What is a nutritional enema and what is it used for?

Medicinal enema, placement algorithm

Medicinal enemas are divided into local-action enemas (micro-enemas) and general-action (drip) enemas. Medicinal enema (microenema). Target . Providing local effects for diseases of the rectum; general (resorptive) effect on the entire body. Indications. Diseases of the rectum. Contraindications. Acute inflammation of the anus; rectal tumor; gastrointestinal bleeding. Equipment. Medicinal solution as prescribed by a doctor; Janet syringe or rubber spray; sterile rectal tube 30 cm long or catheter; sterile petroleum jelly; sterile gauze wipes; water bath, clean jar; water thermometer; oilcloth, diaper.

Features of the procedure

You can do a cleansing enema first. Next you need to prepare large diapers, oilcloth, a water thermometer and heating pads (40°-45°C). The temperature of the solution should not exceed 42°C, the volume of liquid is equal to one liter.

When carrying out the manipulation, it is necessary to follow the algorithm for administering a nutritional enema:

• heat the solution to 40-42°C;
• put the substance into the can (until a few drops of the solution appear outside);
• treat the tip of the can with Vaseline ointment;
• put the patient on his left side, bend his legs at the knees (bend his left leg);
• Pour the nutrient solution into a bottle, remove air from it, wait for liquid to appear outside, slowly press on the bottle;
• spread your buttocks;
• The tip of the can, pre-lubricated with Vaseline, is smoothly inserted into the patient’s rectum;
• gradually introduce the solution, avoiding an increase in pressure;
• at the end of the procedure, treat the anus with an antiseptic.

The technique of administering a nutritional enema also takes into account the characteristics of the patient’s behavior after the procedure. At the end of the manipulation, the patient should remain in a lying position for an hour. If the urge to stool occurs, the patient should be advised to breathe deeply through the nose.

Administration of a medicinal enema (microclyster):

1. The patient is warned about the upcoming procedure. Since you need to lie down after it, it is better to give the enema at night in the ward. 2. 30 - 40 minutes before administering a medicinal microenema, a cleansing enema is given. 3. The medicine in the indicated dose is poured into a clean jar and heated in a water bath to a temperature of +37...+38°C. 4. Take the medicine (50 - 200 ml), heated in a water bath, into a Janet syringe or rubber balloon. 5. Place an oilcloth under the patient, then a diaper and ask him to lie on his left side, pulling his legs, bent at the knees, towards his stomach. 6. A rectal tube (or catheter) is inserted into the rectum with a 20 cm rotational movement and connected to a Janet syringe (or balloon). 7. Slowly inject the medicine into the rectum in jerks. 8. Having finished the insertion, clamp the tube with your fingers, remove the syringe, draw a little air into it, connect the syringe to the tube again and, releasing the air from it, push it! remaining medication from the tube into the intestines. 9. Remove the syringe, clamp the tube, and carefully remove the tube from the rectum using rotational movements. 10. The patient is advised to take a comfortable position and not stand up.

Medicinal enema, technique of execution.

Notes . To avoid irritation of the rectal wall and the urge to defecate, the concentration of the drug should be hypertonic. The medicine should be administered in small volumes. The medicine must be heated. After use, the rectal tube is soaked in a 3% chloramine solution for 1 hour. If a catheter is used instead of a rectal tube, it should be labeled and used only for insertion into the rectum. The manipulation should be performed with rubber gloves.

Administration of enemas

A technique that involves introducing a liquid substance (water, medicine, oil, etc.) into the intestines through the rectum is called an enema. This is a therapeutic and diagnostic procedure, which involves the introduction of various liquids into the lower part of the colon.

Depending on the purpose (to remove the contents of the intestines or, conversely, to introduce some substance into it along with liquid), therapeutic enemas are divided into two types. The first type includes cleansing and laxative enemas, the second - medicinal, drip and nutritional.

The natural release of the contents of the large intestine - defecation - is a complex reflex act that occurs with the participation of the central nervous system. Liquid contents from the small intestines pass into the large intestine, where they linger for 10-12 hours, sometimes more.

As it passes through the large intestine, the contents gradually become denser due to the vigorous absorption of water, turning into feces. In the intervals between bowel movements, feces move in the distal direction of the intestine due to peristaltic contractions of the muscles of the colon, descend to the lower end of the sigmoid colon and accumulate there. Their further advancement into the rectum is prevented by the third rectal sphincter. The urge to defecate occurs in a person only when feces enter the rectum and accumulate in its cavity. It is caused by mechanical and chemical irritation of the receptors of the rectal wall, especially by stretching of the intestinal ampulla. Outside of defecation, the anal sphincters (external - from transverse muscles, internal - from smooth muscles) are constantly in a state of tonic contraction.

The tone of the sphincters increases when feces enter the rectal cavity. When the urge appears and during defecation, the tone of the sphincters reflexively decreases - they relax. This removes the obstacle to the passage of feces out. At this time, under the influence of irritation of rectal receptors, the circular muscles of the intestinal wall and pelvic floor contract.

The movement of feces from the sigmoid colon into the rectum, and from the latter outward, is facilitated by the contraction of the diaphragm and abdominal muscles during held breathing. A person may have or delay bowel movements. The extinction of the reflex from the rectal ampulla leads to proctostatic constipation.

Irritation of the rectum, especially stretching of its ampulla, reflexively affects the function of the overlying parts of the digestive apparatus, excretory organs, etc. An enema acts as such a mechanical irritant. In addition to active peristaltic contractions of the muscles of the colon wall, an antiperistaltic contraction also occurs, which ensures that even a small amount of liquid introduced into the rectum quickly passes into the overlying sections of the colon and quite quickly ends up in the cecum.

Absorption of the injected liquid occurs in the colon, and it depends on various conditions. The composition of the liquid and the degree of mechanical and thermal irritation, as well as the condition of the intestine itself, are of greatest importance.

Warm hypotonic solutions of glucose - 1%, table salt - 0.7% are best absorbed. Drinking water remaining in the intestines, although irritating it, is also absorbed gradually. With intestinal atony, absorption increases; with increased peristalsis, it occurs to a small extent; with prolonged spasm, absorption can be complete.

Diagnostic enemas

Diagnostic enemas allow you to determine the capacity of the colon and introduce a contrast agent for X-ray examination of the colon.

A contrast enema is used for X-ray examination of the intestine and allows the introduction of a contrast solution (barium sulfate) into the intestinal lumen. By monitoring the screen of an X-ray machine or electron-optical converter, the doctor can determine the nature of the movement of the contrast mass through the intestine and identify various pathological formations in its lumen or wall.

The contrast mass is poured into the flask of the Bobrov apparatus, which is connected by a rubber tube to a tip inserted into the intestine. Bobrov's apparatus is a glass reservoir in the form of a large bottle, tightly closed with a rubber stopper with two glass tubes (short and long). The tightness of the closure is ensured by a screw device located in the plug. The patient is placed on the table of the X-ray machine, the tip is inserted into the rectum to a depth of 10-12 cm. Using a rubber bulb, the pressure in the flask of the Bobrov apparatus increases, which expels the contrast mass through the connecting rubber tube into the intestine. To perform irrigoscopy, it is usually sufficient to inject 2 liters of contrast mass into the lumen of the large intestine.

Cleansing enemas

Cleansing enemas are used for mechanical emptying of the colon in case of constipation and stool retention of any origin, food poisoning, preparation for surgical interventions (not only on the gastrointestinal tract), childbirth, X-ray examinations of the abdominal cavity and pelvic organs, as well as before the use of medications, drip and nutritional enemas.

Contraindications to cleansing enemas:

• acute inflammatory purulent diseases (appendicitis, etc.) and ulcerative processes in the anus and colon;

• inflammation of the peritoneum (peritonitis);

• gastric and intestinal bleeding;

• the first days after surgery on the abdominal organs;

• cracks in the anus and its gaping, prolapse of the rectal mucosa.

There are two ways to introduce fluid into the rectum:

• from a reservoir located above body level - hydraulic method;

• injection using appropriate devices - injection method.

To perform a hydraulic enema you must have:

• a reservoir for injected liquid (Esmarch mug, glass funnel, rubber mug) with a capacity of 1 to 5 m;

• a rubber tube conducting liquid, about 1.5 m long and at least 1 cm in diameter (the tube must be thick-walled);

• intestinal tube - a tip inserted into the lumen of the rectum, made of various materials (thick-walled rubber, ebonite, glass), at least 15 cm long with a rounded intestinal end;

• thermometer for measuring liquid temperature.

A special connecting tube with a tap is placed between the rubber tube and the tip, designed to regulate the amount of liquid introduced into the intestine. The injected liquid, exerting mechanical, temperature and chemical effects, enhances peristalsis, loosens feces and facilitates their elimination.

The greater the amount of fluid, pressure and rate of administration, the greater the mechanical effect of an enema.

For an adult enema, take an average of 1 liter of water (from 750 ml to 2 liters), for infants - 30-150 ml, from 1 to 5 years - 150-300 ml, from 6 to 14 years - 300-500 ml.

The higher the tripod and, therefore, the Esmarch mug hangs (0.5-1-1.5 m), the greater the pressure of the injected liquid. The speed of its arrival is controlled by a tap.

In addition to the mechanical effect, the low temperature of the injected liquid contributes to increased peristalsis. With atonic constipation, the fluid temperature can be 20 °C. For spastic constipation, warm or hot enemas (30-40-42 °C) are used to relax the smooth muscles of the intestine. The optimal temperature is 25-30 °C.

It must be remembered that the higher the temperature of the injected liquid and the higher the Esmarch mug is located, the greater the likelihood of absorption of the injected liquid through the intestinal mucosa, and this, in turn, causes “fecal intoxication”.

When repeating cleansing enemas, you can increase the position of the Esmarch mug (raise it), thereby promoting better and better bowel cleansing.

The patient with his legs bent and pulled up to his stomach is placed on a trestle bed or bed on his left side closer to the edge; if he cannot move, he is placed on his back. A vessel and an oilcloth are placed under the buttocks, the free edge of which is lowered into a bucket in case the patient does not retain water. 1 - 1.5 liters of water at room temperature are poured into Esmarch's mug, raised up, lowering the tip down, a small amount of water is released, and together with her - air. Having filled the system, without lowering the mug, close the tap on the rubber tube. Check the integrity of the tip, lubricate it with Vaseline and, spreading the patient’s buttocks, insert the tip to a depth of 10-12 cm with light rotational movements. First, 3-4 cm, the tip is inserted towards the navel, then parallel to the tailbone. After inserting the tip, open the tap, raise the Esmarch mug by 40-50 cm and introduce liquid, gradually raising the mug to a height of 1 m. If water does not enter the intestines, it is necessary to slightly change the position of the tip, extending it by 1-2 cm, or increase pressure, raising Esmarch's mug higher. If this does not help, you need to remove the tip, restore its patency with a stream of water and reinsert it. At the end of the infusion, the tip is carefully removed.

The injected liquid can penetrate all parts of the colon, including the cecum, causing increased peristalsis and the urge to defecate, which the patient must hold for 5-10 minutes.

Children should be administered the liquid slowly, without much pressure, and after removing the tip, squeeze the child’s buttocks for a few minutes, helping him to delay the urge to defecate. If there is gas and a feeling of fullness appears, immediately lower the mug below the level of the bed and, after the gas has passed, gradually raise it again. Leaving a little water at the bottom so that air does not enter the intestines, close the valve that regulates the flow of liquid and remove the tip. It is advisable that the patient hold the water for 10 minutes. To do this, he must lie on his back and breathe deeply.

At the end of the procedure, Esmarch’s mug is washed, wiped dry and subjected to mechanical cleaning, disinfection and sterilization.

When administering a cleansing enema, it is necessary to ensure that no more than 1.5-2 liters of liquid are administered at a time.

Siphon enemas

Siphon enemas are used for colon lavage (more often in case of Hirschsprung's disease before surgical treatment), they are used in cases where conventional cleansing enemas do not have an effect, as well as for therapeutic purposes (to eliminate volvulus of the long sigmoid colon). Siphon washing is based on the principle of communicating vessels. One of them is the intestine, the other is a funnel at the outer end of a rubber tube inserted into the rectum.

Main indications:

• lack of effect from cleansing enemas and laxatives;

• removal from the intestines of products of increased fermentation and putrefaction, mucus, pus, poisons that enter the intestines through the mouth;

• after operations on the abdominal cavity (except for cases of intervention on the intestines), when the patient cannot activate the act of defecation due to contraction of the muscles of the abdominal wall.

Contraindications are the same as for cleansing enemas.

For a siphon enema, you need a sterilized tube 75 cm long and 1.5 cm in diameter with a funnel attached to the outer end that holds about 0.5 liters of liquid, a jug, 10-12 liters of disinfectant liquid (weak sodium bicarbonate solution) or boiled water (isotonic solution ). The temperature of the liquid is set by the doctor in each specific case.

The patient is placed on the left side or on the back, with an oilcloth placed under the buttocks. A bucket for draining and a jug of liquid are placed by the bed. The end of the tube inserted into the rectum is generously lubricated with Vaseline and moved forward 20-30 cm. It is necessary to ensure that the tube does not curl up in the ampulla of the rectum, controlling its position with a finger, if necessary.

The funnel should be held slightly above the patient's body in an inclined position. Then, gradually filling it with liquid, it is raised above the body to a height of 1 m. The water begins to pass into the intestines. As soon as the level of decreasing water reaches the narrowing of the funnel, it is lowered over the bucket (or basin), without turning over, until water from the intestines fills the funnel. With the funnel in this position, air bubbles and lumps of feces are clearly visible - these contents are poured into a bucket and the funnel is filled again with water. The procedure is repeated several times until the release of gases stops and clean water begins to flow into the funnel.

After the procedure is completed, the funnel is removed, disinfected and sterilized. The rubber tube is left in the rectum for 10-12 minutes, lowering its outer end into the pelvis to drain residual fluid and remove gases. Then they are taken out, washed, disinfected and sterilized.

For children, the nurse performs cleansing and siphon enemas together with a junior nurse. There should be a quiet, calm environment. It is advisable to perform enemas in a special room. It can be a bathroom or toilet room, which has a medical couch, toilet, etc.

If the patient cannot move, the enema can be performed in the ward. Under ideal conditions, such a patient should be in a special box or ward. If the patient is in a general ward, then patients who are allowed to move are asked to leave for a certain time. The patient is separated from the others remaining in the ward by a screen. Before the procedure, the nurse conducts an explanatory conversation with all patients, observing all ethical rules of behavior.

Drip enemas

Drip enemas belong to the category of medicinal enemas, as they are used to compensate for the loss of blood or fluid (restoring the volume of circulating fluid, blood). Typically, a 5% glucose solution with an isotonic sodium chloride solution is injected dropwise.

They use the same devices as for cleaning. The device for drip enemas consists of an Esmarch mug, a rubber tube, a dropper inserted between its segments, a connecting and intestinal tube. A clamp is attached to the rubber tube in front of the dropper. With its help, the flow of liquid into the dropper is regulated (adults - 60-100 drops, children - 15-20 drops per minute). The patient lies in a comfortable position on his back. A solution heated to 37 °C is poured into a mug, a system of tubes is filled with it, regulating the frequency of drops with a clamp. Then an intestinal tube is inserted into the patient’s rectum to a depth of 20-30 cm. The tube is suspended on a tripod.

The same solutions, as well as a 15% solution of amino acids (nutrient enema), can be administered with a rubber balloon into the rectum 2-3 times a day, 150-200 ml. A drip enema is a more expedient way of introducing medicinal liquids into the body, since, entering the intestine in drops and being absorbed, they do not stretch the intestines, do not increase intestinal motility and do not provoke defecation.

Drip enemas are easily tolerated by patients, do not cause pain and make it possible to administer a large amount of liquid without overfilling the bloodstream. If there are no contraindications, then before the drip enema it is advisable to perform a cleansing or siphon enema, remembering that each of them is a difficult manipulation for the patient.

Laxative enemas

The purpose of laxative enemas is not mechanical and thermal irritation of the colon with a subsequent increase in intestinal peristalsis, but a laxative effect, i.e. strengthening the secretory function of the intestine and the regulation of intestinal motility, which should not be violent.

During the procedure, which lasts several hours, the nurse should monitor her to:

• due to bending of the tubes, the flow of fluid into the intestines did not stop;

• a certain infusion rate was maintained;

• the solution did not cool down, for which Esmarch’s mug was placed in a cotton cover, and a bottle of boiling water was placed in the solution.

To do this, use vegetable oil, solutions of medium salts, various infusions in an amount of 100 ml, administered using rubber balloons. At the end of the procedure, the patient should lie quietly so that the fluid does not leak out of the rectum. Stool appears, as a rule, after 12-16 hours.

Medicinal enemas

If administration of drugs by any other route is not possible, they can be administered through the rectum. Absorbed through the hemorrhoidal veins, they quickly enter the bloodstream, bypassing the liver.

Medicinal enemas are divided into local and general.

Mast medicinal enemas are used to reduce the phenomena of irritation and inflammation in the large intestine, eliminate the spastic state of this segment of the intestine, heal erosions and ulcers, as well as to treat the inflammatory process in the perirectal tissue and the pelvic cavity.

General enemas are used to administer medications or nutrients and affect the body as a whole.

A cleansing enema is given 30-40 minutes before the medication. Medicines are administered after bowel movements.

Medicinal enemas are mainly microenemas, their volume does not exceed 50-100 ml. Medicinal substances are drawn into a 20-gram syringe, a Janet syringe, or a rubber container with a capacity of 50-100 ml. The temperature of the medicinal substance must be at least 40 °C. At a lower temperature, the urge to defecate occurs, and the medicine does not have time to be absorbed.

The patient lies on his left side, legs bent at the knees and pulled up to the stomach. Spreading the buttocks with your left hand, with your right hand, with a rotational movement, insert a catheter lubricated with sterile petroleum jelly 15-20 cm into the rectum. Then connect the catheter with a syringe or bottle containing the medicinal substance, and slowly squeeze this solution into the catheter in small portions under low pressure. Next, holding and squeezing the outer end of the catheter to prevent fluid from flowing back out of it, carefully remove the balloon from the catheter, pump air into it, reinsert it into the catheter and blow through it to push out the remaining fluid. In order not to cause mechanical thermal and chemical irritation of the intestines, drugs must be administered in a relatively low concentration, diluted with a warm isotonic sodium chloride solution or in an enveloping substance (50 g of starch decoction).

Most often, painkillers, sedatives and hypnotics are administered in microenemas. Starch enemas are used to reduce peristalsis and as an enveloping, emollient agent for acute colitis. To do this, 5 g of starch (potato, rice, corn, wheat) are diluted in 100 ml of cool water and, stirring, gradually add 100 ml of boiling water. Then cool the solution to 40 °C and inject it into the rectum.

Chloral hydrate enemas are prescribed for convulsions and sudden agitation. Chloral hydrate (1 g) is diluted in 25 ml of distilled starch (at a rate of 1:50), since chloral hydrate has an irritating effect on the rectal mucosa.

Hypertensive enemas cause a laxative effect without sharp intestinal peristalsis. Usually a 5-10% solution of sodium chloride, a 20-30% solution of magnesium sulfate or sodium sulfate is used. 100-200 ml of warm solution is injected into the rectum using a rubber balloon - a “pear”. Contraindications: inflammatory and ulcerative processes in the lower part of the colon.

Oil enemas are used for persistent constipation, when the administration of large volumes of fluid is ineffective or contraindicated. For this, vegetable oils are used: sunflower, olive, hemp, vaseline. For one enema, take 50-100 ml of oil heated to 37-38 °C. The oil is usually administered using a rubber balloon, syringe or catheter, pushing it 10 cm into the rectum. The oil spreads along the intestinal wall, relaxes the intestinal muscles, promoting the excretion of feces. The patient should lie quietly for 10-15 minutes so that the oil does not leak out.

Emulsion enemas

Prepare 2 cups of chamomile infusion in advance (1 tablespoon of chamomile flowers per 1 tablespoon of boiling water). Beat 1 yolk with 1 teaspoon of sodium bicarbonate and pour in chamomile infusion, adding 2 tbsp. spoons of petroleum jelly or glycerin.

Nutrient enemas

In cases where droplet substances cannot be administered through the mouth, they are administered through the rectum. The use of nutritional enemas is very limited.

In the lower segment of the colon, water, isotonic sodium chloride solution, glucose solutions and alcohol are absorbed. Proteins and amino acids are partially absorbed.

A cleansing enema is given 30-40 minutes before the nutritious enema. The volume of a nutritional enema should not exceed 1 glass.

Take a warm solution into a rubber can and add 5 drops of opium tincture. The spout of the can is lubricated with petroleum jelly, the air in it is released and inserted into the rectum. You need to press the can slowly so that the liquid enters the intestines gradually, without irritating the mucous membrane. After this, the patient should lie still so that there is no urge to defecate.

Updated: 2019-07-09 23:50:30

• This is a special therapeutic and anti-relapse nutrition for diseases of the stomach, and sometimes the small intestine. Depending on the severity and severity
• Pain in the abdomen With a stomach ulcer or ulcer of the stomach and duodenum With a stomach ulcer, inflammation of the intestines With cholera,
• Indications for use. 1) Acute inflammatory bowel diseases during the recovery period as a transition to a general diet.
• Indications: flax seed mucus is used orally and in the form of enemas for inflammation of the esophagus, gastric ulcer and duodenal ulcer.
• Pathologies of the rectum - hemorrhoids, anal fissures, paraproctitis, tumors - are now quite common. Proctologist
• Intestinal obstruction is the inability of the intestinal contents to move towards the anus. Symptoms: the onset of the disease is characterized by severe paroxysmal or constant pain

Drip enema.

Target . Drip enemas are given for therapeutic and nutritional purposes. Indications . Large loss of blood or fluid; artificial nutrition through the rectum. Contraindications . Acute inflammation of the anus; rectal tumors; gastrointestinal bleeding. Equipment . Sterile system for drip administration of liquids for single or multiple use; a bottle with a medicinal solution or flask; sterile rectal tube 30 cm long or catheter; water bath; heating pad with warm water (+40…+42 °C); lining oilcloth, diaper; Vaseline oil; gauze napkin; water thermometer; latex gloves.

What is a nutritional enema?

A nutritional enema is a type of medicinal enema and is used in situations in which a person has lost a lot of fluid and needs artificial nutrition. Carrying out the procedure requires the availability of all necessary accessories and adherence to a clear sequence of actions.

Features of the composition of a nutritional enema

The nutrient enema solution consists of the following components:

• sodium chloride;
• amino acids;
• glucose.

The composition of the solution may vary depending on the doctor’s prescriptions and the characteristics of the patient’s disease. Nutrient enemas are used when it is necessary to introduce a sufficiently large amount of liquid into the human body. Thanks to the gradual introduction of the substances, they are absorbed at an optimal speed, so during the procedure the intestines are not stretched and the patient does not experience any discomfort.

The use of a nutritional enema is quite limited, since only sodium chloride, water, alcohol, glucose solution and some amino acids are absorbed in the lower part of the large intestine

Indications and contraindications for the procedure

Most often, the procedure is used in a situation in which the human body has lost a lot of fluid. Manipulation can only be carried out with the consent of the patient.

Contraindications to the procedure are as follows:

• rectal prolapse or hemorrhoids;
• neoplasms and tumors of the rectum;
• HIV infection;
• ulcerative and acute inflammatory processes in the anus and colon;
• bleeding inside the gastrointestinal tract;
• chronic hepatitis.

Indications and contraindications for a nutritional enema can be determined individually by a doctor, depending on the patient’s health status and medical history.