June 22, 2014 at 4:30 PM #13673
By popular demand, here is my way of cleaning people out:
The Hautala method of giving an enema: Hautala’s High, Hot, Hell of a lot, Hold it ‘til you Hiccup Enema.
The tubing which comes attached to the enema bucket is pretty stiff and I know of at least one case in which the colon was perforated with that tube and the patient died, (no, it wasn’t me.) This made me worried to ever stick that death tube up someone’s backside, so I now use my own method to avoid killing people.
Hook the enema tubing up to the bucket as normal, but the lubricated end with the holes in it, cut that part off. Find the largest Foley catheter you can find (we typically only go up to 20Fr, but if you can find a 24Fr cath, that works even better.) Do NOT use a coude catheter for this. One would think that the tip shape would help get proximal to the stool blockage, but coude catheters have only one hole which can be plugged with poop instead of two holes like found on most Foley catheters, (more holes are better when you are pushing it through poop.)
Connect the enema bucket tubing to the Foley cath. It will look like it is a perfect fit, but it isn’t. You will want to wrap the junction with tegaderm or opsite or some product like that to keep fluid from leaking out. Next put the castile soap packet into the bucket and then also squeeze about 20 packets of surgilube or KY Jelly or whatever you water soluble lubricant you use. Not only will this fill the colon with something slippery, it also makes the water cloudy/chunky so you can see the water flow down the tubing and you will know if there is a blockage.
Fill the bucket up to the top with hot/warm water, (don’t burn their colon out, but 40C is a good temp. Next step is to find a garbage liner and a roll of tape. In addition to the chucks pad you will place under the patient, have the patient lay on her left side and tape the garbage bag liner under the buttocks along the back, below the rectum, and then down the left leg for a ways. This will collect the fluid as it comes out. I usually turn the suction canister on full and have that handy to suck out any of the foul smelling fluid that comes out. You should use the tubing without the Yankuer attached and get rid of the elbow shaped attachment on the suction canister and connect the tubing to the ortho port instead of the patient port because you don’t want it to get plugged up with corn or peanuts or anything like that.
You are now ready to Stick It to Them. Lube the Foley as well as you are able and put it up the poop shoot all of the way to the hilt. When you hit the blockage it sometimes helps to give a twisting motion to get the catheter to go along the side of it instead of coiling up or getting buried in stool. Do your best to get the tube proximal to the stool blockage. If both holes of the catheter get blocked with stool, you can leave the clamp open so water can flow and “milk the Foley cath” like we used to do with chest tube tubes before we realized we were killing people by doing that. This will push enough water through the system that the water with lubrication will flow in. Put in as much as they can tolerate. If fluids start to leak out (stand at the patient’s shoulders and not her knees, as sometimes it comes out with some pressure,) use the suction tubing to suck it up out of the garbage bag liner and into the smell proof canister.
Have the patient hold the fluid in as long as they can. If you get proximal to the blockage, you can usually get at least a liter of fluid in. I will typically leave the catheter in place to help plug the dam, so to speak, but I don’t inflate the balloon like a retention enema as I have heard some people cause damage by inflating the balloon too much and causing pressure on the colon walls.
If they are able to hold it in for 5-10 minutes I will have them roll over onto their right side to slosh the lube over towards the appendix. When they can no longer hold the fluid in, or whenever I get tired of waiting I get them up to the restroom, (stand on their side, NOT behind them, just saying.)
This method has worked wonders for me and I have become the enema king at work.
As a side note, if the patient is full of gas, you can use this same method, but when you fill the patient with the fluid, put the bucket on the ground. The fluid will drain back out into the bucket, and then the syphon effect will suck the extra air out of the colon. It will bubble for several minutes. If at all possible, have a nursing student or new nurse hold the catheter in place during the bubbles so you can leave the room to pretend to chart … those bubbles to not smell very good.
Some of you old school nurse may remember milk and molasses enemas. This method works very well for giving those, and they work with a vengeance, but just adding several packets of lube to the water seems to be all of the extra help I need to get someone cleaned out well.
Enjoy your next enema and stay MIGHTY.June 22, 2014 at 5:06 PM #13674
Disclaimer: I’m poor as dirt, so if you kill someone doing this, you should have followed your hospital’s policy. Don’t sue me.June 23, 2014 at 8:50 PM #13695
After charting this method several times I decided to save time by just stating, “enema given using the Hautala method,” and have never had a chart come back to me 🙂 Now that it is officially described online, feel free to use “Hautala method” in your charting too 🙂
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