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57 The mechanism of action – dilution of feces and peristalsis increasing. Indications: constipation; poisoning; before giving enemas: medicinal, drip, siphon; before introducing of a flatus tube; before operations; before X‑ray and endoscopic study of the gastrointestinal tract; before labor; to prepare the patient for radiological study of organs of the urinary tract and pelvis. Contraindications: acute cerebrovascular accident; myocardial infarction; inflammatory diseases of the rectum and anus; bleeding hemorrhoids; the first days after operation on the digestive tract; hypertension; bleeding from the digestive tract; massive edema; tumors of the rectum. Equipment : Esmarch’s irrigator, sterile rectal cannula, 1–1.5 l of water with temperature 22–24 °C, tripod, cotton wool, vaseline, a bedpan or bowl, plastic spatula, tweezers, gloves, water thermometer. The sequence of actions in performing a cleansing enema. 1. Hang Esmarch’s irrigator on a tripod, close the valve on the rubber tube. 2. Take rectal tip by forceps (or sterile cloth), check its integrity. 3. Put the tip on the rubber tube of the Esmarch’s irrigator. 4. Put water in the irrigator, pre-measuring the temperature (22–24  0 C). 5. Open the tap and fill the system, displacing air and directing a jet of water to the bedpan basin or bowl. 6. Ask the patient to lay on the left side, to bend his knees and press to the stomach. 7. Type by spatula necessary amount of vaseline and grease the tip, put on gloves. 8. With your left hand, spread the buttocks of the patient. By the right hand enter the tip with rotational movements in the rectum first 3–4 cm towards the navel, then parallel to the sacrum to a depth of 10–12 cm (Fig.24). 9. Holding the tip, open the tap and enter the liquid into the bowel. 10. Ask the patient to keep water in the bowel for 5–10 minutes (ask him to lay on his back and to breathe deeply). Siphon enema cleanses the bowel more effectively, because it is washed by water repeatedly. This is a heavy manipulation for the patient, so it is necessary to closely monitor his condition. Fig. 24. Enema technique