distension if she was given the enema to relieve constipation ask her if her symptoms have subsided help the patient into a comfortable position and show her how to summon assistance as part of your follow-up care record the type and volume of enema given the time of administration the characteristics of the resulting stool and the patient's tolerance of the procedure