Steps of Procedure
1. Wash hands
Reason: to prevent cross infection.
2. Prepare the solution at the required temperature. Test the temperature at the inner aspect of the wrist.
3. Attach the tubing and the rectal tube with the funnel, pour the solution in it and check for leakage.
Reason: to check the articles to be in good working condition.
4. Lubricate the tip of the rectal tube about 4 inches.
Reason: for the easy insertion of the tube and to prevent friction.
5. Fill the funnel with the solution and expel the air from the tubing by allowing a small amount of fluid to run into the kidney tray. Pinch the tube.
Reason: expelling the air from the funnel and tubing prevents air entering into the colon.
6. Separate the client’s buttocks to visualize the anus clearly and insert the tip about 4 inches, while the client exhales a deep breath.
Reason: the rectum is relaxed when the client breathes out and makes the insertion of the tube easier.
7. Lower the funnel below the level of the rectum.
Reason: to allow the flatus if any to escape from the rectum. It will be seen bubbling through the fluid in the funnel.
8. Raise the funnel and allow the fluid to run in, continue to pour more fluid into the funnel, before the funnel is empty.
Reason: pouring the solution before the funnel is empty, prevents entry of air into the rectum.
9. When 200 to 300 ml of fluid has gone in, pinch the tube before the funnel is completely empty and invert it over the bucket and siphon off the fluid.
Reason: the fluid which has gone in should be drained out before introducing more fluid.
10. When the return flow ceases turn the funnel upright and pour more solution. Lower the funnel until the air from the tube has been expelled. Then raise the funnel and repeat the procedure as in the article no. 8 above.
Reason: care is taken to expel the air from the tubing, as well as from the rectum.
11. Continue the procedure until all the fluid ordered has been given or until the return flow is clear.
12. Temporarily stop the procedure (do not remove the rectal tube) if the client develops any discomfort.
Reason: entry of fluid into the rectum stimulates the peristalsis. Stopping the procedure for few moments will relax the bowels as the peristaltic movement is passed off.
13. Gently remove the rectal tube by pulling it through 3 to 4 layers of rag pieces.
Reason: pulling through the rag pieces removes the faeces from the tube.
14. Discard the rag pieces in the paper bag. Place the funnel with the tubing in the kidney tray.
Reason: avoid contamination of the articles and environment with the soiled articles.
After Care of the Client and Articles
1. Turn the client on the back and assist him to the toilet, commode or bedpan to drain out any fluid left in the rectum.
2. Bring the toilet tray and assist him for the perineal care.
3. Put on the garments, change the bed linen if needed, straighten the sheet and adjust the position of the client in bed and make the client comfortable.
4. Take all articles to the utility room, disinfect the funnel, tubing, catheter and bucket. Clean them, dry them and replace them into their proper places.
5. Tidy up the client’s unit.
6. Wash hands.
7. Record the type of procedure and the result with date and time in the nurse’s record.
8. Return to the bedside. Evaluate the client’s condition and comfort.
Colonic Irrigation Using ‘2 Tube’ Method – One Rectal Tube and a Catheter
In this method, an irrigation can with tubing, glass connection, screw clamps, one rectal tube and a catheter are used. Attach the rubber tubing and catheter to the enema can. Fill the can with the solution and expel the air (this acts as the inflow tube and the rectal tube acts as the outflow tube).
Mark the catheter about 6 inches from its tip and the rectal tube 4 inches from its tip. Insert the tip of the catheter into the eye of the rectal tube and insert the two tubes together into the anal canal after lubricating them well. When the dislodge it from the rectal tube and then insert the catheter alone until the marks on both tubes come together at the anus. The preparation and after use of the client will be same as that of the funnel method. The fluid that flows from the enema-can through the rectal catheter enters the rectum and returns through the rectal tube which is situated 2 inches lower than the rectal catheter.
Colonic Irrigation Using ‘Y’ Connection and Rectal Tube
Articles will be same as that of two tube method. A ‘Y’ connection will permit the regulation of the inflow and outflow. The tube for inflow is attached to one prong of the ‘Y’ connection, the outflow tube is attached to the other prong. The stem of the ‘Y’ connection is attached to the rectal tube. Clamps on the inflow and outflow tubes make it possible to direct the flow of fluid into the rectum and then out of the rectum.
The solution flows from the inflow tube through the rectal tube into the rectum. When the clamp on the inflow tube is closed and the clamp on the outflow tube is opened, the fluid flows from the rectum through the rectal tube to outflow tube and into the bucket. By opening and closing the clamps on both tubes alternately, the fluid enters the rectum and returns after washing out the rectum.
Colonic irrigation or enteroclysis refers to the treatment of washing out the colon with large quantities of a solution in order to clear the colon the faeces.
To clean the colon of faeces, gas, excess mucus, barium etc.
To dilute and remove any of the toxic agents that may be present in the large intestine.
To keep the individual clean in faecal incontinence and to check diarrhea.
To supply heat to the colon or to the pelvic and abdominal organs surrounding the large intestine (to relieve pain and bring about circulatory changes in these organs).
To reduce temperature in hyperpyrexia and heat stroke.
To apply medications locally.
To supply the body with fluid and electrolytes that are absorbed from the intestine.
As a preparation for diagnostic examinations and certain surgeries to cleanse the bowel.
Painful and bleeding haemorrhoids.
Fistula in anus.
Polypus and diverticulus of the intestines.
Painful skin lesions around the anus.
Massive carcinoma or tumor of the rectum.
Cold water (in ice enemata).
Sodium-bi-carbonate solution. 1 to 2 %
Antiseptic solutions such as silver nitrate 1:5000; potassium permanganate solutions 1:5000; thymol 1:100; alum 1:100; boric solution 1 to 2 percent; tannic acid 1:100 etc.
Amount of solutions used: 2 to 3 litre or till the return flow is clear.
Temperature of the Solution
For cleansing purpose (40 degree celcius)
For thermal effect (43.3 to 46 degree celcius)
For reducing temperature (27 to 32 degree celcius)
Colonic Irrigation – Purpose, Nurse’s Responsibility and After Care of the Client.
1. A cleansing enema should be given 1 hour before the colon irrigation is started, so that the rectum will be free of faecal matter.
2. The bladder should be emptied before a colonic irrigation to reduce the intra-abdominal pressure.
3. The temperature of the solution be kept constant throughout the procedure.
4. Do not allow air to enter into the intestines by:
Expelling the air from the tube.
Not letting the fluid to run in completely from the tube.
5. Make sure that the return flow is not blocked.
6. Stop the procedure temporarily if the client complaints of pain.
7. Use a smooth and flexible rectal tube and lubricate it well to prevent damage to the rectal mucosa.
8. Listen to the complaints of the client and should not ignore any discomfort however small they may be. Stop the treatment if the client shows the signs of fatigue and collapse.
9. Allow only 200 to 300 ml of fluid to run into the rectum at a time. Then it should be drained out completely before introducing the fluid second time.
10.Regulate the flow the fluid. Do not have the in-going tube higher than 45 to 60 cm above the bed level and do not have the outgoing tube more than 30 cm below the bed.
By using funnel and catheter
By using “Y” connection and a rectal tube.
By using “2 tube” method.
Nurse’s Responsibility in Giving Colonic Irrigations
By Using Funnel and Catheter
1. Check the diagnose and general condition of the client.
2. Check the abilities and limitations concerning movement.
3. Check the consciousness and the ability to follow instructions.
4. Check the doctor’s orders and the specific precautions, if any to be followed.
5. Check for any lesions on the rectal or perineal area.
6. Assess the need for extra help.
7. Articles available in the unit.
Preparation of the Articles
A tray containing:
1. Funnel and tubing with glass connection
2. Rectal tube placed in a kidney tray.
Reason: to irrigate the rectum.
3. Mackintosh and towel.
Reason: to protect the bed and bed linen.
4. Water soluble jelly or Vaseline.
Reason: to lubricate the tube.
5. Rag pieces in a container.
Reason: to apply the lubricant and to clean the perineum when necessary.
6. Hot and cold water in jugs or any prescribed solution in jub.
Reason: to irrigate the wastes.
7. Paper bag.
Reason: to discard the wastes.
8. Clean linen as needed.
Reason: to change after the irrigation.
Reason: to receive the return flow.
10. Toilet tray.
Reason: to clean the perineum.
Preparation of the Client and the Unit
1. Explain the procedure to the client to win the confidence and cooperation of the client.
2. Explain the sequence of the procedure and explain how the client can cooperate with you.
3. Provide privacy with curtains and adequate draping.
4. Cover the client with a sheet or bath blanket and fanfold the top covers to the foot end of the bed.
5. Remove the back rest and extra pillows.
6. Place the mackintosh and towel under the client to protect the mattress and the bed clothes.
7. Place the client in a left lateral position with the buttocks close to the edge of the bed.
8. Keep all the articles arranged on the bedside locker.
9. Keep the bucket on a low stool to receive the outflow of fluid.
10. Remove the bottom garments or raise it up above the waist level.
11. Fold back a small portion of the sheet or the bath blanket to expose only the anal region.
AUTHOR : CHAND RANI