Download Procedure Template

Fluid & Medication Management
Rectal Medications
Rectal Medications
Contents
Purpose....................................................................................................................................... 1
Scope .......................................................................................................................................... 1
Associated documents ................................................................................................................ 1
1 Rectal Suppositories.............................................................................................................. 1
Procedural considerations ...................................................................................................... 1
2 Enema Insertion .................................................................................................................... 2
Procedural considerations ...................................................................................................... 2
Retention Enema .................................................................................................................... 2
Evacuation Enema ................................................................................................................. 3
References .................................................................................................................................. 3
Purpose
To ensure suppositoryand enema therapy is managed to best
practice standards.
Scope
Nurses/Midwives/Approved persons with scope for rectal
administration.
Associated documents
CDHB Fluid and Medicaiton Manual
1 Rectal Suppositories
Procedural considerations



Ensure patient is informed of the procedure and obtain their
verbal consent.
Position patient in left lateral position with knees flexed to allow
for easier insertion of suppository.
Lubricate suppository.
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO & EDON
Ref: 4713
Page 1 of 3
Issue Date: August 2014
Be reviewed by: August 2016
Fluid & Medication Management
Rectal Medications





Retention suppository use (drug delivery)
Insert suppositories gently beyond the internal anal sphincter
(approx. 2-4 cm), blunt end first.
Stimulate bowel evacuation
Follow manufacturer’s instructions e.g either into faeces or
against mucous membrane. Administer blunt end first unless
otherwise specifically indicated in manufacturers instructions.
The patient to retain the suppository for at least 20 minutes if
possible.
Ensure patient has access to call bell, is near to bedpan,
commode or toilet.
Document in the clinical record, time given and effects on the
patient. For bowel evacuation use document the amount, colour,
consistency and content, using the Bristol Stool Chart.
2 Enema Insertion
Procedural considerations

Ensure the patient is informed of the procedure and obtain their
verbal consent.
 Encourage patient to empty bladder prior to administration of
enema.
 Warm enema fluid to room temperature if required.
 Position patient on left side with knees flexed, buttocks close to
edge of bed, to allow for easier insertion and flow of solution
 Lubricate nozzle
 Insert nozzle of the enema:
– 5-7 cms into rectum for an adult,
– 2.5-5 cms for a child - 1-13 years
– <2.5 cm for an infant - < 1 year
Please Note:
This is very dependent on individual size of patient – use clinical
judgement.
Retention Enema


Introduce fluid slowly to avoid increasing peristalsis due to
distension of bowel.
To aid retention, elevate foot of bed by 45 degrees after
administration for as long prescribed or as tolerated by patient.
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO & EDON
Ref: 4713
Page 2 of 3
Issue Date: August 2014
Be reviewed by: August 2016
Fluid & Medication Management
Rectal Medications
Evacuation Enema






Introduce fluid slowly. Distension and irritation of the bowel wall
will produce strong peristalsis which is sufficient to empty the
lower bowel.
Ask the patient to retain the enema solution for 10-15 mins if
possible, or as per manufacturer’s instructions.
Ensure patient has access to call bell, is near to bedpan,
commode or toilet.
Ensure privacy and ventilation as appropriate.
Document in the clinical record, time given and effects on the
patient. Report colour, consistency, content and amount of
faeces using the Bristol Stool Form Chart.
Observe patient for any ill effects.
References


Royal Marsden Hospital Manual of Clinical Nursing Procedures
8th Edition 2011, on line – retrieved 06/03/14
http://www.rmmonline.co.uk/rmm8/procedure/06/ss74?q=%2B(su
ppositories)%20%2BcurrentVersion%3Atrue
The Royal Marsden Hospital Manual of Nursing Procedures.
8thEdition 2011, on line – retrieved 06/03/14
http://www.rmmonline.co.uk/rmm8/procedure/06/ss74?q=%2B(en
ema)%20%2BcurrentVersion%3Atrue
Procedure Owner
Procedure Authoriser
CDHB Fluid & Medication Management Committee
CDHB Fluid & Medicaiton Management Committee
Date of Authorisation
August 2014
The latest version of this document is available on the CDHB intranet/website only.
Printed copies may not reflect the most recent updates.
Authorised by: CMO & EDON
Ref: 4713
Page 3 of 3
Issue Date: August 2014
Be reviewed by: August 2016