To administer an enema solution, the clinician should have the patient lie down on the left side, knees bent. Lift the upper buttock so that the rectal opening can be visualized. Place the lubricated tip of the enema catheter at the anal opening, and gently advance the catheter through the anal sphincter into the rectum toward the umbilicus (navel), 3–4 in (7.5–10 cm) for an adult. Insert the tubing 2 in (5 cm) for a child less than six years and 1 in (2.5 cm) for an infant. After alerting the patient, open the enema tubing to allow the solution to flow or squeeze premixed enema solutions slowly into the rectum. If the patient complains of cramping, slow or stop the enema flow and have the patient breathe slowly through the mouth to encourage relaxation. When giving fluid through an enema bag, start with the bag suspended from an IV pole at the patient's hip level. As the tubing is opened, slowly raise the IV pole to promote fluid flow until the bag is 12 inches (30.5 cm) above the hip for an adult. Continue to hold the rectal tube in place throughout the procedure or it will be expelled from the rectum. If the fluid will not flow in, gently rotate the tubing within the rectum to clear the holes of the tubing from the wall of the bowel or the impacted stool that may be occluding the flow. If ordered to give a high enema, slowly raise the bag no more than 18 inches (46 cm) above the adult patient's hip (12 inches (30.5 cm) above a child's hip and six inches (15 cm) above an infant's hip). This will increase the water pressure to deliver the fluid higher into the bowel. When all of the solution has been administered, clamp the tubing, remove the enema catheter, and release the buttock.
Mary Elizabeth Martelli R.N., B.S., The Gale Group Inc., Gale, Detroit,