Ch. 12 Gastrointestinal Procedures

Chapter 12: Gastrointestinal Procedures

Instructions for GI examinations

• Before: 1. Inform the patient they will be moved into several positions
• 2. The instructions form the radiologist are NOT for the patient
• 3. Cramping and the urge to defecate are normal sensations
• After: 1. Explain stools will be white or light colored until barium is expelled, 2 to 3 days
• 2. Contact physician if you have not had a bowel movement within 24 hours
• 3. Increase fluid intake and fiber in the diet for several days.
• 4. Contact physician if you experience abdominal pain, weakness, polyuria, or nocturia.

Positive vs. Negative Contrast Agents

• Positive: 1. Increases organ density
• 2. Improves radiographic visualization
• 3. Examples: Barium Sulfate, Iodionated Preparation
• 4. Creates a density difference by attenuating and absorbing the radiographic beam, which stops the beam from hitting the IR
• Negative: 1. Decreases organ density to produce contrast
• 2. Used alone or with a positive contrast media
• 3. Examples: Carbon Dioxide and air

Adverse Effects for Positive and Negative Contrast

• Positive: !. aspiration of oral or gastric contents can create a life threatening situation for older patients.
• 2. Pneumonia
• 3. Peritonitis
• 4. Fibrosis or formation of a barium granuloma
• 5. Leak of barium into venous circulation
• 6. Bowel obstruction
• Negative: 1. Air embolism

Cleansing Enemas

• 1. Saline Enema
• *Normal is safest
• *Hypertonic is administered quickly and easily for relieving constipation
• 2. Oil Retention Enema
• *Given for relief of chronic constipation or fecal impaction
• 3. Tap Water Enema
• *Used to cleanse bowel preceding imaging procedures
• 4. Soapsuds Enema
• *Promotes peristalsis and defecation
• 5. Self-Administered Cleansing Enema
• *Patient has a study of lower bowel, taught to do it at home

Preparation for Barium Enemas

• Adults: 1. Eat low residue foods 2-3 days prior to exam
• 2. Increase fluid intake 2-3 days prior to exam
• 3. 24 hours prior, liquid diet for all 3 meals
• 4. Evening before exam, laxatives or cathartic may be necessary
• 5. Morning of exam, rectal suppository or cleansing enema may be necessary
• Pediatrics: 1. Newborn-2 yrs: no preparation needed
• 2. 3-10 yrs: put on low residue meal night before

Care for Ostomy with Barium Enema

• Ostomy: general term for an operation in which an artificial opening is formed
• 1. Bring extra drainage pouch, if not inpatient
• 2. Dietary, laxatives, and cleansing preparations depend on type and location of ostomy
• 3. Cone shaped tip with long drainage bag is used
• 4. After the cone is placed, the exam is the same as other patients
• 5. Once the exam is finished, drain barium into bag which is attached to the cone
• 6. Drain and replace drainage bag

Administering Barium Enema

• 1. Place patient in SIMS position
• 2. Put on clean gloves and heavily lubricate enema tip
• 3. Instruct the patient to exhale slowing
• *Do not force to insert the tip, because of the potential for laceration of mucous membranes
• 4. As the tip is inserted 3-4 inches until it passes the anal sphincter
• *Once the tip is in place, return the patient into supine position