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Publication Type: Medical Safety Information
Single or Multiple Incident: Multiple
Date: 12/1/2019 12:00:00 AM
Country: Japan
This alert addresses the risk of administering an enema to a patient in a standing position instead of having the patient lie in a left lateral decubitus position. Four cases were reported in which rectal injury resulted from the administration of a glycerin enema in a standing position. Two cases are described. One resulted in a rectal perforation while the other resulted in mucosal damage. The alert provides recommendations to prevent similar incidents.

Additional Details

Medication/Gas/Fluid:
glycerin enema

Rules / Policies / Procedures
  1. Administer enemas in the left lateral decubitus position.
Training
  1. Ensure that all the institution’s medical staff are aware of the risk arising from administering enemas in a standing position and explain it to the patient, too.

Rectal Injury Due to Glycerin Enema Administered in a Standing Position