ENEMAS (grech, klysma washing) — administration of liquids in a large intestine through an anus from the special or adapted tanks.
Distinguish To. medical and diagnostic, contrast (see. Irrigoskopiya ). Assessment of volume of the liquid coming to intestines (e.g. can have diagnostic value, at intestinal impassability), however a main type To. are medical To.
Medical To. make for removal of contents of a large intestine (cleaning, aperient and promyvatelny To.), and also for the purpose of local (on a mucous membrane of a large intestine) or resorptive effect of the entered substances — medicinal and nutritious To. On a way of administration of liquids and their volume allocate also microclysters and drop To.
The general contraindications for all types To. acute inflammatory and ulcer processes and cracks in the field of an anus, the bleeding hemorrhoids, insufficiency of a proctal sphincter, acute peritonitis are, acute went. - kish. bleeding, and also acute cardiovascular insufficiency.
To. are appointed the doctor, they are usually made by the nurse or experienced junior medical staff under control of the nurse or paramedic.
Cleansing enemas (oporozhnitelny) are appointed at locks of various origin, at food and other poisonings for the purpose of removal of toxicants, before operations, childbirth, before use medicinal and nutritious To., and also for preparation to rentgenol, to a research of abdominal organs, bodies and pelvic bones, lumbar department of a backbone.
Contraindications, except the general, to cleaning To.: acute inflammatory and cankers of a large intestine, an acute appendicitis, the breaking-up tumors of a large intestine, the postoperative period at abdominal organs operations.
At chronic locks it is not necessary to abuse cleaning To., to the Crimea there is an accustoming (see. Locks ).
Cleaning To. put by means of the glass (graduated) or rubber Esmarch's irrigator from 1 to 1,5 l (fig. 1) or a funnel of 0,5 — 1 l connected by a rubber tube length apprx. 1,5 m to the special tip entered into an anus. For To. pure water in volume from 750 ml to 2 l for the adult, with a temperature of 25 — 35 ° is used. If necessary to cause additional irritation of receptors of a large intestine (at atonic locks) use water of lower temperature (from 20 to 12 °) or apply cool hypertensive To. from 2 — 3% of solution of sodium chloride. For strengthening of cleaning action To. sometimes add to water 30 — 50 g of glycerin, vegetable oil (castor, sunflower, etc.) or one tablespoon of a soap chip (from bath or baby soap), to-ruyu is dissolved in water without foaming. At spastic locks are more effective warm and hot To. (water temperature from 37 to 42 °).
Technology of statement To. (fig. 2): introduction of a tip shall not cause in sick sensation of pain; at too bystry and careless introduction of a tip the mucous membrane of a rectum is easily injured. At introduction to a large intestine of liquid there can be a feeling of filling and weak pains on the course of a gut; if pains become strong, it is necessary to reduce head of water. The entered liquid, stimulating a peristaltics of a large intestine, soon causes desires on defecation which the patient needs to constrain within not less than 5 — 10 min. since certain time that force of peristaltic reductions became sufficient for effective emptying of a large intestine is required.
Aperient enemas use for stimulation of independent emptying of a large intestine at atonic locks. Usually are for this purpose put hypertensive and oil To.
At hypertensive To. enter a small amount (50 — 100 ml) of hypertensive solution by means of a rubber pear-shaped bulb (fig. 3) or the Jean syringe with the rubber tip which is put on it into a rectum; use 10% solution of sodium chloride, 20 — 30% solution of magnesium sulfate or sodium sulfate. After introduction to a gut of hypertensive solution to the patient recommend to refrain from defecation within 20 — 30 min. Hypertensive solutions thanks to the osmotic action strengthen transudation of liquid through a mucous membrane of a rectum, irritate a mucous membrane and stimulate a peristaltics of a gut that causes desires on defecation and plentiful, the liquid chair is more often. In this regard hypertensive To. use sometimes in treatment of an edematous syndrome and the intracranial hypertensia connected with wet brain and its covers. Hypertensive To. are not shown at spastic locks since can strengthen a spasm of a wall of a large intestine.
Oil To. appoint at persistent locks. Usually vegetable oils — sunflower, linen, hempy or vaseline in a warm look (t ° 37 — 38 °) in number of 50 — 200 ml are used. Oil is entered into a rectum of the patient by slowly pear-shaped rubber bulb of 100 — 200 ml or the Jean syringe with use of a rubber tip. During introduction of a tip and 20 — 30 more min. after oil loading the patient lies on the left side with the legs given to a stomach that oil did not flow out from an anus at once. To. put usually in the evening, before going to bed, calculating that the laxative effect will occur in the morning, i.e. in 10 — 12 hours after oil loading. Warm oil promotes relaxation of a wall of intestines; extending between a wall of a gut and fecal masses, it promotes mechanical advance of fecal masses, rendering besides some softening, antiinflammatory effect on a mucous membrane. Under the influence of an indestinal flora a part of vegetable oil is gradually split with education fat to - t which stimulate a peristaltics of an intestinal wall. Also aperient microclysters from 5 — 10 ml of glycerin which is usually entered into a rectum by the syringe by means of a soft catheter are applied. If laxative To. did not give effect, it is necessary to resort to additional cleaning To.
Promyvatelny enemas. Treat them siphon To. Subaqual bathtubs and intestinal washings (see) are also promyvatelny procedures.
Siphon To. are used: in the absence of effect from cleaning and laxatives K.; for removal from intestines of products of the strengthened fermentation and rotting or toxic agents at poisonings and intoxications, including and endogenous (e.g., at uraemia); for removal of accumulations of slime and pus from a large intestine at it hron, defeat; at mechanical intestinal impassability as training of the patient for operation and with the diagnostic purpose (in the absence of allocation with rinsing waters of vials of gas and fecal masses the probability of this diagnosis is higher, but also the otkhozhdeniye of nek-ry amount of the gases and fecal masses which accumulated below the place of an obstacle is possible); at dynamic impassability with to lay down. purpose.
A contraindication for siphon To. at acute impassability of intestines suspicion of thrombosis or a vascular embolism of a mesentery, and also heavy cardiovascular insufficiency is.
For siphon To. (fig. 4) use a big funnel — of 1 l and more, connected to a rubber tube of 1 — 1,5 m of length, to internal dia. 10 mm and a rubber tip 20 — 30 cm long (instead of to-rogo the thick gastric tube can be applied). In position of the patient lying on spin with the legs which are a little bent in knees under a basin of the patient enclose an oilcloth and the vessel. The tip or the end of the thick rubber probe grease with vaseline and enter on 20 — 30 cm into a direct and sigmoid gut, then, holding a funnel slightly higher than the level of a basin of the patient, fill it almost to top with pure water (or solution of potassium permanganate 1: 4000) also lift above; at the same time water from a funnel passes through system in intestines of the patient. After the water line, decreasing in a funnel, reaches its narrowing, the funnel is lowered below a couch, on a cut the patient lies, and water from intestines together with vials of gas and pieces of fecal masses begins to come to a funnel. Having poured out contents of a funnel, it is filled with pure water again and continue enteroclyses of 10 — 15 more times (i.e. 10 — 15 l of water are required) and more until transparent water without visible impurity of fecal masses begins to come to a funnel from a gut.
Medicinal enemas use as for local impact on a mucous membrane of a large intestine, and for the purpose of introduction of drugs of resorptive action. Before medicinal To. it is usually put cleaning To. At diffusion subacute and hron, spastic, catarral and erosive and ulcer colitis for medicinal To. usually apply warm solutions (t ° 38 °) which in number of 500 — 1000 ml quite often enter kapelno. Medicinal solution for microclysters by means of a rubber pear-shaped bulb or the Jean syringe with a long rubber tip (e.g., a catheter) is entered deeply into a rectum of the patient. Microclysters are applied 1 — 3 time a day. Apply various antiinflammatory, spasmolytic, antimicrobic and antiparasitics. Use enveloping To. from starch (2 — 3 chayn. l. on 2 — 3 glasses of water), To. from infusion of a camomile (to the 5th a table. l. the dried-up flowers of a camomile to insist on 1 l of boiled water 2 hours, then to filter through a gauze and to enter in a warm look) which are shown also at enterospasms, a meteorism and ponosa. Often resort to To. the knitting action from protargol (1000 ml of 0,1 — 0,2% of solution), a tannin (500 ml of 0,5 — 1% of solution), potassium permanganate (solution 1: 4000).
At an acute and subacute proctosigmoiditis apply medicinal To. with warm luccu oil (30 — 50 ml), antipyrine (20 ml of 1,5 — 2,5% of solution), colloid silver (30 ml of 0,25% of solution), etc. At a proctalgia to lay down. to a microclyster add 0,1% solution of Atropini sulfas (1 — 2 ml), appoint warm novocainic To. (20 — 30 ml of 0,75% of solution); in the presence of bloody allocations from a wall of distal department of a large intestine add 0,1% to microclysters solution of adrenaline (0,5 — 1,0 ml on 100 ml of solution), astringents. At the expressed fermentation in intestines and ponosa enter astringents in the form of microclysters: 50 g of white clay or 2 — 4 g of bismuth of nitrate of the basic on 200 ml of warm water. Warm oil To. with sea-buckthorn oil, fish oil or vaseline (20 — 50 ml) in pure form or in the form of an emulsion with warm alkaline mineral water (50 — 200 ml of mineral Yessentuki No. 4 water or No. 17, Berezovsky, Mirgorod and so forth) appoint at hron, an atrophic proctosigmoiditis. At indications in the form of microclysters it is possible to enter corticosteroid hormones.
From the antibacterial drugs administered in a small amount of liquid — from 10 to 100 ml (microclyster), 0,02% solution of Furacilin (100 ml), 0,05 — 0,1% solution of Aethacridinum of a lactate (Rivanolum), by 1 — 1,5% solution of soluble Streptocidum (100 ml), 10% a sintomitsinovy emulsion (15 — 30 ml), a suspension of Enteroseptolum (from 1 — 2 tab.), some antibiotics, etc. are applied. At an enterobiosis are sometimes applied garlick
by K. Lekarstvennye K. of resorptive action appoint in case of impossibility or inexpediency of introduction of medicine inside or in injections. Not changed mucous membrane of a large intestine has good vsasyvatelny ability in this connection concentration of some drugs entered with the help To., in blood can be higher, than at their introduction in the same dose orally, due to their transition to blood through an anastomosis of a hemorrhoidal veniplex bypassing a liver where many drugs are inactivated.
By means of microclysters a large amount of different medicinal substances of resorptive action can be entered into an organism: cardiac glycosides, hypnotic drugs and drugs, sodium salicylate, etc. If it is necessary to enter the medicinal substance produced in the form of drops it gets divorced in 30 — 100 ml of water or fiziol, solution and then is entered in the form of a microclyster.
Drop To. introductions of large amounts of liquid in the form of isotonic solution of sodium chloride or glucose (are generally applied to introduction of drugs in the large volume of solution (more than 200 ml), usually at the indications similar for hypodermic injections of these liquids), and also to administration of nutritious solutions (see. Parenteral food ). Before drop To. surely put cleaning To.
The device for drop To. (fig. 5) consists of an Esmarch's irrigator, a rubber tube with the dropper inserted closer to an Esmarch's irrigator, a tip for introduction to a rectum and a clip or the switch. Usually use a long rubber tip (30 — 40 cm) diameter apprx. 0,5 cm with side openings for more uniform intake of medicinal substance in distal departments of a large intestine and the best absorption. By means of a clip or the switch the speed of receipt in a large intestine of medicinal solution is regulated, edges are made most often by 60 — 100 drops in 1 min. (for adults).
For the best absorption use warm solutions (to t 43 °).
Use of enemas at children's age
At children is applied cleaning, medical, nutritious are applied by K. Ochistitelnye K. at locks, poisonings, before introduction of medicinal enemas and rentgenol. inspection of abdominal organs. Cleaning To. prepare from boiled water t ° 28 — 38 °. At atonic locks water temperature can be reduced to 20 °. The amount of water depends on age of the child (table).
For To. apply only a rubber tip (not to wound a mucous membrane of a gut), which is plentifully oiled liquid. At children of advanced age it is possible to use an Esmarch's irrigator; to children up to 5 years for To. apply rubber bulbs which before the use need to be boiled. To fill a cylinder, it is squeezed before full replacement of air then lower a tip in water and take her. Then lift a tip up and let out the air before emergence of water. Under the child it is necessary to enclose an oilcloth and to cover it with a bed-sheet. The child is stacked on the left side, holding with the left forearm a body of the child, and the left brush — the legs bent in knees and pressed to a stomach. The right hand enter a tip into a rectum on 3 — 5 cm (depending on age of the child). Liquid should be entered slowly without big pressure.
If use an Esmarch's irrigator, then it is lifted by not higher than 60 cm. After extraction of a tip it is necessary to squeeze buttocks for several minutes to hold water for a sufficient softening a calla.
For strengthening of aperient action To. it is possible to add glycerin (1 — 2 chayn. l. on 1 glass of water). Sometimes use oil To. from liquid or vegetable oil (30 — 50 ml on an enema). Before the use vegetable oil should be boiled for removal fat to - t.
At the paresis of intestines which is observed quite often at babies at a number of diseases put hypertensive To. from 10% of solution of sodium chloride (20 — 30 ml).
At to prostaza apply siphon To. with the general water discharge no more than 1500 ml for children till 1 year, apprx. 5 l for children at the age of 2 — 5 years and apprx. 8 l for children of advanced age.
Medicinal To. it is put to children according to the same indications, as adults, in 15 min. after cleaning K. Temperatura of the entered liquid shall approach the body temperature of the child. Liquid with medicinal substance is entered in a small amount (no more than 15 — 50 ml) and slowly to avoid desires on defecation. After introduction of medicine slowly take a tip and for 10 — 15 min. squeeze buttocks that liquid did not come out back. Drugs which can cause irritation of a mucous membrane of intestines enter with addition of the warm made starch.
To babies at a meteorism quite often apply To. from the camomile which is adsorbing gases and having the weak knitting effect on a mucous membrane of intestines (1 — 2 chayn. l. camomiles on 1 glass of boiled water insist 2 — 3 hours, and then filter). At ulcer coloenterites apply To. from sea-buckthorn oil and oil of a dogrose (20 — 30 ml on an enema). At an enterobiosis recommend soda To. for the night (1/2 chayn. l. soda on 1 glass of water).
In children's practice widely apply To. with analgetics (analginum, pyramidon). Also microclysters in the form of hermetically the corked rectal Pipettes from polyethylene with the dosed maintenance of drugs in the form of emulsions, suspensions, linimentums (pyramidon, antipyrine, Butadionum, furasolidone) are offered.
Table. The recommended amounts of liquid for cleansing enemas at children of different age
A. L. Grebenev; V. L. Zubkova (ped.)