Evidence based to enema procedure

Evidence base

An enema is the administration of a substance in liquid form into the rectum (Higgins 2006). Enemas are used to aid evacuation of the bowel and to administer medicines.

• All nurses are accountable for their actions or omissions (Nursing and Midwifery Council (NMC) 2015). The administration of an enema requires skill and competence on the part of the nurse, and adherence to the local medicine administration policy and the NMC’s (2010) Standards for Medicines Management.
• It is essential that the nurse who undertakes any aspect of this procedure, including digital rectal examination, is deemed competent to do so (Royal College of Nursing (RCN) 2012).
• The administration of an enema is an invasive procedure and has the potential to cause embarrassment; therefore, nurses need to ensure that they are considerate and kind in their actions, communicating effectively with the person at all times (NHS Commissioning Board et al 2012).

Enemas administered for bowel evacuation may be given to produce an immediate effect, the solution lubricates faecal matter and this enables the passage of faeces (Davies 2004). As fluid is administrated into the rectum this can also stimulate peristalsis of the walls of the rectum. A retention enema is also capable of producing the same effects, however the contents should remain in the rectum for a longer period of time as this penetrates and lubricates the faeces further. A retention enema is often oil based.

Other drugs in enema format

There are some medicines that are administered via the rectal route in the form of an enema. The reason for this is to achieve a local effect, for example to administer corticosteroids and other pharmaceutical agents that reduce inflammation associated with the colonic mucosa. Other drugs administered in enema format are absorbed, resulting in a systemic effect, as the vascular network in the rectum is able to absorb the drug. Another type of enema is a barium enema examination that is used in radiological diagnostic procedures providing an outline of the large bowel (Kyle 2007).

When administering enemas, specifically phosphate enemas, the nurse needs to be aware of any contraindications and should be alert to the fact that all rectal administration is associated with a degree of risk (RCN 2012). It is essential for the nurse to ascertain if the patient has any allergies, such as latex, soap (lanolin), phosphate and peanut (arachis oil enema) allergies (British National Formulary 2016), before commencing the procedure.

Davies (2004) advised that phosphate enemas should be used with caution and Mendoza et al (2007) concluded that the evidence concerning the use of phosphate enemas is inconclusive. Adverse reactions and contraindications must be considered before administering an enema.

There may be benefit in warming the enema to body temperature before administration since the heat can result in stimulation of the rectal mucosa (Crisford 2011). The use of cold solutions should be avoided since they may cause abdominal cramping, resulting in pain and discomfort. The provision of patient comfort is essential.

The nurse should consider assessing the person’s vital signs before, during and following the procedure. This is particularly important in individuals with neurological conditions and in others who may be considered to be at risk (Boyd 2013).

Learning points

1. It is essential that before any patient procedure, proper identification of the patient, explanation of the procedure, consent and needs assessment are undertaken to promote patient safety.
2. Maintaining a patient’s privacy and dignity is important.
3. The left lateral position is used, unless contraindicated, for enema administration.
4. The enema is usually inserted about 5cm, but the length of the insertion depends on the type of enema. The patient should retain the contents of the enema for 10-15 minutes; this is often easier if the patient remains lying down.

Disclaimer: please note that information provided by RCNi Learning is not sufficient to make the reader competent to perform the task. All clinical skills should be formally assessed at the bedside by a nurse educator or mentor. It is the nurse’s responsibility to ensure their practice remains up to date and reflects the latest evidence.