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Ateneo de Zamboanga University College of Nursing

NUSING SKILLS OUTPUT (NSO) Report No. _5_ BARIUM ENEMA I. DESCRIPTION: Fluroscopic X-ray examination visualizing the entire large intestine is administered after the patient is given an enema of barium sulfate. Can visualize structural changes, such as tumors, polyps,diverticula, fistulas, obstruction, and ulcerative colitis. Air may be introduced after the barium to provide a double-contrast study. II. MATERIALS/ EQUIPMENT NEEDED: Prepackaged enema or enema container Disposable gloves Water-soluble-jelly Waterproof pad Washcloth and towel Bath blanket Bedpan or commode Basin Toilet tissue

III. PROCEDURE 1. You will dress in a patient gown and lie on an examination table. 2. The radiologic technologist will position you on the table and take a preliminary X-ray to make sure the colon is cleaned out well enough to take good pictures. 3. The radiologic technologist will instill the barium mixture slowly into the colon through a small, lubricated enema tube that is inserted into the rectum. A small amount of air may also be injected to help the barium spread more evenly in the colon and obtain the best images. 4. The radiologic technologist will take a series of painless X-ray pictures. You will be repositioned as needed to get pictures of different areas of the colon. 5. After all the X-rays have been taken, you will wait briefly while the pictures are checked for quality, then most of the barium will flow out of the colon through the enema tube, and the tube will be gently removed. The radiologic technologist may take more pictures before removing the tube.

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IV. DIAGRAM/ ILLUSTRATIONS:

V. NURSING RESPONSIBILITIES: 1. BEFORE PROCEDURE Assess the patients bowel habits (last bowel movement, laxative usage, bowel patterns) and physical condition (hemorrhoids, mobility, external sphincter control). Provide for privacy, and explain procedure to patient.

2. DURING PROCEDURE Wash hands. Place patient on left side with right knee flexed (Sims position). place waterproof pad underneath patient, and cover with bath blanket. Place bedpan or bedside commode in position for patients who cannot ambulate to the toilet or who have difficulty with sphincter control. Remove plastic cover over tubing, and lubricate tip of enema tubing 3-4 inches (7.510cm) unless prepackaged (tip is already lubricated). Even prepackaged enema may need more lubricant. Apply disposable gloves. Separate buttocks, and locate rectum. Instruct patient that you will be inserting tubing and to take slow, deep breaths. Insert tubing 3-4 inches for adult patients. Slowly instill the solution using a clamp and the height of the container to adjust flow rate if using an enema bag and tubing. For high enemas, raise enema container 12-18 inches (30.5-45.5 cm) above anus; for low enemas, 12 inches. If using a prepackaged enema, slowly squeeze the container until all solution is instilled. Lower container or clamp tubing if patient complains of cramping. Withdraw rectal tubing after all enema solution has been instilled or until clear (usually not more than three enemas). Instruct patient to hold solution as long as possible and that a feeling of distention may be felt. Discard supplies in the appropriate trash receptacle. Page 2 of 3

Assist patient on the bedpan or to the bedside commode or toilet when urge to defecate occurs. Observe enema return for amount, fecal content. Instruct patient not to flush toilet until the nurse has seen the results.

3. AFTER PROCEDURE Document the type of enema given, volume, and results on the appropriate chart forms. Assess and document presence or absence of abdominal distention after enema was given. Assist the patient with washing perineum and rectal area, if indicated; may also need a clean gown or linen change.

Reference: Lippincotts Textbook of Manual Nursing Practice 9th Edition by Williams and Wilkins, Volume 1, pp. 653-654 http://www.healthgrades.com/procedures/barium-enema

JULY 18, 19, 20, 2013 Date EDMUND W. RUFINO BSN III-C

MR. ROWENA MENDEZ Clinical Instructors Initials

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