Knee-elbow position
From NursingWiki
The Knee-Elbow position (KEP) is a body position for a variety of medical procedures, and for receiving an enema. The patient kneels on a horizontal soft base or floor mat, bends over forward, and supports herself on knees, elbows, and head. A cushion for her hed turned sideways is recommended.
enemas
The KEP is recommended for large-volume enemas (2 liter or more), because the fluid can reach the transverse colon by gravity, because the normal or pathological sag of the transverse colon is straightened out, and because the rectal tube can be inserted easily in the direction of the abdomen. A lubricated soft-rubber colon tube of FR-30 to FR-36 can safely reach and pass the distal flexure of the sigmoid near 15 to 18 cm. The deeply inserted colon tube places the enema directly into the expandable colon, thus largely avoiding the painful ballooning of the less expandable rectum.
During an enema in the KE position, it is neither comfortable nor necessary for the patient to spread her legs. In the KE position and with closed legs, the anus is easily accessible with or without manual cheek-spreading by the helping person. The pelvic sexual dimorphism helps the female patient: she can expose her anus by flexing the femural joints far more easily than the male patient can.
The KE position for enema is not advised for patients on high hospital beds, because it would require the helper to elevate the enema bag or irrigator can to more than shoulder height. Another disadvantage of the KE position during self-administered home enema is the need for one hand to insert and steady the colon tube.
Done in the KE position on an athletic floor mat, a large-volume enema is convenient for the helper and comfortable for the patient, if the bag or irrigator is suspended about 1 metre above the floor. With necessary care and slowly, the colon tube can be inserted to a depth of 25 to 30 cm, that is, into the descending colon. The Ruesch soft-rubber colon tubes of 40 cm length are excellent devices for this procedure.
