Hypertensive Enema: An Algorithm Of Actions During Setting, Indications

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2024-01-15 19:51

Hypertensive enema: setting algorithm, mechanism of action indications and contraindications

The content of the article:

The mechanism of action of an enema from a hypertonic solution
Indications for a hypertensive enema
Contraindications and complications
Hypertensive enema: action algorithm
Video

A hypertensive enema involves the use of a hypertonic (i.e., exceeding 0.9%) salt solution for the introduction into the rectum.

An enema is a medical manipulation that is often performed both in hospitals and at home, the essence of which is the introduction of water or certain liquids (oil, herbal decoctions, a solution of drugs) into the rectum or colon.

Depending on the purpose, enemas are subdivided into cleansing, nutritional and medicinal (medicinal).

By the amount of injected fluid, there are:

microclysters (50-100 ml) - mainly used to administer medications, oils (oil enemas) and hypertonic saline solutions;
cleansing (1-2 l) - used to cleanse the intestines from feces with constipation, before operations or a number of diagnostic procedures;
siphon (intestinal irrigation or lavage) - during the procedure, 15-20 liters of water are used, which is introduced in portions (1-2 liters each) into the large intestine and removed from it through a special intestinal probe.

In this article, we will tell you in detail why an enema with a hypertonic solution is given, as well as how to give it to adults and children.

For setting a hypertensive enema, syringes with a volume of 50-100 ml are used

The mechanism of action of an enema from a hypertonic solution

As it is clear from the name itself, a hypertonic salt solution (magnesium sulfate, sodium chloride) is used for setting a hypertensive enema.

The main part of the extracellular substance and cellular contents is water, in which various substances are dissolved, including mineral salts. These substances determine the osmotic pressure of the fluid, which in the human body is largely supported by sodium chloride ions at a concentration of 0.9%.

Ions have the ability to move from an area of higher concentration to an area of lower concentration. That is, if, for example, the osmotic pressure in the extracellular fluid becomes greater, then the ions will begin to actively move into the cell, and water from the cell will go out into the intercellular space, trying to dilute and thereby reduce the concentration of the intercellular fluid.

Isotonic or physiological in relation to blood plasma solution is called 0.9% sodium chloride solution. If its concentration is higher, the solution is called hypertonic, and if it is lower, it is called hypotonic.

When a hypertonic solution is injected into the rectum, fluid from the soft tissues begins to flow into the intestinal lumen. This promotes pressure on the intestinal walls, irritation of nerve receptors, which causes profuse bowel movements.

Indications for a hypertensive enema

The main goal of the procedure is to gently stimulate the intestines and remove feces and excess fluid from the extracellular space. It is shown in the following cases:

atonic constipation;
the ineffectiveness of a conventional cleansing enema;
severe swelling;
bowel cleansing in patients suffering from diseases in which attempts should be excluded at the time of defecation (increased intracranial pressure, myocardial infarction, stroke, hypertensive crisis).

Contraindications and complications

Any medical procedure has not only clearly indicated indications, but also contraindications. An enema with a hypertonic solution is contraindicated in the following cases:

malignant neoplasms of the lower part of the large intestine;
intestinal bleeding;
bleeding from hemorrhoids;
prolapse of the rectum;
anal fissures;
acute ulcerative and inflammatory diseases of the rectum;
pain in the abdomen until the exact cause of their occurrence is established.

Given the rather large list of contraindications, an enema from a hypertonic solution should be performed only as directed by a doctor.

Complications of the procedure are extremely rare. These include:

Injury to the rectal mucosa. It can occur when the tip is roughly inserted into the anus, insufficiently lubricated with petroleum jelly or oil.
Fecal intoxication. If, instead of hypertonic, a warm hypotonic solution or water is mistakenly used, then toxins from the intestinal lumen begin to enter the intercellular substance, and from there into the bloodstream, as a result of which fecal intoxication develops.
Intestinal perforation. The reason is very rough insertion of the tip or a sudden abrupt change in the patient's body position. This complication can occur, for example, when an enema is given to children in the first years of life.

Hypertensive enema: action algorithm

Before proceeding directly to the procedure, it is necessary to prepare a hypertonic solution. To do this, take 1 tablespoon of table salt and pour it with a glass of water, bring to a boil, filter through a layer of cotton wool, then add boiled water to a volume of 250 ml, and then cool to a temperature of 25–37 ° С. If necessary, the doctor can write a prescription and the hypertonic solution will be prepared according to it in the pharmacy.

The hypertonic solution can be prepared independently or purchased at the pharmacy.

Further algorithm of actions and the validity of each stage are presented in the table.

Stages	Justification
Preparing for the upcoming manipulation
Prepare everything you need to perform the procedure: a 50-100 ml syringe, a sterile tip, petroleum jelly, a disposable spatula, oilcloth, diaper, napkins, rubber gloves, a container with a disinfectant solution, an oilcloth apron, a measuring container, a hypertonic solution, a water thermometer.	Proper preparation for the upcoming procedure increases its effectiveness.
Explain to the patient the essence of the upcoming manipulation and obtain his consent to carry it out.	Respect for the patient's right to information.
Close the enema room door or, if the enema is administered in the ward, enclose the patient's bed with a screen.	Respect for the person and dignity of the patient.
Measure the volume of the hypertonic solution prescribed by the doctor (the composition is written above) and measure its temperature (from 25 to 37 ° C), and then draw it into the syringe through the sterile tip.	The correct solution temperature and volume ensures the best handling effect.
Put on an oilcloth apron and gloves.	Protecting nursing staff from infectious agents.
Place an oilcloth and a diaper under the patient.	Compliance with sanitary and hygienic regime, preservation of cleanliness of bed linen.
Ask the patient to lie on their left side. The legs are bent at the knee and hip joints, pulled up to the stomach (a supine position is permissible, with the legs bent at the knee and hip joints and spread apart).	The peculiarity of the anatomical location of the rectum and sigmoid colon is taken into account, which facilitates the introduction of the tip and reduces the risk of injury to the intestinal wall.
Technique for performing manipulation
Apply Vaseline to the tip with a spatula and lubricate liberally.	Facilitates tip insertion and reduces patient discomfort.
Release air from the syringe and gently insert the tip into the rectum.	Prevents air from entering the intestines.
Squeeze the syringe slowly, squeezing the solution out of it.	The gradual flow of fluid into the rectum prevents the patient from painful sensations.
While holding the syringe in a squeezed state, remove the tip.	Eliminates solution re-absorption.
Place the syringe and handpiece in a container with a disinfectant solution.	Prevention of nosocomial infection.
Remind the patient to delay bowel movements for 20-30 minutes.	Strengthening the effectiveness of the procedure.
Take the patient to the toilet or offer a bedpan. After defecation, conduct a toilet in the perineal area.
Place the diaper in a bag with dirty linen, and wipe the oilcloth and apron with a rag soaked in disinfectant solution.	Prevention of transmission of nosocomial infection.
Remove gloves and place them in a disinfectant solution.	Prevention of nosocomial infection.
Wash hands thoroughly with soap and running water.	Prevention of the negative effects of talcum powder on the skin of the hands.
Make a note of the performed procedure in the patient's medical record.	Ensuring continuity in the work of nurses.