Administration of High-Volume Cone Enema

In this training video, a gastroenterology nurse at The Children’s Hospital of Philadelphia demonstrates how to give a high-volume cone enema to your child at home.

Start by gathering your supplies — an enema bag with tubing, a roller clamp and an attached cone, saline solution and lubricating jelly. Have your child lay on his left side and in the bathroom, if possible.

First, close the roller clamp. Then fill the enema bag with the amount of saline ordered by your child’s clinician. Next, apply lubricant to the cone and insert it into your child’s rectum where it will stay for about 10 minutes until all of the saline solution has flowed into your child.

The cone acts as a plug during the infusion. Once your child’s body has absorbed the solution, close the roller clamp, remove the cone from his rectum and have your child sit on the toilet for 30-45 minutes until the colon is cleaned out.

Enemas are not painful, but they can be uncomfortable and cause some abdominal cramping.


Enemas - Cone

Now the first demonstration we're going to use is with the cone enema. We're going to gather our supplies. This is an enema bag and it's measured in ccs. You may hear me interchangeably use the word milliliters, those are the same units of measure. The volume that you will fill the enema bag with is determined by your physician or nurse practitioner. They'll tell you how much to fill the bag with. All of that is based upon your child's weight.

The enema bag is connected to the cone. This is what's going to be inserted in your child's rectum. I understand it may look intimidating, but it actually is not a painful procedure. Attached to the enema bag is tubing attached with a roller clamp. Roller clamp opened will allow the fluids to run. Roller clamp closed will stop the flow of the fluids. You have all of your equipment. In addition, you will need some lubricating jelly, water soluble lubricating jelly.

The ideal position for this to occur, to have Johnny on his left side and that just has to deal with the actual anatomy of the colon. If Johnny would like to, he certainly can also be on his knees, chin to chest. The ideal location for this to happen would be in the restroom because after the enema is administered, there will be some urgency where Johnny will need to sit on the commode, and you don't want any accidents to happen in route to the commode.

So, we're going to get started. We're first going to fill the bag with the volume of the saline that your physician or nurse practitioner ordered. For the sake of this video, I actually already have saline, but for home, you will need to make the saline. It's pretty simple.

What you're going to take is half of a teaspoon of table salt and you're going to mix that in two cups of warm water. Two cups is equal to 16 ounces. That's simple solution that you'll make for the saline.

First thing that we're going to do is close the roller clamp, which it is already closed. Now, what would happen if I forgot to close the roller clamp? It wouldn't be the end of the world, it would simply mean that as you're placing the fluid inside of the bag, the bag would fill and the solutions would get all over the floor. Again, not the end of the world. So, we'll make sure the roller clamp is closed.

You can do this over the sink at home, and what you're going to do is open the bag and for the sake of this demonstration, we'll fill it up to 500 mls. There. We're then going to place the bag on a hook. Now in your bathroom, you can use a hanger and placed it on the end of the door or the shower curtain. You just would need a height of 5 to six 6 feet from the level of the bag to where the patient is. This bag, works by gravity. So, the higher the bag is, the faster the fluids will infuse. If you want to slow down the infusion, simply have the bag at a lower height.

So, Johnny is in position. He's on his left side. His knees are up. We're going to lubricate the tip of the cone. Okay Johnny, we're going to get started. You're going to put your hand on Johnny's buttock. Separate his cheeks and you're going to insert the cone. Now after the cone is inserted into the rectum, it will need to stay in place for a period of 10 minutes. This cone is going to act as a plug to help retain the saline solution inside of Johnny's rectum.

Now Johnny is old enough, he can actually participate in his care by holding the cone himself. If that's not the case, you'll have to hold the cone there for a period of 10 minutes. Again, to retain the fluids.

So, now the cone is inside of Johnny's rectum and we're ready to start the infusion. How do we do that? We open the roller clamp. You should see the fluid leaving the bag and entering Johnny. Again, we're going to hold this for the duration of 10 minutes. While we are infusing the solution, it is common for the child to have some cramping. What we would do is massage the abdomen in a circular motion and that will kind of alleviate some of the cramping and also help with peristalsis.

So, we're going to sit here for a period of 10 minutes until all of the fluid has infused and then all of the fluid has been retained.

So, it's been 10 minutes and now it's time to remove the cone. What we're going to do? We're going to close the roller clamp. We'll remove the cone from Johnny's rectum. Now, it's time for Johnny to sit on the commode for a period of 30 to 45 minutes to evacuate his colon.

At this time, feel free to clean the supplies. You can use warm soap water and fill the bag and clean off the end of the cone. Let it air dry.

Topics Covered: Enema Procedure and Administration

Related Centers and Programs: Kohl's GI Nutrition and Diagnostic Center, Division of Gastroenterology, Hepatology and Nutrition