Keywords: enema method
Enema is to pour a certain amount of solution through the anal canal, from the anus through the rectum into the colon to help the patient defecate and exhaust gas. Input drugs can also be used to achieve the purpose of confirming diagnosis and treatment.
(1) Non-retention enema method
1. Mass non-retention enema
(1) Purpose ① Soften and remove feces and eliminate gas in the intestines. ② Clean the intestines and prepare for surgery, examination and delivery. ③ Dilute and remove harmful substances in the intestines and reduce poisoning. ④ Cool down patients with high fever. Medical Education Network www.med66.com
(2) The medical treatment tray is equipped with a set of enema tubes (the total length of the rubber tube and glass tube is 120cm), anal canal, curved disk, hemostatic forceps, and paraffin oil , cotton swabs, toilet paper, water thermometer, dispensing stick, rubber cloth and treatment towel (or disposable diaper), bedpan, infusion stand, screen.
(3) Commonly used solutions: physiological saline, 1% soapy water.
(4) Liquid volume and temperature: The dosage for adults is 500~1000ml per time, the dosage for the elderly is 500~800ml, and the dosage for children is 200~500ml. The liquid temperature is 39-41℃, and the cooling temperature is 28~ 32℃, patients with heat stroke can use 4℃ isotonic ice saline.
(5) Operation method ① Prepare all the supplies and bring them to the patient's bedside, explain the purpose to the patient, eliminate concerns, obtain cooperation, and ask the patient to urinate. Use a screen to shield the patient in the large ward. ②Assist the patient to lie on the left side (according to the anatomical position of the intestine, gravity will help the solution flow smoothly into the intestinal cavity), take off the pants to the knees, bend the right leg at the knee, straighten the left leg naturally, move the buttocks to the edge of the bed, and remove the rubber Place the cloth and treatment towel (or disposable diaper) under the buttocks, and place the curved disk next to the buttocks. If the patient loses control of his anal sphincter, he can lie on his back with a bedpan under his buttocks. Do not expose the patient's lower limbs and cover him with a quilt. ③Hang the enema tube on the infusion stand, with the liquid level 40-60cm away from the anus, lubricate the front end of the anal canal, connect the anal canal to the glass pipe on the enema tube, release a small amount of liquid, discharge the gas in the tube, and clamp the rubber tube with a hemostatic forceps , holding toilet paper in the left hand, separate the patient's buttocks, expose the anus, instruct the patient to open his mouth to breathe, and relax the anal sphincter. Intubate according to the anatomical characteristics, that is, first forward, then right back, gently insert 10 to 15cm into the rectum, loosen the hemostat, and fix it Anal canal, allowing the solution to flow slowly. ④ Observe the situation below the internal fluid level. If the inflow of the solution is blocked, move the anal canal slightly and check if there is any obstruction by fecal matter if necessary. If the patient feels the urge to defecate, the enema tube should be lowered appropriately to slow down the flow rate, and the patient should be instructed to take a deep breath to reduce abdominal pressure. ⑤When the solution is almost gone, clamp the rubber tube, wrap the anal canal with toilet paper, pull it out and put it into a curved plate, and wipe the anus clean. Instruct the patient to lie down for 5 to 10 minutes before defecation to facilitate softening of stool. ⑥For patients who cannot get out of bed, provide a bedpan and place toilet paper within easy reach of the patient. ⑦After defecation, assist the weak patient to wipe the anus and take out the bedpan, rubber sheets and treatment towels. Help patients wash their hands, make their beds, and open windows for ventilation. Observe the stool condition and collect specimens for examination if necessary. ⑧ Arrange, wash and disinfect enema supplies for later use. ⑨Record the results in the stool column of the day's temperature sheet.
(6) Precautions ① Master the temperature, concentration, flow rate, pressure and volume of the enema solution. When giving an enema to a patient with typhoid fever, the solution should not exceed 500ml and the pressure should be low (the liquid level should not be more than 30 meters from the anus) ). ② For cooling enema, you can use isotonic saline at 28-32°C or isotonic saline at 4°C. Keep it for 30 minutes before expelling it. Measure and record the body temperature half an hour after defecation. ③ Pay attention to the patient's reaction during the enema process. If there is pale complexion, cold sweat, severe abdominal pain, rapid pulse, palpitation and shortness of breath, the enema should be stopped immediately and the doctor should be notified for treatment. ④ Patients with hepatic coma are prohibited from using soapy water enema to reduce the production and absorption of ammonia. ⑤Contraindications: Pregnancy, acute abdomen, gastrointestinal bleeding and terminal patients with various serious diseases.
2. Small-volume non-retention enema
(1) Purpose ① Soften stool. Relieve constipation for pregnant women, seriously ill, elderly and frail, children and other patients. ②Discharge accumulated gas. For patients with intestinal flatulence after abdominal and pelvic surgery, it can eliminate gas accumulated in the intestines and reduce abdominal distension.
(2) Please note in the medical treatment tray: a washing machine, a medicine cup or a measuring cup to hold the specified solution, anal canal, 5 to 10 ml of warm water, a bent plate, toilet paper, rubber cloth and treatment towel, lubricating oil, Hemostat, bedpan, screen.
(3) Commonly used solutions ① "1, 2, 3" solutions are 30 ml of 50% magnesium sulfate, 60 ml of glycerin, 90 ml of warm water, and the temperature is 38°C. ②Oil agent, that is, 50ml of glycerol plus an equal amount of warm water, is mostly used for the elderly, frail, children and pregnant women.
(4) Operation method ① Prepare all supplies and bring them to the patient's bedside. Other preparations are the same as enema without reservation. ② Lubricate the front end of the anal canal, use a syringe to absorb the solution, connect the anal canal, clamp the anal canal after exhausting, gently insert 10 to 15cm into the rectum, loosen the hemostatic forceps, slowly inject the solution, and after filling, close the anal canal. The end of the tube is raised to allow all the solution to be injected, then the anal canal is folded, gently pulled out, and placed in a curved plate. ③Instruct the patient to lie down and keep the stool for 10 to 20 minutes as much as possible before defecating.
3. Cleansing enema
(1) Purpose ① Completely remove feces retained in the colon to prepare for rectal and colon examination and preoperative preparation. ② Dilute intestinal toxins and promote their excretion. ③Physical cooling.
(2) Materials used are the same as large-volume no-retention enema
(3) Commonly used solutions: 1% soap solution, isotonic saline.
(4) Operation method: Repeat a large number of non-retention enemas for many times. Use soapy water for the first enema, and then use saline enema after defecation until the discharge fluid is clean and free of feces. Pay attention to the enema during The pressure should be low (the liquid level should be no more than 40cm from the anus). Enema should be completed 1 hour before examination or surgery. Repeated lavage with clean water is prohibited to prevent water and electrolyte imbalance.
(2) Retention enema
1. Purpose: Inject drugs from the anus, retain them in the rectum or colon, and absorb them through the intestinal mucosa to achieve therapeutic purposes. Commonly used for sedation, hypnosis and application of intestinal bactericides.
2. Commonly used solutions
(1) For sedation and hypnosis, use 10% chloral hydrate, and add the same amount of warm boiled water or isotonic saline as directed by the doctor.
(2) Intestinal bactericides: Use 2% berberine, 0.5~1% neomycin and other antibiotics. The dosage should be as directed by the doctor. The dosage should not exceed 200ml and the temperature should be 39~41°C.
(3) Enteral nutrition agent: use 10% glucose solution or milk, etc.
3. Instructions: Use the same small-volume no-retention enema, but choose a thinner anal canal.
4． Operation method
(1) Prepare all the supplies and bring them to the patient's bedside, and explain to the patient to obtain cooperation.
(2) Before the retention enema, instruct the patient to defecate or give a defecation enema once to reduce abdominal pressure and clean the intestines to facilitate drug absorption.
(3) It is advisable for patients with intestinal diseases to instill the enema before going to bed at night. The buttocks should be raised 10cm during the enema to facilitate the retention of the liquid. The lying position should be determined according to the location of the disease. For example, chronic dysentery is more common in patients with intestinal diseases. Sigmoid colon and rectum, so it is better to use the left lateral decubitus position. Amoebic dysentery is more common in the ileocecal area, so the right lateral decubitus position should be adopted to improve the treatment effect.
(4) Other operations are the same as small-volume non-retention enema, but the entrance into the anal canal should be deep, about 15-20cm. The flow rate of the solution should be slow and the pressure should be low (the liquid level should not be more than 30cm from the anus), so as to facilitate Retain in medicinal solution.
(5) After folding the tube and pulling it out, gently rub the anus with toilet paper, and ask the patient to keep it for more than 1 hour to facilitate the absorption of the medicine, and keep a record.
5． Precautions
(1) Understand the location of the lesion before enema so that you can choose the appropriate lying position and the depth of insertion into the anal canal.
(2) In order to improve the curative effect, instruct the patient to defecate first before enema, and master the operating principles of "thin, deep, small, slow, warm and quiet", that is: the anal canal is thin, the insertion is deep, the amount of liquid is Less, slow flow rate, suitable temperature, lie still after filling.
(3) Retention enema is not suitable for patients who have undergone surgery on the anus, rectum, colon, etc., or who have defecation incontinence.