Enema Types and Safety

Study Notes

Enema Types

Tap Water Cleansing (Hypotonic): allows fluid to be in the colon with interstitial fluid to distend colon and increase peristalsis, not safe for infants, children, and heart failure patients, don't give more than 3 liters
Normal Saline Cleansing (Isotonic): adds fluid into colon causing distension and increase peristalsis, safe for children and heart failure patients, dosages vary by age:
- Infants: 50 to 150 mL
- Toddlers: 250 to 350 mL
- School-Age: 300 to 500 mL
Soapsuds Cleansing: Castile soap added to tap or normal saline, distends the colon and irritating walls of colon to cause peristalsis, mix in saline for infants, children, and patients with heart failure
Hypertonic Sodium Phosphate Cleansing: pulls fluid from interstitial space into colon to soften stool and increase peristalsis
Oil Retention: softens hard stool, lubricates and softens hard stool mass, enables easier removal, instill one hour before removing
Medicated Enema: exchange of substances and decreases inflammation, types include:
- Steroid: decreases inflammation of rectal walls and colon
- Kayexalate: pulls potassium from body tissues and binds with it, excess leaves body when expelled
Milk and Molasses Cleansing: hypertonic, pulls fluid into colon to soften stool, must be heated together, then cooled to body temperature

Specialized Enema Procedures

Return Flow/Harris Flush/Siphon Enema: removes flatus, uses tap water or saline with 100 to 200 mL of solution, raises and lowers enema to siphon out flatus, repeat until no bubbles
High Enema: cleanses higher colon, beyond sigmoid, distends colon and moves into descending and transverse colon, begins with patient in left semi-prone position, uses half of the fluid, then turns to back and right side to finish enema

Precautions and Contraindications

Contraindications:
- Rectal surgery
- Severe bleeding hemorrhoids
- Ulcerative colitis/Crohn's disease
- Rectal fissure or cancer
- Excessive bleeding potential from disease or medication
- Heart conditions; myocardial infarction or unstable angina
Associated Problems:
- Stimulation of Vagus Nerve Symptoms: chest pain or heaviness/pressure, shortness of breath or inability to breathe, dizziness, feeling faint, nausea, pallor, clammy skin, pulse below 60 bpm
- Causing constriction of bronchioles in lungs, unable to support adequate blood pressure and circulation
- Perforating the Colon: may introduce bacteria into peritoneal cavity, bleeding, or hemorrhage to occur, don't force when meeting resistance

Ostomies

Urinary:
- Ileal Conduit: ureters attached to section of small intestine, used as a small pouch and stoma where patient wears an appliance over stoma to collect urine, redness can occur which would require the use of barrier ointment to protect skin
- Continent Urostomy/Indiana Pouch: pouch created from large and small intestines, ureters diverted into the pouch with an opening constructed for a catheter to be inserted
- Neobladder/Orthotopic: substitute bladder created from large or small intestine, ureters diverted into it and connected to the urethra

Description

This quiz covers the different types of enemas, including tap water cleansing, normal saline cleansing, and soapsuds, as well as their safe usage for various age groups and medical conditions. Topics include the effects of enemas on the colon, recommended volumes, and safety precautions.