My First Enema, PANICKING?

[XoThatGirlLeX]

Hey guys. So I just started my first nursing job and I’m having a total panic attack because of how my first enema administration went.

So I’m on orientation and my preceptor had me to a tap water enema on our patient right before discharge. So the patient can walk and my preceptor told her to go into the bathroom and bend over near the toilet. My preceptor has me lubricate the tube and he holds the tap water bag while I insert the tube into the patients rectum. So I enter it in and think it’s enoigh, so he opens the clamp and in goes the water. For whatever reason, the water starts shooting out of her immediately so my preceptor was like “it’s probably not in enough.” So I push it in further, feel no resistance or anything and the same thing happens?!

So now I’m like “idk what is happening.” We eventually get the whole bag in, about 50cc end up on me and the floor, and the patient doesn’t have to go at all. Like it did nothing.

So, my questions are, is it common for patients to be unable to retain the fluid? And if I pushed it in too far and did some kind of damage like perforated her bowel or something I would know it right? Like there would be pain and bleeding or something? I’m such an anxious nurse like.. I really am. I asked the patient if she had any pain after the enema and she said she felt fine, no pain.

My preceptor thinks I’m an insane person cause I was freaking out after it like I did something incorrectly or pushed it in too far. Please help!!

[brownbook]

You did fine. The patient is fine. With the soft flexible enema tube you cannot puncture the bowel.

Enemas are difficult under the best circumstances. There are several different ways to give them. Not really a wrong or right way. It depends on the patient's condition and what the nurse is comfortable with or used to doing. Also what equipment you have available. I haven't given an enema the way you describe.

Look on YouTube. They have great educational videos for health care workers on all kinds of procedures. I'm sure enemas are one of them. But as I said there is not just one correct way.

[iluvivt, BSN, RN]

There are several positions that work but what probably happened is that you did not have enough of the tip in and you probably did not get enough of the solution up into rectum and bowel. I like the left sided position and with the patient in bed. If the patient is in bed you can have them change positions if needed for larger volume enemas. Fleets enemas have such a small volume you can get them in easily. For larger volumes you can start instilling slowly and if the patient is feeling pressure they can rotate them to their stomach a bit or even have get up on their knees with buttocks up. This way you can disperse the enema. Also if in bed it leaks on the bed and not on you and the floor.

[JKL33]

I have never administered an enema with a patient in standing position and struggle to understand why I would ever attempt it outside of a patient being absolutely adamant that I try it that way.

If nothing else, it really runs the risk of offending someone's sense of dignity and bodily privacy, whether they say so or not. I much prefer a slower approach which is more successful in allowing the patient retain it for a helpful amount of time. And if nothing else, with a side-lying position one can take every possible measure to maintain someone's dignity - and I do just that.

I'm pretty sure I will make it through my career without asking anyone to bend over near the toilet.

?

However, it doesn't seem like there was anything in particular to panic about with regard to the OP scenario - although it should be noted that it wasn't effective and so it was a waste of time and a huge mess for no benefit.

[Jedrnurse, BSN, RN]

Wow. I didn't think tap water enemas were still a thing...

[OldDude]

On 2/23/2019 at 2:14 PM, JKL33 said:

I have never administered an enema with a patient in standing position and struggle to understand why I would ever attempt it outside of a patient being absolutely adamant that I try it that way.

If nothing else, it really runs the risk of offending someone's sense of dignity and bodily privacy, whether they say so or not. I much prefer a slower approach which is more successful in allowing the patient retain it for a helpful amount of time. And if nothing else, with a side-lying position one can take every possible measure to maintain someone's dignity - and I do just that.

I'm pretty sure I will make it through my career without asking anyone to bend over near the toilet.

?

However, it doesn't seem like there was anything in particular to panic about with regard to the OP scenario - although it should be noted that it wasn't effective and so it was a waste of time and a huge mess for no benefit.

The first thought that came to my mind when I read the post was when I would get in trouble in school and would get "licks." The first instruction was "bend over and grab your ankles." ?

I've only done pediatric enemas...side lying always - left side.

[neuron]

You may have to remove or disimpact stool first or else it may not go in far enough to produce results, I believe this can make it come back splashing at you within seconds. An enema can produce a bowel movement within seconds also, and for 5-10 minutes thereafter.

[allymdd]

Yeah, I'm a bit surprised by the fact the patient was standing, as well.

[Steven Peterson]

Interesting this topic came up. In the last few years, I"ve administered more and more enemas. It used to be a rare thing, now if I go more than a few days without giving one, it's unusual.

I found it pretty run of the mill until 2 years ago when I was given several in the hospital. My perspective changed. No longer do I try to hurry these things and now take my time. It's better for all involved

[canoehead, BSN, RN]

Aww, how cute, your first enema!

Your instructor made it a literal poop splatter. That position was dumb. Get the patient lying on their left side so the fluid flows down with gravity and can soak the poop and make it soft. Ask them to hold it for twenty minutes if they can, and you can have them picture dishes soaking in the sink, how the dirt comes off so easy after a good soak.

Have a commode RIGHT THERE at the bedside, and enjoy the results.