DEFINITION

• Non retention: Enemas which are not to be kept inside
• Retention enema: are to be retained for a shorter( 10- 30 minutes) or longer(30-60 minutes)

• 10 – 12 French catheter is used
• Use isotonic solution (n. saline) or 1tsf salt in normal tape water.
• Hypotonic solution cause fluid sift - fluid overload
• Hypertonic solution cause-fluid sifted extra cellular space (to intestine) - dehydration
• Solution must be warm (38 degree c -40 degree c.)
• Buttock must be held together for a short time to retain the fluid since infant and young children are unable to retain the solution after it is administered
• The result of enema should be carefully charted, including the date and time, the amount and type of solution used the child response and a description of retains.
  

• Left lateral
• Sim’s position
• Knee chest position

A colostomy is an opening -- called a stoma -- that connects the colon to the surface of the abdomen. This provides a new path for waste material and gas to leave the body after part of the colon or rectum is removed because of disease or injury.

• Patients with permanent colostomies and whose opening is in the descending or sigmoid portion of the colon are good candidates for irrigation.
• This is because their stools tend to be more formed.
• People with irritable bowel syndrome, stomal problems, or stomas in the ascending or transverse colons are less likely to have success with irrigation and are, therefore, not good candidates for colostomy irrigation.
  

• Colostomy irrigation is most effective when it is done about one hour after a meal, when the colon is most likely to be full.
• Irrigation may be done once a day or once every other day
• It generally takes about 6-8 weeks for the bowel to become regulated with irrigation. It is important to establish a routine and irrigate at the same time each day
  

• Wash your hands.
• Assemble the necessary equipment
• Irrigation kit (irrigation bag with clamp and tubing, cone-tip irrigation catheter, irrigation drain pouch).
• Water soluble lubricant.
• IV pole (or other suspending hook
  

• Soap and water.
• Washcloth and towel.
• Ostomy appliance.
• Waste receptacle.
• Prescribed irrigating solution, usually 500-1000cc warm (100º--105ºF) tap water.

• Provide for privacy.
• If the patient is ambulatory, have the patient sit on the toilet or on a chair facing the toilet. If the patient is bedridden, elevate the HOBº 45-90ºand position.
• Fill the irrigation bag with the prescribed solution and hang it on the IV pole or hook.
• The bottom of the bag should be placed 18 to 20 inches above the stoma when the patient is in bed.
• Open the clamp on the irrigation tubing and allow the solution to fill the tubing. Reclamp. (This prevents the administration of air into the intestines.)
• Remove the ostomy pouch, if applicable, and place the irrigation drain pouch over the stoma. (Attach stoma belt if required.)
• Place the bottom, open end of the irrigation drain pouch in the toilet (or bedpan) to facilitate drainage by gravity.
• Connect the cone-tip catheter to the tubing and flush with solution
• Lubricate the cone with the water-soluble lubricant to avoid irritating the mucous membranes.
• Gently insert the cone into the stoma so that the stoma is occluded.
• Unclamp the irrigating tubing and allow the water to flow in slowly.
• Allow water to enter the colon over a period of 10 to 15 minutes.
• If cramping occurs, slow down the flow rate and ask patient to deep breathe until cramps subside. Cramping during irrigation may indicate that:
  • The bowel is ready to empty.
  • (b) The water is too cold.
  • The flow is too fast.
  • The tube contains air.
• Clamp the catheter and remove from the stoma. Fold down the top opening of the irrigation drain pouch and secure it in the closed position.
• Have the colostomy patient sit on or near the toilet for about 15 to 20 minutes so the initial colostomy returns can drain into the toilet. (If the patient is on bed rest, allow the colostomy to drain into the bedpan.)
• Close the colostomy irrigation drain pouch with a rubber band or pouch clip, then ambulate the patient, or return him/her to bed.
• Ambulating stimulates elimination, producing improved irrigation return.
• Have the non-ambulatory patient lean forward or massage his/her abdomen to stimulate return.
• Wait approximately 1 hour for the rest of the colostomy return, then remove the irrigation drain pouch from the patient. Gently clean the area around the stoma with mild soap and water.
• Be careful not to rub the skin.
• Rinse and dry the area with a towel.
• Apply a clean pouch or dressing, as applicable.
• Provide for the patient's comfort; remove and dispose of used supplies.
• Record the procedure and significant nursing observations in the patient's clinical record and report it to charge nurse.
• Note color and condition of stoma and peristomal skin.
• Record color, consistency, and amount of drainage.
• Note amount of irrigating solution used.
• As recovery progresses, the nursing personnel should gradually assume a more passive role in colostomy care, allowing the patient to assume the active role.