How do you administer rectally? A guide to proper rectal medication administration

Rectal administration is an effective drug delivery method that can bypass the liver's first-pass metabolism, potentially increasing a drug's bioavailability. For patients who cannot take oral medications due to nausea, vomiting, or other conditions, knowing how do you administer rectally is an important skill for safe and effective treatment.

Quick Summary

Rectal medication is administered using various forms like suppositories, enemas, and gels for local or systemic effects. The process requires specific preparation, positioning, and insertion techniques to ensure proper absorption and patient comfort.

Key Points

• Hand Hygiene: Wash hands thoroughly before and after administration to prevent infection.

• Proper Positioning: Lie on your left side with the right knee bent (Sims' position) to facilitate easier and more comfortable insertion.

• Use Water-Soluble Lubricant: Always use a water-based lubricant to ease insertion and ensure medication absorption. Avoid petroleum jelly, which can block absorption.

• Ensure Retention: After inserting a suppository, remain lying down for 15 minutes. After an enema, encourage the patient to retain the fluid for the directed period to maximize absorption.

• Know Your Contraindications: Do not use the rectal route for patients with active rectal bleeding, severe diarrhea, or recent rectal surgery, and follow all professional guidance.

• Store Properly: Keep rectal medications, especially suppositories, in a cool place to prevent melting before use.

• Consider the Blunt End First: When inserting a suppository, placing the blunt end first can sometimes improve retention by helping the rectal sphincter hold it in place.

What is Rectal Administration?

Rectal administration involves inserting medication into the rectum, offering an alternative when oral intake is not feasible due to vomiting, unconsciousness, or difficulty swallowing. The rich blood supply in the rectum allows for potential rapid absorption and a quicker onset of action compared to oral routes, with some of the drug bypassing liver metabolism. Medications for rectal administration come in forms such as suppositories, enemas, and semi-solids like gels or foams.

Advantages and Disadvantages

Advantages of Rectal Delivery

• Bypasses first-pass metabolism: A portion of the drug enters the systemic circulation directly.
• Suitable for certain patients: Ideal for those unable to take oral medications.
• Treats local conditions: Effective for conditions like hemorrhoids and IBD.
• Reduced gastric side effects: May cause less irritation to the stomach.

Disadvantages and Considerations

• Patient discomfort and acceptance: Some patients find this route uncomfortable.
• Erratic absorption: Factors like fecal matter can affect drug uptake.
• Contraindications: Avoid in cases of recent rectal surgery or bleeding.
• Risk of irritation: Can sometimes lead to local irritation.

How to Administer a Suppository

A suppository is a solid form of medication that melts or dissolves in the rectum.

Preparation:

1. Wash hands thoroughly.
2. If soft, harden the suppository under cool water or in a refrigerator.
3. Empty bowels if possible.
4. Remove wrapper and handle minimally.
5. Lubricate the tip with a water-soluble lubricant.

Positioning:

• Lie on your left side with your upper leg bent (Sims' position) to relax the sphincter.
• Alternatively, stand with one foot on a chair and lean forward.

Insertion (Adults):

1. Separate buttocks.
2. Gently insert the suppository about 1 inch past the sphincter, rounded end first is common, though the blunt end first may aid retention.
3. Hold buttocks together for a few seconds.
4. Remain lying down for at least 15 minutes.
5. Wash hands.

Insertion (Infants and Children):

1. Clean hands.
2. Position the child on their left side with knees bent.
3. Insert the suppository about 1/2 to 1 inch, past the sphincter.
4. Gently hold the child's buttocks together for a few minutes.
5. Wash hands.

How to Administer a Rectal Enema

Enemas are liquid preparations for medication or bowel cleansing.

Preparation:

1. Wash hands and put on gloves.
2. Prepare the solution and ensure it's at room temperature.
3. Place a waterproof pad.
4. Explain the procedure.

Positioning:

• Have the patient lie on their left side with the right knee bent (Sims' position).

Insertion:

1. Lubricate the nozzle.
2. Lift the upper buttock.
3. Gently insert the nozzle 3 to 4 inches for adults, towards the umbilicus.
4. Slowly infuse the solution, pausing if uncomfortable.
5. Encourage the patient to retain the solution for 5 to 15 minutes.
6. Dispose of equipment and wash hands.

Using Rectal Gels, Foams, and Creams

These semi-solid forms are often used for local treatments.

General Steps:

1. Wash hands and ensure the area is clean.
2. Attach the applicator if needed.
3. Lubricate the applicator tip with a water-based lubricant.
4. Follow positioning guidelines similar to suppositories or enemas.
5. Gently insert the applicator tip as far as comfortable.
6. Dispense the medication.
7. Slowly remove the applicator while keeping the container compressed.
8. Follow instructions and wash hands.

A Comparison of Rectal Dosage Forms

Feature	Suppositories	Enemas	Gels/Foams
Form	Solid, melts or dissolves in rectum	Liquid solution or suspension	Semi-solid, often dispensed with an applicator
Speed of Action	Medium; must melt/dissolve first	Fast; liquid state allows for quick absorption	Fast, particularly for local effect
Purpose	Local (e.g., hemorrhoids) and systemic (e.g., pain, fever) effects	Local (e.g., constipation, IBD) and systemic effects (e.g., seizures)	Primarily local (e.g., hemorrhoids, colitis)
Retention	Good; designed to stay in place, especially when blunt end is inserted first	Variable; patient must retain solution for a specific time	Better than liquids; mucoadhesive properties can improve retention
Ease of Use	Moderate; may be uncomfortable for some	Variable; larger volumes can be harder to retain	Moderate; applicators aid targeted delivery
Absorption Consistency	Variable; influenced by rectal contents	Variable; can be affected by bowel motility	More consistent for local effects

Contraindications and Best Practices

Certain conditions make rectal administration unsafe. Always consult a healthcare professional first.

• Active rectal bleeding: Increases unpredictable systemic absorption.
• Neutropenia or thrombocytopenia: Higher risk of infection and bleeding.
• Rectal or bowel surgery: Contraindicated shortly after surgery.
• Diarrhea or fecal impaction: Interferes with absorption.

Best Practices:

• Always perform hand hygiene.
• Store medications properly, often in a cool place.
• Trim fingernails.
• Use only water-soluble lubricant.
• Ensure patient privacy and comfort.

For specific medication details, such as diazepam rectal gel, consult authoritative sources like the Texas Department of State Health Services.

Conclusion

Rectal administration is a valuable alternative for medication delivery when oral intake is not possible. Following proper procedures for suppositories, enemas, and gels, understanding risks, and observing contraindications ensure safe and effective treatment. Prioritize hygiene, correct technique, and patient comfort, and always consult a healthcare provider with questions.

Frequently Asked Questions

What is the best position to administer a rectal suppository?

The Sims' position is generally recommended. Lie on your left side with your left leg straight and your right knee bent toward your stomach. This position helps relax the sphincter muscle and provides good access for insertion.

Can I use petroleum jelly to lubricate a suppository?

No, you should not use petroleum-based lubricants like Vaseline. These can prevent the suppository from melting and releasing the medication properly. Use a water-soluble lubricating jelly instead, or moisten the area with cool tap water.

What should I do if a suppository is too soft to insert?

If a suppository is too soft, you can hold it under cool running water while it's still in the wrapper or place it in the refrigerator for a few minutes to harden it before unwrapping and inserting.

How deep should a suppository be inserted?

For an adult, a suppository should be inserted about 1 inch (2.5 cm), or past the muscular sphincter, to prevent it from being expelled. For children, the depth is typically less.

What should I do if the medication leaks out after administration?

Leakage can occur with liquid forms or if a suppository isn't inserted far enough. For suppositories, hold the buttocks together for a few seconds and remain lying down. For enemas, ensure the patient holds the liquid for the recommended time.

Are there any conditions where I should avoid rectal administration?

Yes. Avoid rectal administration if the patient has active rectal bleeding, severe diarrhea, or a recent rectal or bowel surgery. Additionally, patients with neutropenia should avoid this route due to the risk of infection.

How can I make the process less uncomfortable for a patient?

Ensuring the patient's privacy and explaining the procedure can help. Using a water-soluble lubricant, proper positioning, and inserting gently can minimize physical discomfort. For children, distraction techniques may be helpful.