Administration of Enema in Nursing: Definition, Types, Indications, Procedure, and OSCE Guide

A Step-by-Step Nursing Procedure Guide for Students, OSCE Preparation, and Clinical Practice

Introduction

The administration of an enema is a fundamental nursing procedure commonly performed in clinical practice to relieve constipation, prepare the bowel for diagnostic or surgical procedures, or deliver medication via the rectal route. This comprehensive guide is designed for nursing students, student nurses, and healthcare professionals, providing clear explanations, indications, equipment, procedures, and aftercare aligned with OSCE and clinical standards

Definition of an Enema

An enema is a nursing procedure that involves the introduction of a prepared solution into the rectum and lower part of the large intestine. This is done to stimulate bowel evacuation, soften stool, or deliver medication for local or systemic effect.

Types of Enemas

Enemas are broadly classified into two main types:

1. Cleansing (Evacuant) Enema

2. Retention Enema

Cleansing (Evacuant) Enema

Description

A cleansing enema is administered to promote the evacuation of faeces from the lower bowel by stimulating peristalsis and softening stool.

Indications

A cleansing enema may be given in the following situations:

• To relieve constipation

• To empty the bowel before diagnostic procedures such as rectal X-ray or colonoscopy

• Pre-operative bowel preparation

• Post-operative bowel management, especially after lower bowel surgery

Equipment Required

Trolley – Top Shelf

• Enema apparatus (funnel or enema can)

• Rubber tubing with clamp

• Disposable rectal catheter (appropriate size for adults or children)

• Swabs or applicators in a gallipot

• Jug containing the prepared enema solution placed in warm water

• Water-soluble lubricant (e.g. K-Y jelly)

• Thermometer

• Clean gloves

Trolley – Bottom Shelf

• Mackintosh and towel

• Receiver for used swabs

• Receiver for used catheter

• Bedpan with cover (if the patient is bedridden)

• Toilet paper

• Soap

• Apron

Bedside Preparation

• Privacy screen

• Hand-washing facilities

Procedure for Administering a Cleansing Enema

1. Explain the procedure to the patient to gain cooperation and reduce anxiety.

2. Ensure privacy by using screens and closing windows or curtains.

3. Assemble all equipment and position the trolley close to the patient.

4. Wash hands thoroughly and put on clean gloves.

5. Position the patient in the left lateral position with knees flexed, as this follows the natural curve of the colon.

6. Place a mackintosh and towel under the patient’s buttocks to protect bed linen.

7. Prepare the enema solution and expel air from the tubing before insertion.

8. Lubricate the rectal catheter generously to minimize discomfort and prevent injury.

9. Gently insert the catheter 8–10 cm into the rectum, following the direction of the rectum.

10. Hold the funnel approximately 24 cm above the patient’s buttocks to allow gentle gravity flow.

11. Release the clamp and allow the solution to flow slowly into the rectum.

12. Monitor the patient for discomfort and slow the flow if cramping occurs.

13. Once most of the solution has been administered, clamp the tubing and gently withdraw the catheter.

14. Encourage the patient to retain the solution for about 10–15 minutes if possible.

15. Assist the patient to use a bedpan or toilet as appropriate.

16. Provide toilet paper and ensure the patient is clean, dry, and comfortable.

17. Observe and note the amount, colour, and consistency of stool passed.

18. Dispose of waste appropriately and clean reusable equipment.

19. Remove gloves and wash hands.

20. Document the procedure and findings accurately.

Care of Equipment After Use

1. Decontaminate all reusable equipment according to infection-control guidelines.

2. Wash equipment with soap and water.

3. Rinse thoroughly and soak in the recommended disinfectant.

4. Hang tubing and apparatus to dry completely.

5. Store equipment properly to prevent damage and contamination.

Commonly Used Enema Solutions

1. Ready-Made Enema

This is a commercially prepared enema solution, usually hypertonic sodium phosphate, supplied in a disposable bottle with an applicator. The standard volume is approximately 120 ml.

2. Soap Solution Enema

Preparation:

• Dissolve approximately 50 ml of mild soap in 450 ml of warm water

• Stir until fully dissolved

• Allow the solution to cool to body temperature (about 37°C)

3. Normal Saline Enema

Preparation:

• Dissolve 2 teaspoons of salt in 500 ml of clean water

Note:

Adult volume ranges from 500 ml to 1000 ml depending on tolerance