Colonic Irrigation Prepared by : Christian Raveina

Definition

• Colonic Irrigation or enteroclysis or bowel wash refers to the treatment of washing out the colon with large quantities of a solution in order to clear the colon of faeces

Purposes • To clean the colon of faeces , gas , excess mucus ,

barium etc .

• To dilute & remove any of the toxic agents that may be present in the large intestine

• To keep the individual clean in faecal incontinence and to check the diarrhoea

• To supply heat to the colon or to the pelvic & abdominal organs surrounding the large intestine to (to relieve pain & bring about circulatory changes in these organs )

Purposes

• To reduce temperature in hyperpyrexia & heat stroke

• To apply medications locally

• To supply the body with fluid & electrolytes that are absorbed from the intestine

• As a preparation for diagnostic examinations & certain surgeries to cleanse the bowel

Contraindications

• Loose sphincter

• Painful & bleeding hemorrhoids

• Fistula in anus

• Polyps & diverticulus of the intestines

• Rectal infections

• Painful skin lesions around the anus

• Massive carcinoma or tumors of the rectum

Solutions used

• Plain water

• Cold water

• Normal saline

• Sodium bi-carbonate solution 1 to 2 %

• Antiseptic solution such as silver nitrate 1 : 5000 ; potassium permanganate solutions 1 : 5000 ; thymol 1 : 100 ; alum 1 : 100 ; boric solution 1 to 2 % tannic acid 1 : 100 etc

• Amount of solution used :

•2 to 3 liter or till the return flow is clear

• Temperature of the solution :

•For cleansing purpose 104 ºF ( 40 º C )

•For thermal effect 110 to 115 ºF ( 43.3 to 46 ºC)

•For reducing temperature 80 to 90 ºF ( 27 to 32 ºC )

General Instruction • A cleansing enema should be given 1 hour before the

colon irrigation is started , so that the rectum will be free of faecal matter

• The bladder should be emptied before a colonic irrigation to reduce the intra-abdominal pressure

• The temperature of the solution be kept constant throughout the procedure

• Do not allow the air to enter into the intestine by :

• Expelling the air from the tube

• Not letting the fluid into to run in completely from the tube

• Make sure that the return flow is not blocked

• Stop the procedure temporarily if the client complaints of pain

• Use a smooth & flexible rectal tube & lubricate it well to prevent damage to the rectal mucosa

• Listen to the complaints of the client should not ignore any discomfort however small they may be

• Stop the treatment if the client shows the signs of fatigue & collapse

• Allow only 200 to 300 ml of fluid to run into the rectum at a time

• Then it should be drained out completely before introducing the fluid 2nd time

• Regulate the flow of fluid . Do not have the ingoing tube higher than 45 to 60 cm above the bed level & do not have the outgoing tube more than 30 cm below the bed

Methods used

By using

funnel

and catheter

By using

“Y” connector

and rectal tube

By using

2 tube method

By using funnel & catheter

Preparation of article

•Funnel & tubing with

glass connection

•Rectal tube placed in

a kidney tray

•Mackintosh & towel

•Water soluble jelly or

Vaseline

•Bucket

•Rag pieces in a

container

•hot & cold water

jug with prescribed

solution

•Paper bag

•Clean linen

•Parineal tray

Procedure

• Wash hands

• Prepare the solution at the required temp.Test the temp at the inner aspect of the wrist

• Attach the tubing & the rectal tube with the funnel , pour the solution in it & check for leakage

• Lubricate the tip of the rectal tube about 4 inches

• Fill the funnel with the solution & expel the air from the tubing by allowing a small amount of fluid into kidney tray. pinch the tube

• Separate the client’s buttocks to visualize the anus clearly & insert the tip about 4 inches , while the client exhales a deep breath

• Lower the funnel below the level of rectum

• Raise the funnel & allow the fluid into the funnel , before the funnel is empty

• When 200 to 300 ml of fluid has gone in , pinch the tube before the funnel is completely empty & invert it over the bucket & let the fluid drain

• When the return flow ceases turn the funnel upright & pour more solution

• Lower the funnel until the air from the tube has been expelled , then raise the funnel & repeat the procedure

• Continue the procedure until all the fluid ordered has been given or until the return flow is clear

• Temporarily stop the procedure ( do not remove the rectal tube ) if the client develops any discomfort

• Gently remove the rectal tube by pulling it through 3 to 4 layers of rag pieces

• Discard the rag piece in the paper bag. Place the funnel with the tubing in the kidney tray

• Turn the client ,assist him in a bed pan or commode

• Bring the parineal tray & give the parineal care

• Put on garments & change the linen if needed & make the client in comfortable position

• Wash hands

• Record & report the procedure

Using “2 tube” method

• In this method :

• An irrigation can with tubing

• Glass connection

• Screw clamp

• One rectal tube

• Catheter

• Attach the rubber tubing & catheter to enema can

• Fill the can with solution & expel the air ( this acts as the inflow tube & the rectal tube acts as the outflow tube )

• Mark the catheter about 6 inches from its tip & the rectal tube 4 inches from its tip

• Insert the tip of the catheter into the eye of the rectal tube & insert the tube together into the anal canal after lubricating them well

• When the tubes are in , pull the catheter slightly backward in order to dislodge it from the rectal tube

• Then insert the catheter alone until the marks on both tubes come together at the anus

• The preparation & after care of the client will be same as that of funnel method

• The fluid that flows from the enema can through the rectal catheter enters the rectum & return through the rectal tube which is situated 2 inches lower than the rectal catheter

Using “Y” Connection & Rectal Tube

• Articles will be same as that of 2 tube method

• A “Y” connection will permit the regulation of the inflow & outflow

• The tube for inflow is attached to one prong of the Y connection & the outflow tube is attached to the other prong

• The stem of the Y connection is attached to the rectal tube

• Clamps on the inflow & outflow tubes make it possible to direct the flow of fluid into the rectum & then out of the rectum

• The solution flows from the inflow tube through the rectal tube into the rectum

• When the clamp on the inflow tube is closed & the clamp on the outflow tube is opened , the fluid flows through the rectal tube to outflow tube & into the bucket

• By opening & closing the clamps alternatively , the fluid enters the rectum & return after washing out the rectum

Thank you…