Enema is to pour a certain amount of solution into colon through anal canal, from anus to rectum, to help patients defecate and exhaust. Imported drugs can also achieve the purpose of diagnosis and treatment.
(A) do not retain the enema method
1. A lot of enema without reservation
(1) Objective ① To soften and remove feces and eliminate intestinal pneumatosis. (2) clean the intestines to prepare for operation, examination and delivery. ③ Dilute and remove harmful substances in the intestine to reduce poisoning. (4) cooling patients with high fever.
(2) Prepare a set of enema tube (the total length of rubber tube and glass connecting tube is 120cm), anal tube, bent plate, hemostatic forceps, paraffin oil, cotton swab, toilet paper, thermometer, dispensing stick, rubber blanket, therapeutic towel (or disposable diaper), bedpan, infusion stand and filter screen in the substance therapy tray.
(3) Common solutions? Normal saline? 1% soapy water.
(4) Liquid volume and temperature? Adult dosage 500- 1000ml each time? ,? The dosage for the elderly is 500-800 ml, and that for children is 200-500 ml. The liquid temperature is 39-465438 0℃, and the cooling temperature is 28-32℃. Patients with heatstroke can use 4℃ iced salt water.
(5) Operation method ① Prepare articles and bring them to the patient's bedside, explain the purpose to them, eliminate concerns, get cooperation, guide them to urinate, and screen patients in large wards. (2) Assist the patient to take the left lateral position (according to the anatomical position of the intestine, make the solution flow into the intestinal cavity smoothly with the help of gravity), take off pants to the knees, bend the right leg, naturally straighten the left leg, move the buttocks to the bedside, put a blanket (or disposable diaper) under the buttocks, and bend the plate to place the buttocks. If the patient's anal sphincter is out of control, he should lie on his back, put a bedpan under his hip, don't expose the patient's lower limbs, and cover the quilt. (3) Hang the enema tube on the infusion stand, the liquid level is 40-60 cm away from the anus, lubricate the front end of the anal tube, connect the anal tube with the glass connecting tube on the enema tube, release a small amount of liquid, exhaust the gas in the tube, clamp the hose with hemostatic forceps, hold the toilet paper in the left hand to separate the patient's buttocks, expose the anus, and ask him to open his mouth to breathe, so as to relax the anal sphincter. Intubate according to the anatomical characteristics, that is, first forward, then right, and then gently insert into the rectum. Loosen the hemostatic forceps, fix the anal canal, make the solution flow into ④ slowly, and observe the situation under the internal liquid level. If the inflow of solution is blocked, the anal canal can be moved slightly, and if necessary, check whether there is feces blockage. If the patient has stool, the enema tube should be lowered appropriately to slow down the flow rate, and the patient should be told to take a deep breath to reduce abdominal pressure. ⑤ When the solution is almost exhausted, clamp the rubber tube, wrap the anal canal with toilet paper, pull it out and put it into a curved plate to wipe the anus. Before defecation, patients are required to lie flat and keep it for 5- 10 minutes, so as to facilitate stool softening. ⑥ For patients who can't get out of bed, give bedpans and put toilet paper where patients can easily get it. ⑦ After defecation, assist the weak patient to wipe the anus and take out the bedpan, rubber and treatment towel. Help patients wash their hands, make their beds and open windows for ventilation. Observe the stool and take samples for inspection if necessary. ⑧ Finishing, cleaning, disinfection and enema. Pet-name ruby record results, recorded in the stool column of the temperature list that day.
(6) Precautions ① Master the temperature, concentration, flow rate, pressure and liquid volume of enema. When performing enema on typhoid patients, the solution should not exceed 500ml and the pressure should be low (the liquid level should not exceed 30 from the anus). (2) cooling enema, can use 28-32℃ isotonic saline, or use 4℃ isotonic saline, keep it for 30 minutes and then discharge it. After defecation, measure your body temperature every half hour and record it. ③ Observe the patient's reaction during enema. If you have pale face, cold sweat, severe abdominal pain, rapid pulse, palpitation and shortness of breath, stop enema immediately and notify the doctor for treatment. ④ Soap water enema is forbidden for patients with hepatic coma to reduce the production and absorption of ammonia. ⑤ Contraindications: patients with pregnancy, acute abdomen, gastrointestinal bleeding and various serious diseases in the late stage.
2. Do not keep a small amount of enema
(1) Objective ① To soften feces. Relieve constipation of pregnant women, seriously ill patients, the elderly and infirm, children and other patients. ② Exhaust the accumulated gas. For patients with flatulence after abdominal and pelvic surgery, the gas accumulated in the intestine can be eliminated to reduce abdominal distension.
(2) Pay attention to the gasket in the medicine tray. The medicine cup or measuring cup is filled with specified solution, anal canal, warm water 5- 10 ml, arc-shaped tray, toilet paper, rubber blanket and therapeutic towel, lubricating oil, hemostatic forceps, bedpan and filter screen.
(3) Common solutions? ① "1,2,3" solution, namely 30ml of 50% magnesium sulfate, 60ml of glycerol, 90ml of warm water, 38℃. ② Oils, that is, 50 ml of glycerol and the same amount of warm water, are mostly used for the elderly, the infirm, children and pregnant women.
(4) Operation method ① Prepare the materials and bring them to the patient's bedside. Other preparations are the same as mass enema. (2) Lubricate the front end of the anal canal, suck out the solution with a gasket, connect the anal canal, clamp the anal canal after exhausting, gently insert it into the rectum 10- 15 cm, loosen the hemostatic forceps, slowly inject the solution, raise the end of the anal canal until the solution is completely injected, then fold the anal canal, gently pull it out, and put it into an arc plate.
(3) Before defecation, let the patient lie on his back for 10-20 minutes.
Clean enema
(1) Objective ① Thoroughly remove the feces in the colon, so as to prepare for rectal examination and preoperative examination. ② Dilute intestinal endotoxin and promote its excretion. ③ Physical cooling.
(2) use? Use a large number of non-reserved enema
(3) Common solutions? 1% soap solution, isotonic saline.
(4) How to operate? Repeatedly do a lot of enema without retention, use soapy water for the first time, and then use normal saline enema after defecation until the discharged liquid is clean and free of fecal lumps, and pay attention to low pressure (the liquid level is not more than 40cm from the anus). Enema should be completed 1 hour before examination or operation, and repeated lavage with clear water is prohibited to prevent electrolyte disorder.
(2) Retention enema
1. Purpose? The drug is injected from anus, stays in rectum or colon, and is absorbed through intestinal mucosa to achieve the therapeutic purpose. Commonly used for sedation, hypnosis and application of intestinal microbicides.
2. Common solutions
(1) Sedation and hypnosis? Use 10% chloral hydrate, and add the same amount of warm water or isotonic saline according to the doctor's advice.
(2) Intestinal bactericide? Antibiotics such as 2% berberine and 0.5% ~ 1% neomycin were used. , the dosage is not more than 200ml, and the temperature is 39-465438 0℃.
(3) Intestinal nutrients? Use 10% glucose solution or milk.
3. use things? A small amount of enema, choose a thinner anal canal.
4. Business methods
(1) Prepare the materials, bring them to the patient's bedside, and explain them to the patient for cooperation.
(2) Before retention enema, patients are required to defecate once or be given defecation enema, so as to reduce abdominal pressure and clean intestines, which is beneficial to drug absorption.
(3) It is advisable for patients with intestinal diseases to be infused at night before going to bed, and the buttocks are raised 10cm during enema? The lying position depends on the lesion site. For example, the focus of chronic dysentery is mostly in sigmoid colon and rectum, so the left lying position is appropriate, and the focus of amebic dysentery is mostly in ileocecum, so the right lying position should be adopted to improve the therapeutic effect.
(4) Other operations are the same as a small amount of enema, but the anal canal is deep, about 15-20 cm? The liquid flow rate should be slow and the pressure should be low (the liquid level should not exceed 30cm from the anus) to keep the liquid.
(5) After the folding tube is pulled out, gently press and rub it on the anus with toilet paper, and ask the patient to keep it above 1 hour to facilitate drug absorption, and make records.
5. Preventive measures
(1) Know the lesion site before enema, so as to choose the appropriate lying position and anal canal insertion depth.
(2) In order to improve the curative effect, the patient should be instructed to defecate before enema, and the operating principle of "thin, deep, less, slow, warm and quiet" should be mastered, that is, the anal canal should be thin, inserted deeply, the fluid volume is small, the flow rate is slow and the temperature is appropriate, and the patient should lie still after irrigation.
(3) Patients with postoperative diseases such as anus, rectum and colon, and those with incontinence in defecation, should not keep enema.