Wednesday, March 18, 2020

Getting to the Bottom of the Tidal Wave Enema Story

The trinity of nursing care for big invasive abdominal surgeries included scultetus binders, Montgomery straps, and last, but certainly not least, tidal wave enemas. I briefly mentioned tidal wave enemas in a previous post and I received an email asking about the unsavory details of this backward procedure. I just love esoteric, little known nursing procedures and  nothing came up when I googled tidal wave colonics. So, an idea for this  post about this bowel ballooning buffoonery was born

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."
Rank had privilege in hospital  nursing and full fledged RNs had the benefit of an IV pole to suspend an enema can above their anxious patient awaiting the hydraulic highjinks. Student nurses were mandated to hand hold the enema can at the prescribed height; no easy feat with a fully loaded 2 liter can. That loaded can got heavy rather quickly unless you had the arm strength of Miss Bruiser, my favorite instructor.

 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.

12 comments:

  1. I just love your Miss Bruiser OFRN! What a great character! I would love more stories about her!
    Glad my days of having to give enemata to long suffering patients are long over... cheers, Sue

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  2. Thank heaven the OR was an enema free environment. Older nurses were overly enthused about the therapeutic value of enemas. There were stimulant enemas, carminative enemas for distention, antihelminic for parasites, Neomycin preop enemas and various solutons for nutrition. The all time worst enema in terms of discomfort and end result was a
    milk and molasses concoction affectionately referred to as the "M&M." The amount of gas and cramping produced by this witch's brew produced was truly a Vesuvius like event.

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  3. You describe it beautifully OFRN - A Vesuvius like event!

    We always used to say that nurses develop a very "basic" sense of humour - it was the only way to survive! Cheers, S.

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  4. "The proof was in the pudding." OMG!

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  5. Jono, I thought that little parting nugget would go unnoticed. Just more foolishness!

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  6. I hope you're doing well, wherever you are. Stay safe! And thank you for the continued posts - I have always enjoyed reading your blog, but want to emphasize how much I appreciate you.

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    1. Thanks so much for your kind words and I hope that you are well too. I was into social isolation before it was in vogue and other than my usual age related problems feel fine.

      I'm SE of Pittsburgh and there were 30 new Corona virus cases identified today in Allegheny County. We have had 7 deaths and one poor soul was diagnosed post mortem.

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  7. Every hospital had a "house special" when it came to enemas. At our elite institution the bell ringer of enemas was termed "The rolling thunder." The instillation began with the patient on his right side and then proceeded to supine and finished up lying on his left side. The twisting and turning helped the flow cover the complete colon.

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    1. I'm thinking that it might be a challenge for a patient with an enema tube inserted to turn on his back. Maybe turning to a prone position might be easier. Anyhow, I bet a duet of the rolling thunder enema with a tidal wave would make for some impressive music.

      Thanks for perusing my foolishness and taking the time to leave a comment. Stay safe in these bizarre times!

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  9. We used to call tidal wave enemas EBB & FLOW.

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