Enema THROUGH an ileostomy?

[cardiacqueen]

I had a patient admitted last night with an old RLQ stoma - either an ileostomy or colostomy (look to me based on the location like an ileostomy). The patient needed a CT abd but radiology would not scan the patient because he had residual Barium from a previous study in his bowel.

Therefore, the physician ordered a warm tap water enema - when I asked for clarification, he said yes - through the stoma.

I have never given an enema through a stoma before, so I asked our supervisor. I was told to just give the enema like a normal rectal enema except obviously, through the stoma. I used a soap suds enema kit sans the soap (the one with the plastic tubing + irrigation bag) and inserted the end of the enema only about 1-2 inches, no resistance. Due to the poor sphincter control of the stoma most of the water immediately drained out and the rest after I removed the enema tube. After completing the procedure I decided to go home and read up on the current literature regarding ostomy irrigation.

I now have 2 huge concerns.

#1 - For the enema, was it Ok for me to use a normal enema tip? I'm reading that these can potentially cause bowel perforations? It seems hard for me to believe that a gently placed plastic tube can rip through the bowel...do I need to worry if I didn't "hit a wall" or insert the tube far? I am panicking! I have read that foley catheters can be used for irrigation as well. This seems similar to the plastic enema tubes.

#2 - Not sure if the patient had a colostomy or illeostomy, but illeostomy irrigation is not recommended due to risk of dehydration, but this patient needed cleared out for CT. Do you think giving an enema through an ileostomy was OK in this case?

I know I was following Drs. orders, but after doing some extensive research I am second-guessing my actions...please help!

[mmc51264, BSN, MSN, RN]

I've done it for same reason. Only once, but our sister unit is urology and they do it a lot for procedural reasons

[cardiacqueen]

thanks!

[nurse4ever08]

It's normal to do this in an old ostomy. You can also use the enema bottles to be more gentle

[registerednutrn, BSN, RN]

You needed to use a cone irrigation kit. And yes using a regular enema tip could cause a perforation. I tried to post a picture of one but couldn't but Google cone irrigation set and you will several pictures

[cardiacqueen]

Thanks. I did read about the ostomy cones but I haven't been able to find them in our facility. Back at work tonight a few days later and the patient is improving without signs of perf, so thankfully looks like no harm came of using the regular enema. But, good to know for future reference.