Why is Ba Enema done? How it is done? ;-)

Bulotano, John Paul O.  53-A

Barium enema

A barium enema

is an X-ray exam that can detect changes or abnormalities in the large intestine (colon). The procedure is also called a colon X-ray. An enema is the injection of a liquid into your rectum through a small tube. In this case, the liquid contains a metallic substance (barium) that coats the lining of the colon. Normally, an X-ray produces a poor image of soft tissues, but the barium coating results in a relatively clear silhouette of the colon .During a barium enema exam, air may be pumped into the colon. The air expands the colon and improves the quality of images. This is called an air-contrast (double-contrast) barium enema. Before a barium enema, your doctor will instruct you to completely empty your colon. Barium enema is done if your doctor may recommend a barium enema to determine the cause of signs and symptoms, such as the following: Abdominal pain, Rectal bleeding, Changes in bowel habits, unexplained weight loss, chronic diarrhea, Persistent constipation. The risks of a barium enema exam pose few risks. Rarely, complications of a barium enema exam may include: Inflammation in tissues surrounding the colon, Obstruction in the gastrointestinal tract, Tear in the colon wall, Allergic reaction to barium. Barium enema exams generally aren't done during pregnancy because X-rays present a risk to the developing fetus. Before a barium enema exam, you'll be instructed to empty your colon. Any residue in your colon may obscure the X-ray images or be mistaken for an abnormality. To empty your colon, you may be asked to: Follow a special diet the day before the exam, fast after midnight, Take a laxative the night before the exam, Use an enema kit and Ask your doctor about your medications. During your barium enema, you'll wear a gown and be asked to remove eyewear, jewelry or removable dental devices. The exam will be performed by a radiology technician and a physician who specializes in diagnostic imaging (radiologist). You'll begin the exam lying on your side on a specially designed table. An X-ray will be taken to make sure your colon is clean. Then a lubricated enema tube will be inserted into your rectum. A barium bag will be connected to the tube to deliver the barium solution into your colon. As your colon fills with barium, you may feel the urge to have a bowel movement. You may be asked to turn and hold various positions on the exam table. This helps ensure that your entire colon is coated with barium and enables the radiologist to view the colon from various angles. You also may be asked to hold your breath at times. The radiologist may press firmly on your abdomen and pelvis, manipulating your colon for better viewing on a monitor attached to the X-ray machine. A number of X-rays will likely be taken of your colon from various angles. A barium enema exam typically takes about 30 to 60 minutes. When the examination of barium enema is done the barium will be removed from your colon through the enema tube. When the tube is removed, you'll be able to use the toilet to expel additional barium and air. Contrast media used is barium sulfate and it is prepare by choosing the right water temperature.Most enemas should be given at close to human body temperature, or between 98 and 105 degrees Fahrenheit (37 to 40.5 degrees Celsius). Enemas may be given with water as cool as 86 degrees Fahrenheit (30 degrees Celsius) or as hot as 113 degrees Fahrenheit (45 degrees Celsius). Mild soap is added to the enema solution when the enema is intended to relieve constipation.. Sodium phosphate is added to commercial enema solutions designed to clean out the colon prior to a colonoscopy or sigmoidoscopy. Fill the enema bag or syringe. The amount of enema solution the recipient will be able to accept varies according to the size of the recipient's colon and how much fecal matter is inside it. A child 11 years old or older has the same colon capacity, on average, as an adult. If using a pre-measured enema solution, a child aged 5 to 10 years can be given a full bottle of a child-sized enema, while a child aged 2 to 4 years needs only half a bottle. Connect the bag to the tubing.

Summary of Enema tip insertion

  Enema tip insertion is a method or a procedure use for imaging the large intestine. In preparation for an enema tip insertion is, first you decide where to give enema to the patient and there are three most common places to give enema and this could be on the bed, bathroom floor or in a bathtub, next place the place the supporting hook in the right height, it should be from 18-24 inches (45-60 cm) above the surface where the recipient of the enema will be lying and the enema   bag is suspended 12- 18 inches (30-45 cm) above the recipient anus so that the enema solution or contrast media will gradually flow out of the enema bag, prepare for spills or leakage in giving enema and if you are giving enema  in the bedroom or bathroom  floor place a  thick absorbent pad or a towel where the recipient is lying, next is position the patient in a sims position and administer now the enema by coating the tubing nozzle with a lubricant and also lubricate the anus and rectal area then  insert the tube into the rectum and twist the tube back and forth to make it easier to go in, the tube should be inserted not more than 3-4 inches (7.5-10 cm) into the rectal area without forcing, let the enema solution flow into the colon slowly in a suggested flow rate of 4-8 ounces (118-236 mL) per minute, have the patient take a slow and deep breath, and at the first sign of cramping stop the flow and have the patient take a quick and shallow breath, then resume the flow when the discomfort passes, allow up to 15 min to administer a large volume of enema, massage the abdomen slowly and deeply in a counter-clockwise direction starting from the lower left side of the body, work-up to the rib cage and then work back down to right side, this will work the enema solution higher, and a number of x-rays will likely be taken in a different angle or position, clamp off the tube once the enema is stopped so that it will prevent backflow into the bag when it is time to evacuate the bowels, give time for the enema time to do its job, the enema should be held between 5-15 min before evacuating with longer times desired for relieving constipation. Expel the enema; have the patient squat over the toilet. The enema solution and any waste matter should come out within a few minutes.

Patient Position for rectal tip insertion: There are three most common positions for rectal tip insertion and these are the Sims' position, the knee-chest position and lying on the back with knees bent. Sims' position can be used whether receiving an enema from someone else or giving an enema to you. To assume Sims' position, lie on your left side with your left leg straight and your right leg bent at the knee. Place your left arm behind your back and your right hand under the pillow at your head. If administering the enema to yourself, the flow regulating clamp should be placed where your left hand can reach it. Knee-chest position may be more comfortable for someone receiving an enema from someone else, particularly if the recipient is pregnant, and may also be called for in cases of severe constipation. In this position, the recipient gets on hands and knees, places 1 or more pillows under the chest and leans on them while turning the face sideways and resting it on another pillow his or her arms are wrapped around. It does not lend itself to controlling the enema flow if you're giving it to yourself, however. Use the lying on the back with knees bent position if giving you an enema while lying on the bathroom floor or in the bathtub. Put a pillow under your head and make sure you can reach the flow regulating clamp before you start.

1. HOW PROCEDURE IS DONE
   
2. ESSENTIAL EQUIPMENTS NEEDED
   
3. PATIENT POSITION FOR RECTAL TIP INSERTION