Enema (Barium, Air Contrast, Renografin)

Prep Code: ENEM
Prep Time: 24 Hours
Enema: (Barium, Air contrast, Renografin)

PREPARATION:(Day before exam) 

1. Schedule with Radiology, ext. 78900 Internal or 847-8900 External.
   
2. Drink 8 oz. of clear liquid (no milk) each hour from 11 a.m. to 8 p.m.
   
3. For all meals, a clear liquid diet starting with breakfast.
   
4. Take 4 oz. of Castor Oil 1 hour after the noon meal.
   
5. Take 2 1/2 oz. of x-prep liquid at 4 p.m.
   
6. After evening meal, take only sweetened strained fruit juice, coffee, or tea with sugar, but no milk, cream, or creamora.
   
7. NPO after midnight.
   
8. Day of exam--no breakfast.
   
9. Note--Patients strongly suspected of having inflammatory bowel disease or other special problems should be discussed with the radiologist in advance of the preparation.
   
10. Patient should come to X-ray in a hospital gown with no pajama bottoms or underwear.
    
11. Send chart with patient and blue card.
    
12. Patient suspected of having an obstruction should not have a barium enema prep-Radiologist will advise the prep. If patient is ALLERGIC TO IODINE OR LATEX please notify radiologist.
    
13. Diabetics and renal patients may use Golytely solution at a rate of 1 liter per hour until fecal discharge is clear (minimum of 3 liters and maximum of 5 liters). Must be cleared with radiologist before using Golytely.

Ileostomy and ileoanal enemas may be done as well. Schedule with Radiology. There is no special prep for this exam. Please notify Radiology if the patient is ALLERGIC TO IODINE OR LATEX. 

PROCEDURE:

Pediatric Preparation:

0-4 years=no prep

5-11 years=Day prior to exam-->liquids only

12+ years=full prep=Castor oil at 1:00 p.m.

X-Prep 4:00 p.m.

Clear liquids all day

NPO after midnight

A lubricated enema tip is inserted rectally. Under fluoroscopy, the desired contrast media is administered slowly and spot films are taken as the patient is rotated into various positions. This allows visualization of all flexures and loops of the colon. The patient may experience a feeling of fullness, cramping, and the urge to evacuate during the enema. Upon completion of the study, the contrast is drained back into the enema bag, and the enema tip is removed. The patient will then be assisted into the bathroom to evacuate the remaining contrast. The exam takes about 1 hour. After the procedure is completed, the patient should be encouraged to drink 6 to 8 glasses of water, juice, tea, coffee, or soda and check the frequency and consistency of the stools. (Stools will be white for a while after barium contrast). The patient may need a laxative per physician orders (if barium used).

PATIENT EDUCATION:

You are scheduled for an exam called a Barium Enema. A barium enema allows the doctor to look at your colon or large bowel (intestine) to identify any abnormalities.

Note: To Women of Childbearing Age

Ideally, abdominal x-ray procedures on a woman of childbearing age should be performed during the first 10 days following menses to minimize the possibility of irradiating an embryo.

If there is any possibility you might be pregnant, please notify your physician and the Radiology Department.

This exam requires a thorough cleansing of the intestinal tract to provide for maximal information and avoid repeating the exam. Foods that leave a residue in the bowel prevent adequate cleaning, therefore a special diet consisting basically of clear liquids is necessary in order to clean out the bowel. This clear liquid diet should begin at breakfast time the day before your exam. 

Clear liquids may include any of the following: water, gatorade, coffee, or tea (without milk, cream or creamora), juices (apple, cranberry, grape, strained orange or grapefruit), bouillon, Kool-aid, Jell-o (without fruit), soda or soft drinks, and hard candies. It takes a lot of liquids to flush the colon, so the more you drink, the better your bowel will be prepared for the exam. You must drink at least an 8 oz. glass of liquid every hour with 4 oz. castor oil at 1:00 p.m., 2 1/2 oz. xprep at 4:00 p.m. and NPO after midnight.

Laxatives (cathartics) are also usually necessary to stimulate emptying of the bowel. These laxatives are usually quite harsh and result in frequent trips to the bathroom. It would be best to remain near a bathroom to avoid embarrassing accidents. You may also feel somewhat weak from the laxatives and the numerous trips to the bathroom. It is important that you take the laxatives at the designated time(s) so your bowel will be adequately prepared. If you should happen to vomit the laxative, you must notify the nurse or doctor immediately. If you have special problems, your doctor should discuss these with the radiologist before you start the prep for this exam. (In some cases, the prep may need to be changed for patients with special bowel problems).

You should be ready and at the X-ray department at the scheduled time. You will then be asked (or assisted) to lie on a table where a plain abdominal film will be taken. This will tell us if your bowel is adequately prepared for the exam. If there is inadequate visualization of your bowel, the exam cannot be done. You will then have to repeat the prep and return the following day for the exam. If visualization of your bowel is adequate, then the exam will begin. A special enema tip will be inserted into your rectum (or stoma if you have a colostomy). 

The enema tip has a balloon attached to it so that once it is beyond the rectal sphincter it can inflated to prevent backflow of barium (or renografin around the tip of the tube). If you have difficulty controlling your bowels on a day-to-day basis, please alert the technologist before he/she inserts the enema tip. Do not fear that you will be unable to retain the solution for the exam as the balloon on the enema tip will assist you to hold it. Once the enema tip is secured in place, the barium or (renografin) will be instilled into your bowel. While the solution is filling your bowel, the radiologist will be watching it on a screen that looks like a TV. He/she may ask you to assume several different positions in order to facilitate the movement of the solution throughout your large bowel. Sometimes air will need to be instilled after the barium in order to assist in moving the barium through. If you feel uncomfortable during the enema, try to take deep breaths in and out through your mouth to help you relax. Remember, the tenser you are, the more uncomfortable you will be. Sometimes the radiologist may ask that you be given an injection of a drug called Glucagon which will relax your bowel and allow the barium to flow quicker. As the solution flows through your bowel, the radiologist will take a number of pictures. The technologist will then take several more pictures with you in various positions. The exam takes approximately 1 hour.

After the exam is completed, you should drink 6 to 8 8-oz glasses of fluid over the next 8 to 10 hours (only if barium is used) to assist in passing the barium from your bowel. Your bowel movements will be whitish colored until the barium is excreted from your bowel. If you do not have a bowel movement within 2 to 3 days, you should notify your physician for further orders.