Ch. 12 Slides

Chapter 9: Gastrointestinal procedures

Chapter 9: 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 sensationsAfter: 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 constipation2. Oil Retention Enema    *Given for relief of chronic constipation or fecal impaction3. Tap Water Enema    *Used to cleanse bowel preceding imaging procedures4. Soapsuds Enema    *Promotes peristalsis and defecation5. 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 necessaryPediatrics: 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 position2. Put on clean gloves and heavily lubricate enema tip3. Instruct the patient to exhale slowing   *Do not force to insert the tip, because of the potential for laceration of mucous membranes4. 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