Enema Types and Safety

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