Question about enemas...

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Specializes in Hemodialysis, Home Health.

OK, all you seasoned nurses, I need advice. :)

I should know this from my days in school, but we all know how that goes, and how QUICKLY that goes "bye-bye" ! :chuckle

If you give an enema and it is does not produce the desired result, (as in NADA)... is it appropriate/policy to give another? And if so, how long should one wait before administering another? Could it not mess up the electrolytes to give two successively within a relatively short period of time.. or would it not have any adverse affect?

I remember reading this before in school, but really cannot remember now, and I'm too sorry to go digging through my books to find out. You guys are a whole lot quicker "reference"! :D

Thanx for any input in advance.

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Specializes in LTC, assisted living, med-surg, psych.

Depends on the patient and the type of enema prescribed.

I had to bust loose a nursing-home resident once who was so FOS that the doctor ordered an NG tube, plus tap-water enemas to be alternated with Fleets every HOUR until results were obtained. :eek: Even so, it took over half the shift to get her started, and when she finally went.............well, that's a story for a whole 'nother thread:sofahider I don't recall the MD worrying too much about her electrolytes at the time, although we did have an IV going.

Now, a TWE isn't too bad, and Fleets is also pretty gentle, but I wouldn't repeat a soap-suds enema within a 24-hour period, as it irritates the lower bowel something fierce. :uhoh21: Hopefully it doesn't even come to that; TWEs and Fleets are usually effective within a few hours, if not sooner.

Hope this helps!

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I'm assuming oral stuff has been tried, like Fleets Phos or mag citrate?

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what are 'twe's' ?

agree w/marla: 1 sse pr qd only.

a little digital stimulation is very effective also.

i'm accustomed to doing full blown disimpactions. sometimes even enemas don't work. how uncomfortable for your pt jnette.

leslie

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TWE= Tap Water Enema

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Specializes in Nephrology, Cardiology, ER, ICU.

We have an ER MD who swears by the milk and molasses enemas! Talk about sticky and messy!!

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Specializes in Hemodialysis, Home Health.

Thanx, peeps. It is my paraplegic... and he gets fleets QOD or so. But recently he's been having trouble.. the last time I had no results after 40 minutes.. not even a tiney bit of fluid return, nothing. Wasn't sure about giving another fleets, so I went after it. Apparantly the nurse the other day couldn't get any results after 20 minutes, and gave another fleets... I just couldn't remember if that was the thing to do or not.

Thanx again. :)

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Apparantly the nurse the other day couldn't get any results after 20 minutes, and gave another fleets...

Thanx again. :)

did he have results after the 2nd enema?

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Specializes in Education, Acute, Med/Surg, Tele, etc.

The last LTC/ALF facilities I worked for all haved a house protocol for enemas. Typically they are as follows:

1. MOM at 2000

2. If no or little results, ducolax supp. X 1 at 0900 the next day.

3. If no results one hour after, fleets enema x1.

4. RN may give one more after one hour, but must callPCP for follow-up instructions.

5. RN may choose to do a digital extraction of feces if indicated at any time. Must call MD if this is utilized.

This was a general house protocol signed by the MD every three months. I would certainly weigh the pros/cons per individual however and modify or call MD. Also, always check into why the constipation may be occuring...look at their meds/diet/mobility/etc. A routine by MD order may be very helpful so the PRN's aren't used as much.

IF I have someone with history of bradycardia...I tend to never do the digital and really watch them carefully! One bad 'push' and you can go into a fatal arrthymia! That is when specific and very detailed Rx and individual bowel programs are very important! (had it happen too many times to count in my last ALF!).

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IF I have someone with history of bradycardia...I tend to never do the digital and really watch them carefully! One bad 'push' and you can go into a fatal arrthymia! That is when specific and very detailed Rx and individual bowel programs are very important! (had it happen too many times to count in my last ALF!).

agreed. that's why i'm big on preventing constipation, esp w/the elderly. even w/o bradycardia, i've encountered too many vasovagal episodes with one bad push.

at least w/digital disimpaction, the pt isn't pushing alot; most of the work is done by the nurse.

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Specializes in Hemodialysis, Home Health.

Well, this young man is kind of in a different situation, as he is paraplegic (from waist down).

He has orders for fleets QOD or as needed, I guess because he is a HH pt. and has no one with hi 27/7 to clean him up if he were to take a suppository or stool softener and end up going on his own, do you see what I'm saying? He can't clean himself up as he can't move his lower body at all.

So we do him the favour of helping him along on our visits and cleaning him up when he's done.

Yes, the second fleets did work after another 20-30 minutes. I had forgotten if this was ok or not, I knew there were some stipulations (as in SS enemas) but had forgotten jsut what they were. But she gave it after 20 minutes (after the first).. is that ok? Or is it better to wait an hour?

I know she didn't want to hang around there all day, but still.... seems like that was too soon?

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We have an ER MD who swears by the milk and molasses enemas! Talk about sticky and messy!!

OMG!!!!! I'm laughing my butt off!!!! We used to give those in our ER ALL THE TIME!!!!!!! I had completely forgotten about them!

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