184 CARE OF PATIENT IN DIAGNOSTIC RADIOGRAPHY

fluid still in the can at the end of this procedure, or air will enter the system
again at the top. The catheter is clipped with the spring clip, and it is then
ready for insertion in the rectum.
In doing this, the radiographer must have no hesitation in making sure
that it is possible to see what is being done. There must be a good light,
and one hand should be used firmly to part the buttocks at the natal cleft
so that the anal orifice is fully revealed. Only in this way can the catheter
be inserted with the ease and sureness that make it least disagreeable for
the patient. Inspection will show whether the patient has any haemor
rhoids, condition which will require very gentle insertion of the catheter,
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as the area is extremely sensitive; in the case of a female patient it will also
allow the radiographer to be sure that the catheter is being inserted in the
right orifice. It is easier than might be supposed for someone lacking
experience and the wisdom to look, to put a catheter into the vaginal
opening instead of the rectum.
It relaxes the anal sphincter and makes insertion easier if the patient is
asked to bear down during the process. Without using force, the catheter
is gently passed forwards and upwards until 3-4 inches of it have been
inserted. It will be seen to be gripped by the anal sphincter. After a brief
pause in which the enema can may be filled up, the tubing clip is released
and the fluid is run in.
It should be given at low pressure, the pressure and speed of administra
tion being controlled by the height of the enema can above the patient's
body. This should be about 12 inches at the start, and should not exceed
18 inches. If the can is too high and the enema is given too quickly, the
fluid will not flow right round to the caecum, the patient may not be able
to take the full amount, and the fluid will be returned quickly. So time
should be allowed for the enema to be given slowly and evenly, a pause
being made if the patient complains of pain or the desire to evacuate. He
should be encouraged to take the full amount.
When the enema has been given, the catheter is removed from the
rectum, disconnected from the tubing (which should be clipped off if the
remaining contents of the can are not to escape), and placed in a receiver.
When the patient's needs have been given attention, the catheter is flushed
with cold water, and both it and the receiver are washed with warm soapy
water to remove all grease and then boiled for 5 minutes.
If the patient is able and mobile and the lavatory is closely adjacent, he
may be sent to the lavatory to evacuate the enema. However, the radio
grapher should remain at hand to see that all goes well, and that the
patient does not become or faint while he in the lavatory wise
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