Enema - procedure

Procedure
Confirm the patient’s identity, explain the procedure and obtain consent.	Assess the patient’s needs, ascertaining if there are specific needs that necessitate particular assistance.
Gather equipment, check the medication (enema), examine the enema packaging noting the medication has not expired, remove packaging and read the manufacturer’s instructions.	Check that the enema has been prescribed for the patient.
Ask the patient to empty their bladder, if necessary, before the procedure.	Assist the patient to remove their clothing from the waist down or if the patient is able to do this themselves, ask them to do so. Ensure that they are not unnecessarily exposed and they are kept warm.
Figure 1 Assist the patient to adopt the left lateral position (if there are no contraindications, such as the presence of any musculoskeletal disorders), with the knees drawn up towards the chest (Figure 1).	Warm the enema by submerging it in the jug of hand-hot water; check the manufacturer’s instructions.
Place the protective bed cover under the person.	Wash and dry your hands, put on the apron and non-latex gloves.
Continuously explain to the patient the procedure and what you are doing.	Gently part the buttocks and observe the perineal and perianal areas. Note, document and report any abnormalities, for example haemorrhoids, rash, rectal prolapse, discharge, infestation or bleeding.
You may be required to make an assessment of the rectum by gently inserting a lubricated gloved finger into the rectum to ascertain if the rectum is empty or full if an evacuant enema is required.	Figure 2 Remove the protective cap from the enema (Figure 2). Place the lubricating gel on the gauze swab, and use this to coat the end of the enema nozzle.
Expel any excess air from the enema.	Gently introduce the nozzle of the enema into the anus and into the rectum, usually about 5cm. The length of insertion depends on the type of enema. Slowly insert the contents of the enema into the rectum informing the patient at all times of what you are doing and what you intend to do.
You must stop immediately if the patient is experiencing any discomfort when the nozzle is inserted or during administration of the fluid or if you are asked to stop by the patient. If this happens, seek advice from a senior clinician.	Stop the procedure if there is any bleeding or the patient complains of pain. You must inform a senior clinician immediately.
Slowly remove the nozzle.	Wipe or ask the patient to wipe (if they are able to) their perianal area with tissue.
Cover the patient, ensuring dignity.	Ask the patient to retain the contents of the enema for 10-15 minutes before using the commode or toilet; this may be easier if the patient remains lying down.
The manufacturer’s instructions should always be followed.	Dispose of the equipment, adhering to local policy and procedure. Remove your gloves followed by the apron. Wash and dry your hands, and offer the patient the opportunity to do the same.
Ensure that a call bell is made available and is in close proximity to the patient, and that a commode and toilet paper are available.	Document all care activity after the procedure and ensure that any documentation concerning the administration of medicines is also completed, such as the prescription chart.
Document the effect of the enema; the Bristol Stool Chart can be used to describe any stool passed. Observe the patient for any adverse reactions.	Respond to any further needs the patient may have.