Enemas. Concept, types, goals
Enema
Types of enemas
| Types of enemas | Indications for staging | solution, water | Liquid volume | Fluid temperature, | action effect | |
| Cleansing | 8-10 | 1-1.5 l | 20-28 14-16 37-40 | |||
| Siphon | 20-40 | Water | 8-10 l | 30-37 | ||
| Hypertensive | 15-20 | 50-100 ml | 37-38 | |||
| oily | 15-20 | 100-200 ml | 37-38 | |||
| Medicinal | 15-20 | 50-100 ml | 38-42 |
Purpose of enemas
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Enemas. Concept, types, goals
Enema(Greek klysma) - the introduction of fluid into the lower part of the large intestine for therapeutic or diagnostic purposes. The liquid introduced into the intestine, its volume and temperature affect the receptor apparatus of the intestinal wall in different ways. Water irritates the intestinal mucosa and thereby increases peristalsis.
The nature of constipation determines the temperature of the water:
Indifferent (30-37) - does not affect the emptying function, purification is due to the mechanical effect of the volume of water;
Cold (12-18) - increases the stimulation of the contractile activity of the intestine (increases peristalsis);
Warm (38-40) - increases the absorption (absorption) of fluid and relaxes the smooth muscles of the intestine.
Types of enemas
| Types of enemas | Indications for staging | Tip insertion depth, cm | solution, water | Liquid volume | Fluid temperature, | action effect |
| Cleansing | 1. Constipation. 2. Preparation for diagnostic studies. 3. Preparation for surgery, childbirth. 4. Food poisoning. | 8-10 | Water Atony of the intestine Spasmodic condition of the intestine | 1-1.5 l | 20-28 14-16 37-40 | Emptying, after 5-10 minutes |
| Siphon | 1. Diagnosis and treatment of intestinal obstruction. 2. Poisoning with poisons, mushrooms, drugs. 3. Ineffectiveness of other types of enemas. | 20-40 | Water | 8-10 l | 30-37 | Diagnostic (detoxification) to clean intestinal lavage |
| Hypertensive | 1. Atonic constipation. 2. Massive edema. 3. Postoperative period. | 15-20 | Saline solutions: 10% sodium chloride solution; 20-30% solution of magnesium sulfate. | 50-100 ml | 37-38 | Emptying (laxative), after 20-30 minutes. |
| oily | 1. Spasmodic constipation. 2. "Stubborn" constipation. 3. Postoperative period. | 15-20 | Vaseline oil, glycerin, vegetable oils: sunflower, sea buckthorn, rosehip. | 100-200 ml | 37-38 | Laxative, after 6-10 hours (at night) |
| Medicinal | 1. Hyperthermia. 2. Inflammatory processes of the large intestine. 3. Convulsive syndrome. | 15-20 | Double oral dose of an aqueous solution. | 50-100 ml | 38-42 | Therapeutic: hypothermic, anti-inflammatory, anticonvulsant. |
Purpose of enemas
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Contraindications for setting enemas:
Acute inflammatory processes of the large intestine;
Bleeding from the organs of the digestive system;
Malignant neoplasms of the rectum;
The first days of the postoperative period on the organs of the digestive tract;
Fissures in the anus / prolapse of the rectum;
Pain in the abdomen of unknown origin;
The first 3 days after the transfer acute infarction myocardium.
The procedure for setting an enema is performed by a ward sister. This is dependent nursing intervention. Indications and contraindications are determined by the doctor.
Algorithm for performing the manipulation "Placing the gas outlet tube"
Prepare:
Non-sterile gloves - 1 pair.
Gas outlet tube - 1 pc.
Oilcloth - 1 sq. m.
Spatula -1 pc.
Vaseline - 5 ml.
Tray - 1 pc.
Vessel with water.
Antiseptic solution- 1 single dose.
Liquid soap - in the absence of an antiseptic for hand treatment.
Dispenser with disposable towel.
Container with disinfectant solution.
I. Preparation for the procedure:
1. Introduce yourself to the patient, explain the purpose and course of the upcoming procedure.
2. Fence off the patient with a screen (if the procedure is performed in a multi-bed room).
3. Help the patient lie closer to the edge of the bed on his side, slightly bring his legs to his stomach, put an oilcloth under it. If the patient is contraindicated in the position on the side, the gas tube can be placed in the supine position.
4. Place a vessel with a small amount of water next to the patient.
5. Put on an apron, gloves.
6. Lubricate the rounded end of the tube with Vaseline for 30 cm.
II. Execution of the procedure:
1. Take the rounded end of the tube in your right hand like a “writing pen”, and hold the free end with fingers 4 and 5.
2. Spread the buttocks with 1-2 fingers of the left hand. Right hand insert the gas outlet tube to a depth of 15-30 cm, the first 3-4 cm towards the navel, and the rest parallel to the spine, so that the outer end protrudes at least 10 cm.
3. Lower the free end of the tube into a vessel of water. Leave the tube in the intestine for 1-2 hours until the gas is completely removed.
4. Cover the patient with a sheet or blanket.
III. End of procedure:
1.Remove the gas outlet tube when the effect is achieved through a napkin. Place the tube in a container with a disinfectant.
2. Wipe the patient's anus with a napkin (toilet paper) in the direction from front to back (for women), place the napkin in a container for disinfection.
3. Remove the vessel, place the oilcloth in a waterproof bag for transportation to the place of disinfection
4. Place the patient in a comfortable position.
5. Remove the apron, discard the gloves in a container for disinfection.
6. Wash and dry your hands (using soap or antiseptic).
7. Make an appropriate record of the performed medical documentation procedure.
"Installation of a gas outlet pipe." The algorithm will allow the nurse to quickly navigate the sequence of the procedure.
How to properly install a gas outlet tube - sequential technique, indications and contraindications.
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Indications
Flatulence.
Contraindications
- intestinal bleeding;
- bleeding tumor of the rectum;
- acute inflammation of the anus.
Equipment
- A sterile gas outlet tube connected by means of a control glass to a rubber tube 30-50 cm long;
- petrolatum;
- a vessel with a small amount of water;
- oilcloth;
- diaper;
- gauze napkin; zinc ointment;
- a container marked "For enema tips" with a 3% solution of chloramine.
Gas tube placement technique
- An oilcloth and a diaper are placed under the patient.
- The patient is placed on the left side with legs bent at the knees and pulled up to the stomach. If the patient cannot turn on his side, then he remains lying on his back, legs bent at the knees and separated.
- Lubricate the rounded end of the gas outlet tube with petroleum jelly.
- Putting on rubber gloves, they spread the buttocks with the left hand, and with the right hand, taking the tube with a gauze napkin, insert it with rotational movements, observing all the bends of the rectum, to a depth of 20–25 cm. or, even better, at the patient's bedside on a stool.
- After 1.0 - 1.5 hours, the tube should be removed, even if there is no relief, in order to avoid the formation of bedsores on the wall of the rectum.
- After removing the gas tube, the patient should be washed. In case of reddening of the anus, it is lubricated with a drying ointment, such as zinc.
- After use, the system is immediately soaked in a 3% solution of chloramine, then processed according to OST 42-21-2-85.
Equipment: sterile vent tube, petroleum jelly, spatula, gloves, vessel, toilet paper, screen, oilcloth, diaper, waterproof bag.
Algorithm for performing manipulation:
1. Explain to the patient the purpose and course of the upcoming manipulation and obtain his consent.
2. Fence off the patient with a screen.
3. Put on gloves.
4. Help the patient lie closer to the edge of the bed on the left side with legs pressed to the stomach (if the patient is contraindicated in the position on the left side, the gas tube can be placed in the supine position).
5. Put an oilcloth under the buttocks of the patient, and a diaper on it.
6. Put a vessel on the diaper next to the patient (pour some water into the vessel).
- Lubricate the rounded end of the tube with Vaseline for 20-30 cm.
8. Bend the tube, pinch the free end with 4 and 5 fingers, and take the rounded end as a handle.
9. Spread the buttocks, insert the gas outlet tube into the rectum to a depth of 20-30 cm.
10. Lower the free end of the tube into the vessel (the duration of the procedure is determined by the doctor).
11. Ensure the safety of the patient, cover with a blanket.
12. Remove gloves, wash and dry hands.
13. After 30-60 minutes. put on gloves, unfold the blanket, remove the tube and throw it into the waste container.
- Wipe the patient's anus with toilet paper.
15. Remove the oilcloth and diaper, throw it into a waterproof bag.
16. Remove gloves.
17. Help the patient to take a comfortable position, cover him, remove the screen.
18. Wash your hands, dry.
- Make an entry in the Medical record about the performed manipulation
Installation of a gas outlet pipe. Target. Removal of gases from the intestines.
Indications. Flatulence.
Contraindications. intestinal bleeding; bleeding tumor of the rectum; acute inflammation of the anus.
Equipment. A sterile gas outlet tube connected by means of a control glass to a rubber tube 30-50 cm long; petrolatum; a vessel with a small amount of water; oilcloth; diaper; rubber gloves; gauze napkin; zinc ointment; a container marked "For enema tips" with a 3% solution of chloramine.
Technique for setting a gas outlet tube.
1. An oilcloth and a diaper are placed under the patient.
2. The patient is laid on the left side with the legs bent at the knees and pulled up to the stomach. If the patient cannot turn on his side, then he remains lying on his back, legs bent at the knees and separated.
3. Lubricate the rounded end of the gas tube with petroleum jelly.
4. Putting on rubber gloves, spread the buttocks with the left hand, and with the right hand, taking the tube with a gauze napkin, insert it with rotational movements, observing all the bends of the rectum, to a depth of 20–25 cm. on the bed or, even better, at the bedside of the patient on a stool.
5. After 1.0 - 1.5 hours, the tube should be removed, even if there is no relief, in order to avoid the formation of bedsores on the wall of the rectum.
6. After removing the gas tube, the patient should be flushed. In case of reddening of the anus, it is lubricated with a drying ointment, such as zinc.
7. After use, the system is immediately soaked in a 3% solution of chloramine, then processed according to OST 42-21-2-85.
Notes. During the day, the tube can be inserted 2-3 times. If the water in the vessel is bubbling, then the gases are escaping. If there is no relief after the installation of the gas outlet tube, then it should be prescribed by a doctor.
How to install a gas outlet pipe? This question arises in almost every new mother. After all, it is this remedy that helps babies get rid of painful gas formation. Also, sometimes the installation of a gas outlet tube is necessary for adult patients. Consider the algorithm of actions, as well as indications for the use of this tool.
Who needs to use the device? Indications for manipulation
The installation of a gas outlet tube is prescribed for patients who have anal fissures and cannot empty the intestines on their own from the accumulation of air and liquid feces. Also, with inflammatory diseases of the stomach and intestines, this procedure is prescribed. It is worth noting that an enema is more often recommended for adult patients. The installation of a gas outlet tube is indicated in cases where Esmarch's mug or siphon enema cannot be used.
Often this device is recommended for children in the first months of life. A gas outlet tube for newborns is sold in almost every pharmacy chain. This remedy helps to get rid of the accumulation of gases and feces.
Preparation for the procedure
Before using the gas outlet tube, you must read the instructions. A separate annotation is attached to each device. What does the instruction say? The gas outlet tube must be pre-washed and sterilized. It is especially important to follow this point when the device is to be used on newborns.
Before using the gas outlet tube, prepare the necessary material. You will need tissues, a stool tray, disposable sterile gloves, and Vaseline or a thick cream to lubricate the tip. How is the gas outlet tube installed? Consider the algorithm of actions.
Patient position
Before inserting the device into the intestine, it is necessary to correctly position the patient. An adult should be asked to lie on his right side and pull his legs to his stomach. This position will allow air to exit the intestines faster.
The neonatal gas tube can be placed in any position. Often, mothers put the child on the back and raise the legs up. It is also allowed to put the baby on the barrel or tummy. It is worth noting that in the latter case, the air will come out much faster, but in this case it will be inconvenient to insert the tube.
Hand cleaning and instrument tip preparation
Wash your hands thoroughly with antibacterial soap or use antiseptic gel. Wipe your brushes dry and put on gloves. This method will help you not to get your hands dirty in feces. Also, gloves will protect the tube and the patient's intestines from microbes.
Apply a lubricant to the very tip of the tube. It can be a regular Vaseline lubricant, a special gel or a greasy baby cream. Apply liberally to the end of the fixture. Remember that grease must not be allowed to enter the hole. Otherwise, your tool will simply become clogged and will not allow gases to be expelled.
Insertion of a tube into the intestine
How should the gas outlet tube be inserted? Reviews of doctors say that you need to make spiral movements.
Spread the buttocks with the index finger and thumb of the left hand. When inserting the tube, the child can simply raise the legs. Such manipulation will expose the anus. Gently insert the tip of the tube into the intestine and begin to gradually turn it clockwise. First, the direction of the tip should go towards the navel. Then lean back slightly and point the device parallel to your spine.
During the introduction of the device, gases and feces may begin to come out. That is why it is worthwhile to put a small tray on the other end of the device in advance. Some straws are equipped with lids. Until you remove this part from the opposite side of the device, air will not begin to leave the intestines.
Removal of gases - the purpose of the procedure
You need to insert the tube to a certain depth. For babies, this distance should not exceed five centimeters. For adult patients, the tube can be inserted up to twenty centimeters. Most fixtures have a special engraving. Focus on it during the introduction of the device.
When the tube is inserted, it is necessary to make several gentle movements with it. Tilt the device several times in different directions. At this point, you will notice how stool is released from the tube. Substitute the tray and collect the contents of the intestine in it.
Removing the gas tube from the intestines
When the manipulation is over, and the air stops coming out, you need to carefully remove the tube. You can do this in the following way.
Pull the device towards you. In this case, there is no need to make rotational movements. All your actions should be slow, never pull the tube sharply. Thus, you can deliver discomfort or even pain to the patient. Be prepared for the fact that after removing the venting device, some more feces may come out of the anus. That is why it is worthwhile to place a waterproof diaper under the patient's pelvis in advance.
Purification of the device for removing gases
When the tube is removed, it is worth wiping the baby's anus with a damp cloth or rinsing it. An adult patient is recommended to take a shower or take hygiene measures.
The tube for removing gases must be thoroughly rinsed in hot water using soap. After that, the device must be sterilized and placed in a storage container. Remember that separate tips or tubes should be used for different people.
An alternative to a gas outlet tube, or making it yourself
If you cannot find such a device on sale, then you can make it yourself. Take a rubber syringe and cut it in half at its widest point. As a result, you will get a gas outlet tube with a small capacity. Outwardly, it resembles a funnel.
You need to use such a device in the same way as described above. Don't forget to lubricate the tip. Otherwise, you may damage the intestinal mucosa. Thoroughly clean and sterilize the device after use.
Results and conclusion
Now you know what a gas outlet tube is and why it is needed. Remember that you need to use it as directed by a doctor. Frequent use of this device can lead to subsequent problems with peristalsis. Try not to abuse this procedure and carry out the manipulation correctly.
If the patient experiences pain immediately after insertion, it is urgent to remove the device and contact a specialist for advice. When blood is released from the intestine, the procedure must be stopped immediately. Otherwise, serious pathology may develop. Listen to the advice of doctors. Good health to you!