Definition
Barium enema is a diagnostic procedure in which a radiopaque substance (barium sulfate) is instilled rectally in order to view the large intestine by the fluoroscope and to obtain radiographic films. For double contrast, gas (CO2) is pumped through a tube to distend the large bowel before the radiographs are taken.
Purposes for Barium enema
- To detect the presence of polyps, tumors, ulcerations of lining epithelium and other lesions of large intestine.
- To detect any abnormal anatomy or abnormal motility of the lower Gl tract.
- To find out the pressure deformities secondary to extrinsic masses.
- To determine the efficiency of the colon to empty its contents.
- To study the distensibility and filling defects of the bowel.
Indications for Barium enema
- Polyps.
- Ulceration.
- Scarring of lining epithelium.
- Lesions of large intestine.
Contraindications for Barium enema
- Suspected large bowel obstructions.
- Acutely ill patients.
- Post-Gl surgery.
- Weak and debilitated patients.
- History of anaphylactic allergic reactions.
Preparation for Barium enema
Preparing a patient and assisting with a barium enema involves several important steps to ensure the procedure is safe and effective:
- Dietary Restrictions:
- Follow a clear liquid diet for 1-2 days before the procedure to ensure the colon is empty.
- Avoid solid foods and dairy products during this period.
- Bowel Preparation:
- Use prescribed laxatives or enemas as directed by the healthcare provider to cleanse the bowel.
- Ensure the patient has easy access to a restroom during this preparation.
- Medication Adjustments:
- Inform the healthcare provider about any medications the patient is taking, especially blood thinners or diabetes medications, as adjustments may be necessary.
- Clothing and Accessories:
- Advise the patient to wear loose, comfortable clothing and remove any jewelry or metallic items.
- Consent and Communication:
- Explain the procedure to the patient, addressing any concerns or questions, and obtain informed consent.
Procedure for Barium enema
| Nursing action | Rationale | |
| 1. | Explain the purpose, steps of the procedure, and where it will be done. | Minimizes anxiety. Knowledge of the procedure promotes relaxation and cooperation. |
| 2. | Instruct to take minimal residual diet for 4-5 days preceding the test, fluid diet on the day before and no food or fluids from midnight. | Provides an empty, clean bowel. |
| 3. | Administer cleansing enema in the evening before and morning till return flow is clear. | Eliminates artifacts that can be produced by fecal matter in the colon. |
| 4. | Send the patient to radiology department with in-patient chart. | |
| 5. | Explain to client the importance of retaining enema contents and assuming different positions as instructed by the technician. | Promotes good visualization of the bowel and obtains clear X-ray films. |
| 6. | One-half to one liter of enema fluid is instilled through rectal tube and the entire colon is outlined, viewed in the fluoroscope and then filmed. The entire colon, ileocecal region and appendix are viewed. The procedure takes about 15 minutes. | Barium sulfate fills the organs and causes them to cast an outline shadow on film. |
| 7. | Once filming is over make provision for patient to expel the enema fluid. | Facilitates evacuation of barium. |
| 8. | After patient is received in the ward encourage oral fluids over 5-6 L/day (24 hours). | Prevents constipation and obstruction. Facilitates expulsion of barium. |
Special Consideration
- Confirm the patient has followed pre-procedure instructions, such as bowel preparation and dietary restrictions.
- Address any anxiety by explaining the procedure clearly and reassuring the patient.
- Observe the patient for signs of discomfort or complications, such as cramping or allergic reactions.
- Adjust the flow of the barium solution as needed to ensure patient comfort.
- Maintain strict sterile conditions to minimize the risk of infection.
- Ensure the enema tip and barium solution are properly prepared and functioning.
- Encourage the patient to drink plenty of fluids to help eliminate the barium from their system.
- Monitor for any delayed complications, such as constipation or bowel obstruction.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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