A nurse is preparing to administer a cleansing enema to an adult client in preparation for a diagnostic procedure. Which of following are appropriate steps for nurse to take? Select all that apply.

a. Warm enema solution prior to installation.
b. Position client on left side with right leg flexed forward.
c. Lubricate rectal tube or nozzle.
d. Slowly insert rectal tube about 2 inches.
e. Hang enema container 24 inches above clients anus.

Correct Answer: A, B, and C.

Enemas are rectal injections of fluid intended to cleanse or stimulate the emptying of the bowel. Enemas can be administered by a medical professional or self-administered at home. Enemas may also be prescribed to flush out the colon before certain diagnostic tests or surgeries. The bowel needs to be empty before these procedures to reduce infection risk and prevent stool from getting in the way.

• Option A: The nurse should warm the enema solution because cold fluid can cause abdominal cramping and hot fluid can injure the intestinal mucosa. Cleansing enemas are water-based and meant to be held in the rectum for a short time to flush the colon. Once injected, they’re retained for a few minutes until the body rids itself of the fluid, along with loose matter and impacted stool in the bowel.
• Option B: Option B allows a downward flow of solution by gravity along the natural anatomical curve of the sigmoid colon. Some advocates claim that enemas can support weight loss, remove toxins and heavy metals from the body, and improve the skin, immunity, blood pressure, and energy levels.
• Option C: Lubrication prevents trauma or irritation to the rectal mucosa. The least irritating of all options, water or saline — salt water that mimics the body’s sodium concentration — are used primarily for their ability to expand the colon and mechanically promote defecation.
• Option D: This is an appropriate length of insertion for a child. For an adult client, the nurse should insert a tube 3 to 4 inches. Research shows that enemas used in preparation for medical procedures significantly disrupt gut bacteria, though the effect appears to be temporary. However, enemas that are split and administered in two doses seem to have fewer effects on the microbiome.
• Option E: The height of the fluid container affects the speed of installation. The maximum recommended height is 18 inches. Hanging the container higher than that could cause rapid installation and possibly painful distention of the colon.