Clinical Skills - Enema Administration

Hi. I'm Ellis with Level Up RN. And in this video, I'll be demonstrating how to administer an enema. I'll be following along on the steps in our clinical nursing skills deck. So if you have this deck, grab this card and you can follow along with me. If you don't have the deck and you're interested in checking them out, then you can head on over to leveluprn.com.

To prepare my patient for an enema, I've gone ahead and positioned them in a modified left lateral recumbent position, which you might know is the Sims' position, and that's so that I can have access to the rectum to insert the enema tip itself. So the enema has been pre-warmed to room temperature, which simply means if I got it from a fridge or from the sink, that I have allowed it to become room temperature. Because if I instill a really cold solution into their rectum, it can be extremely uncomfortable. It can cause cramping and pain. And so I want to just make sure that that is not going to happen. I've also placed it on a pole. So you can use an IV pole or something, or you can hold it, but you want it at least 18 inches above their rectum to facilitate the enema actually being introduced.

So I simply expose the rectum. I get my tubing. Many of them come pre-lubricated, but if they don't, then I simply remove the cap and I lubricate it. I'm not sure this will fit in my mannequin, but we're going to try. I'm going to ask them to please relax. How lovely. I'm going to insert it three to four inches pointing towards the umboligus. And while I'm doing this, I want to just note that I did make sure this was clamped. So nothing is happening right now. All I'm doing is inserting the tube. When we're ready, I can unclamp this tubing. And I noticed that the enema begins instilling. And I can change the pace. If I raise it high, it goes much faster. If I raise it low, you can see the bubbles here in this have kind of backed up a little bit. And so if they start complaining of severe discomfort or cramping, I can lower it to make it go a little bit slower, or I can even clamp it right here and pause it. If they have extreme discomfort, I can stop it altogether.

So once my enema has infused, and that can take anywhere from five to ten minutes, depending on the size and the type, I simply remove the catheter, the tubing. So I'm going to take it back out. I'm going to go ahead and waste this because that's been in their rectum. So all of this would be wasted. And I would ask them to lay as they are, or supine is fine as well, but I need them to stay and retain that enema for, it's usually, at least 10 minutes. And once they have the inability to resist the urge to bear down, I want to tell them, "Try not to bear down. Trying not to sit up." Once they can no longer resist that, then I would assist them to some kind of combination like a bedpan, a bedside commode or even a bathroom. Whichever one is the safest and easiest for them to get to for them to void the enema. And that's how you complete that skill.