A practitioner orders a return flow enema (Harris flush drip) for an adult patient with flatulence. When preparing to administer this enema nurse compares steps of a return flow enema with cleansing enemas. What should nurse do that is unique to a return flow enema?

Correct Answer: D. Lower the solution container after instilling about 150 mL of solution.

Lowering the container of solution creates a siphon effect that pulls the instilled fluid back out through the rectal tube into the solution container. The return flow promotes the evacuation of gas from the intestines. This technique is used only with a return flow enema. This action is appropriate for all types of enemas.

• Option A: All rectal tubes should be lubricated to facilitate entry of the tube into the anus and rectum and prevent mucosal trauma. Use a solution at a temperature of 105o to 110oF in adults and 100oF in children. Cool solutions will increase the incidence of cramping.
• Option B: The anal canal is 1 to 2 inches long. Inserting the rectal tube 3 to 4 inches ensures that the tip of the tube is beyond the anal sphincter. The recommended position for the patient during enema administration is lying in the left lateral position with their right leg flexed as much as possible.
• Option C: The solution container should be raised no higher than 12 inches for all enemas; this allows the solution to instill slowly, which limits discomfort and intestinal spasms. Alternately, raise the enema container 12-18 inches above the rectum for an adult and administer approximately 200 ml of fluid, then lower the container 12-18 inches below the patient’s rectum until no further flatus is seen.