Before the late 1960s enema administration apparatus consisted of a 2 liter metal can with a tapered spout at the bottom that mated with a 2-3 foot length of opaque rubber tubing. This tubing was connected to a nozzle that ranged in size from a small straight length to a longer tapered instrument that resembled a bandicoot's snout. Small straight nozzles were useful in uncomplicated cases, but it was tough to beat a large tapered nozzle when retention problems caused unpleasant blow backs. Once a tapered nozzle was snugly ensconced within the leaky aperture, it tended to stay there, putting the brakes on the flustering back blow.
|"The only tidal wave I wanna see better be in the ocean."|
Enemas could be embarrassing for both patients and student nurses alike with Miss Bruiser's running commentary about our lack of arm strength. One of her favorite lines as we struggled with the heavy enema can was, "Is the responsibility of nursing care WEIGHING HEAVILY UPON YOU?" Of course it was and in more than one way.
The transition to disposable enema sets with crystal clear tubing illustrated an interesting phenomenon. While struggling to hold the clear enema bag airborne, an observant nurse noted the oscillation of the infused solution rising up and down with the patient's respirations. As the enema was nearing completion, expansion of the chest pressurized the colon causing the fluid level in the tubing to rise. Exhalation resulted in a marked descent of the fluid level.
Hand held enema bags and the graphic illustration of the to and fro flow of the solution provided one of those rather profound "EUREKA" moments in nursing history. The tidal wave enema was born. Nurses soon discovered that any enema could be super charged, so to speak, by aggressively raising and lowering the enema bag while the solution was flowing in. Suddenly raising the enema bag to it's maximum height from a level which was sometimes below the patient produced dramatic results. Patients often complained bitterly of cramping during the peak of the tidal wave, but the end results were often impressive in restoring normal bowel function.
Peristalsis, the progressive wave like movement of the bowel was frequently brought to a halt by old school open abdominal surgeries. When the surgeon noted an absence of bowel sounds during the post -op period, action was required. An order for TWE was written. A plain old TWE order was for the run of the mill tap water enema. A TWE order with wavy lines scribbled alongside was a directive to bring on the big guns of the tidal wave flush.
The proof was in the pudding with tidal wave enemas which worked wonders in restoring normal peristalsis. They really did the trick.