reception, comprising administering to the intestine through the rectum of a liquid substance (water, medicines, oils, etc.), Called enema.This therapeutic and diagnostic manipulation, provides an introduction to the lower parts of the colon of different liquids.
Depending on the purpose (to remove gut contents or, alternatively, with the fluid to enter into it any substance) therapeutic enemas divided into two types.The first type includes cleansing and laxative enema, the second - medicinal, nutritious and drip.
Conclusion out the contents of the large intestine in a natural way - defecation - slozhnoreflektorny act taking place with the participation of the central nervous system.The liquid contents of the small intestines enters the large intestine, which is delayed for 10-12 hours, and sometimes more.
With the passage of the contents of the large intestine but gradually thickens due to the energetic absorption of water, turning into calories.Between the emptying of stool move distally intestine b
sphincter tone increases with the entry of feces in the rectal cavity.When the urge and during the defecation reflex sphincter tone decreases - they relax.This eliminates an obstacle for stepping stool out.At this time, under the influence of the rectum receptor stimulation is a reduction ring muscle of the intestinal wall and the pelvic floor.
Promotion stool from the sigmoid colon in a straight line, and from the latter - to the outside contributes to the reduction of the diaphragm and abdominal muscles when to hold your breath.A person may carry or to delay defecation.Extinction reflex on the part of the ampoule of the rectum leading to constipation proktostaticheskomu.
irritation of the rectum, especially stretching her ampoules, reflexively affects the function of the overlying sections of the digestive system, excretory organs, and so forth. As such a mechanical stimulus appears enema.In addition to active peristaltic contractions of muscles of the colon wall occurs anastaltic reduction, which contributes to the fact that introduced into the rectum, even in a small amount of liquid quickly passes into the overlying sections of the colon and is quite fast in the cecum.
In the colon of a fluid is sucked, and it depends on various conditions.The highest value at the same time have the composition of the liquid and the degree exerted by the mechanical and thermal stimuli, as well as the condition of the intestine.
is best absorbed warm hypotonic solutions of glucose - 1%, salt - 0.7% solution.Potable water remaining in the intestine, although it annoying, but too slowly absorbed.When atony intestine absorption is enhanced, with increased peristalsis it comes to a small extent, long-term spasm of absorption can be complete.
Diagnostic enema can determine the capacity of the colon, introduce a contrast agent for X-ray examination of the colon.
Contrast enema is used for X-ray examination of the intestine and allows you to enter into the intestinal lumen contrast solution (barium sulfate).Watching the screen X-ray machine or an image intensifier, a doctor can determine the nature of the contrast mass promotion for colon and detect various pathological formation of its lumen or wall.
Contrast mass is poured into the flask Bobrov apparatus which a rubber tube connected to the tip introduced into the intestine.The apparatus Bobrova - glass tank in a large bottle, a tight-fitting rubber stopper with two glass tubes (short and long).Tightness is provided a screw closure device located in the tube.The patient is placed on the table, X-ray machine, is introduced into the rectum tip to a depth of 10-12 cm. With the help of a rubber bulb in the bulb apparatus Bobrova pressure rises, which expels a lot of contrast by connecting rubber tube into the intestine.For the barium enema is usually enough to enter into the lumen of the large intestine 2 liters contrast mass.
enema used for mechanical emptying of the colon in constipation and stool retention of any origin, food poisoning, preparation for surgical intervention (not only in the gastrointestinal tract), childbirth, X-ray examination of the abdomen and pelvis, as well asbefore using drugs, and nutritional drip enema.
• acute purulent inflammatory diseases (appendicitis, etc.) and ulcerative processes in the area of the anus and colon;
• inflammation of the peritoneum (peritonitis);
• gastric and intestinal bleeding;
• the first days after surgery on the abdominal organs;
• anal fissures and dehiscence, loss of rectal mucosa.
There are two ways of introducing a liquid into the rectum:
• from a reservoir located above the level of the body, - hydraulic method;
• injection using appropriate tools - discharge method.
to perform hydraulic enema, you must have:
• reservoir for fluid administration (douches mug, glass funnel, rubber mug) with a capacity of 1 to 5 m;
• rubber tube, conducting liquid, about 1.5 m long and with a diameter of at least 1 cm (thick-walled tube should be);
• intestinal tube - the tip introduced into the colon lumen, made of different materials (thick-walled rubber, rubber, glass), length of at least 15 cm from the rounded end of the intestinal;
• thermometer to measure the temperature of the liquid.
between the rubber tube and the tip placed special connecting tube with a valve designed to control the amount of fluid introduced into the intestine.Of fluids, providing mechanical, thermal and chemical effects, increases peristalsis, loosens the stool and facilitates their excretion.
Mechanical action enemas the greater, the greater the amount of fluid pressure and rate of administration.
enema adults take an average of 1 liter of water (750 ml to 2 liters), for infants - 30-150 ml, 1 to 5 years - 150-300 ml, from 6 to 14 years - 300-500ml.
tripod higher and therefore hangs Esmarch mug (0,5-1 - 1.5 m), the greater the pressure of fluid injected.The speed of its receipt is regulated by the tap.
In addition to mechanical impact, enhancing peristalsis contributes to the low temperature of fluids.In atonic constipation fluid temperature may be 20 ° C.In spastic constipation use warm or hot enemas (30-40-42 ° C), relaxing the smooth muscles of the gut.The optimum temperature - 25-30 ° C.
important to remember that the higher the temperature of fluids, and is located above the mug Esmarch, the greater the probability of absorption through the intestinal mucosa of fluids, and this, in turn, causes a "fecal intoxication."
By repeating the cleansing enemas can increase the location of the mug Esmarch (pick it up), thus contributing to better and better bowel cleansing.
patients with flexed and tightened to the abdomen legs are laid on the couch or the bed on the left side close to the edge;If you can not move, he laid on his back.Under the buttocks enclose the ship and the oilcloth, the free edge of which is immersed in a bucket in case the patient does not hold water in the mug douches pour 1 - 1.5 liters of water at room temperature, raise it up, lowering the tip down, releasing a small amount of water, and togetherwith it - air.After filling the system, without dropping the cup, close the valve on the rubber tube.Verify the integrity of the tip, lubricate it with vaseline and parted the buttocks of the patient, twisting slightly the tip introduced to a depth of 10 to 12 cm beginning 3-4 cm tip is introduced toward the navel, and then -. Parallel to the coccyx.After the introduction of the tip valve open, raise a mug Esmarch 40-50 cm and inject the liquid, gradually raising a mug to a height of 1 m. If the water does not flow into the intestine, you must change the position of a few tip by pulling it by 1-2 cm, or increasepressure, lifting a mug Esmarch above.If this does not help, you need to remove the tip, running water and restore its patency reintroduce.At the end of the infusion tip carefully removed.
introduced liquid can penetrate all of the large intestine, until the blind, causing increased peristalsis and the urge to defecate, which the patient has to hold for 5-10 minutes.
Children should enter the liquid slowly, without much pressure, and after the extraction tip - to squeeze the buttocks of the child for a few minutes, helping him hold this urge to void.In the presence of gases and occurrence of feeling of fullness - immediately lowered the mug below the level of the bed and after passing flatus gradually raise it again.Leaving at the bottom a little water to the intestine did not get the air valve is closed to regulate flow of liquid, and the tip is removed.Desirably, the patient is kept in water for 10 minutes.To do this, he should lie on his back and breathing deeply.
After the procedure, mug Esmarch washed, wiped dry and subjected to mechanical cleaning, disinfection and sterilization.
When setting cleansing enema is necessary to ensure that simultaneously introduced no more than 1,5-2 liters of liquid.
Siphon enema is used to wash the colon (often with Hirschsprung's disease before surgery), they are used in cases where the usual cleansing enemas do not give effect, as well as for therapeutic purposes (to eliminate the bloat long sigmoid colon).At the heart of the siphon rinsing the principle of communicating vessels.One of them is the intestine, the other - the funnel at the outer end of a rubber tube inserted into the rectum.
• lack of effect of cleansing enemas and laxative intake;
• Remove power from the gut fermentation and decay products, mucus, pus, poisons, got into the intestine through the mouth;
• after abdominal surgery (except in the case of intervention on the intestine), where the patient can not activate an act of defecation due to reduction of the abdominal wall muscles.
Contraindications - the same as that of a cleansing enema.
to siphon enema be sterilized tube length of 75 cm and a diameter of 1.5 cm with a plastic on the outer end of the funnel that holds about 0.5 liters of fluid, jug, 10-12 liters of disinfectant liquid (weak solution of sodium bicarbonate) or boiled water(isotonic).The temperature of the fluid sets the doctor in each case.
The patient is placed on the left side or at the back, under the buttocks enclose oilcloth.In the bed put a bucket to drain and a jug of liquid.The end of the tube introduced into the rectum, liberally smeared with Vaseline and is advanced by 20-30 cm. Make sure that the handset is not curled in a vial of the rectum, controlling it, if necessary, the position of the finger.
funnel should be kept slightly above the patient's body in an inclined position.Then it was gradually filling with liquid, lifted above the body to a height of 1 m. The water begins to pass into the intestine.Once the water level reaches a decreasing funnel narrowing its lowered over a bucket (or pelvis), without turning, as long as the water from the intestines does not fill funnel.In this position the funnel clearly visible air bubbles and lumps of faeces - the content was poured into a bucket filled with water and again funnel.The procedure is repeated several times until no further passage of gases, but not in the funnel will flow pure water.
After the procedure, the funnel is removed, disinfect and sterilize.Rubber tubes for 10-12 minutes left in the rectum, lowering its outer end in a basin for the outflow of liquid residues and gazootvedeniya.Then removed, cleaned, disinfected and sterilized.
Kids cleaning and siphon enema nurse spends with a younger nurse.There should be a quiet, relaxing atmosphere.It is advisable to carry out enema formulation in a special room.She may be a bathroom or powder room, in which there are medical couch, bathroom, etc.
If the patient can not move, enema formulation can be carried out in the ward.Under ideal conditions, a patient must be in a special box or chamber.If the patient is in a general ward, the patients who are permitted movement, asked to leave by a certain time.From the rest remaining in the chamber, the patient fence off a screen.Before the procedure, the nurse conducts explanatory conversation with all patients, observing all the rules of ethical behavior.Drip
enemas are classified as medicinal enemas, since they are used to compensate for the loss of blood or fluid (restoring amount of the circulating fluid, blood).Usually the drip is administered a 5% glucose solution with isotonic sodium chloride solution.
enjoy the same instruments as for the cleaning.The device for drip enema consists of a mug Esmarch, rubber tubing, drip, inserted between its segments, connecting and intestinal tubes.Before dropper to reinforce rubber tube clamp.With it regulated the flow of fluid in a drip (adults - 60-100 drops of children - 15-20 drops per minute).The patient lies in a comfortable position on your back.The solution is poured into a mug, heated to 37 ° C, filled into tubing by adjusting the frequency of the clip drops.Then direct the patient's intestine injected intestinal tube to a depth of 20-30 cm. The tube is suspended on a tripod.
Those solutions, as well as a 15% solution of amino acids (nutritional enema) can be administered to a rubber balloon in the rectum 2-3 times a day for 150-200 ml.Trickle enema is a more efficient method of administering drugs in body fluids, as, acting in the gut and drops soaked, they do not stretch the intestine, do not increase the intestinal peristalsis, and not provoke the act of defecation.
Drip enema easily tolerated by patients, do not cause pain and make it possible to introduce a large amount of liquid, not overflowing with the bloodstream.If there are no contraindications, before dropping to conduct a cleansing enema desirable or siphon enema, remembering that each one of them - a portable hard manipulation to the patient.
purpose of purgative enemas - not mechanical and thermal stimulation of the colon with a consequential increase in the intestinal motility, and laxative effect, ie,strengthening of the secretory function of the intestine and the regulation of intestinal peristalsis, which should not be violent.
During the procedure, which lasts a few hours, the sister should watch over it, to:
• due inflection tubes did not stop flow of fluid into the intestine;
• maintain a certain rate of infusion;
• not cooled solution, which douches mug placed in a cotton bag and put into the solution bottle with boiling water.
used for this vegetable oil, salt solution medium, various infusions of 100 mL administered with rubber cylinders.After the procedure, the patient should lie down quietly, so that the liquid does not leak from the rectum.Chair occurs usually after 12-16 hours.
When administering drugs by other possible, they can be administered via the rectum.Absorbed through the hemorrhoidal veins, they are bypassing the liver, quickly enter the blood.
Medicinal enemas are divided into local and general.