Administration of High-Volume Enema Using a Red Rubber Catheter

In this training video, a gastroenterology nurse at The Children’s Hospital of Philadelphia demonstrates how to administer a high-volume enema to your child using a red rubber catheter.

Start by gathering your supplies — an enema bag, connection device, red rubber catheter, lubricating jelly and a tape measure. Have your child lay on his left side and in the bathroom, if possible.

First, you need to measure the red rubber catheter at 6 inches and 10 inches to ensure proper placement into your child’s colon. You never want the catheter to be inserted more than 10 inches.

Once the enema bag is connected to the red rubber catheter, close the clamp, then add the amount of saline that your child’s clinician directed. Hang the enema bag.

Next, lubricate the tip of the red rubber catheter. Insert it into your child’s rectum in a twisting motion. Once the catheter is inserted between 6 and 10 inches, open the clamp and allow the infusion solution to flow into your child. You can massage your child’s abdomen to minimize cramping.

Once your child’s body has absorbed the solution, wait another 10 minutes, then remove the catheter 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 Rubber Catheter

Nicole: So, this is our third and final delivery method of providing a saline high-volume enemas. At this point, we're going to use a red rubber catheter. If you notice with this catheter, it does not have a port for a balloon inflation. This size of this catheter is a 24 French. That is actually going to be determined by your physician or nurse practitioner, but you will use anywhere from a 24 to a 26 French red rubber catheter. The rest of your supplies will remain the same. You'll need an enema bag. You'll need a connecting device, water soluble lubricant, and a measuring tape.

So, one of the first things that we're going to do, we're going to measure the catheter and mark it to give you an idea of how far to insert this red rubber catheter. Now the difference between this catheter and the Foley catheter, one, we don't have a balloon so we won’t be retaining any fluids with the help of a balloon. In addition, we're actually going to go farther inside of the colon than you would with a Foley catheter.

So, we want to measure and mark the distance that we're going to insert the catheter. We'd like to measure at a point of 6 inches and mark it. And again we're going to measure at 10 inches and mark it. The maximum that you will insert the red rubber catheter is 10 inches. You do not want to go beyond 10 inches. So now we're going to connect all of our supplies.

We're going to take the tubing from the enema bag, connect it to the red rubber catheter by way of the connection device. Simply insert the connection device into one end and the red rubber catheter into the other. Make sure all your connections are secure.

You're then going to take your bag and get it ready to receive the fluids. First thing you need to do? Make sure your slider clamp is closed. You'll need two hands to make sure that the clamp is closed.

So, again, we're going to use the same amount that we've been using, which is 500 milliliters. Again, based off of your physician or nurse practitioner's orders.

It's time to hang the bag, and we're now going to prime the fluids through the tubing. You're going to need two hands. You prime it by opening the slider clamp. It will prime through quickly.

And close the roller clamp. And now we have Johnny in position on his left side. We're going to lubricate the tip of the catheter.

And we talked about how far we're going to go in. You want to take a look at your markings, 6 inches and 10 inches. While Johnny is on his side, you're going to spread his buttocks and insert the catheter. We talked about ease of insertion by placing the catheter inside and inserting it in a twisting motion.

This is not a painful procedure. Johnny will feel the catheter, but he shouldn't be uncomfortable. Once the catheter is in place, we're going to hold it in place with our hand and we're going to open the slider clamp to infuse the enema.

While the fluids are infusing, massage Johnny's stomach. Again, you're going to need to hold the catheter in place so that it doesn't migrate in and out of the rectum. Once all the fluid has been removed from the bag, you're going to hold this catheter in place for a period of 10 minutes. Once the catheter has been removed, you'll need Johnny to sit on the toilet for a period of 30 to 45 minutes to fully evacuate his colon.

During that time, you can use that time to actually clean your supplies. You can rinse out your bag and your catheter with warm soapy water and 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