13. Procedure
Preprocedure steps
• Explain the procedure to the patient
Explain to the patient that this test evaluates the function of the pharynx and
esophagus.
Explain that the test takes approximately 30 minutes. Describe the
milkshake consistency and chalky taste of the barium preparation the patient will
ingest; although it’s flavored, it may be unpleasant to swallow.
Tell him he’ll first receive a thick mixture and then a thin one and that he must
drink 12 to 14 oz (355 to 414 ml) during the examination.
Inform him that he’ll be placed in various positions on a tilting radiograph table
and that radiographs will be taken.
14. • Check the patient history for contraindications to the barium swallow, such as
intestinal obstruction and pregnancy. Radiation may have teratogenic effects.
• Just before the procedure, instruct the patient to put a hospital gown and to
remove jewelry, dentures, hairpins, and other radiopaque objects from the
radiograph field.
• Consent to be taken
• Fasting from 6-8 hrs. before the procedure
15. Intra procedure steps
1.The patient is placed in an upright position behind the fluoroscopic
screen, and his heart, lungs, and abdomen are examined.
2.The patient is instructed to take one swallow of the thick barium mixture;
pharyngeal action is recorded using cineradiography.
3.The patient is instructed to take several swallows of the thin barium
mixture. Passage of the barium is examined fluoroscopically; spot films
of the esophageal region are taken from lateral angles and from the right
and left posteroanterior angles.
4.To accentuate small strictures or demonstrate dysphagia, the patient may
be asked to swallow a “barium marshmallow” (soft white bread soaked in
barium) or a barium pill.
5.The patient is then secured to the X-ray table and rotated to
trendelenburg position to evaluate esophageal peristalsis or demonstrate
hiatal hernia and gastric reflux.
16. Post procedural steps
1.Instruct the patient to drink plenty of fluids, unless contraindicated, to help
eliminate the barium.
2.Advice the patient to eat foods high in fibre
3.Assess the abdomen for distension.
4.Give cathartic as prescribed.
5.Tell the patient to notify the physician if he fails to expel the barium in 2 to 3
days.
6.Inform the patient that stools will be chalky and light colored for 24 to 72
hours.
17. Complications
• Barium retained in the intestine may harden, causing obstruction or fecal
impaction.
• Abdominal distention and absent bowel sounds, which may indicate
constipation and may suggest barium impaction.
23. PREPROCEDURAL STEPS-NURSING
RESPOSIBILITIES
• Explain the procedure and its purpose to the patient
• Get informed consent
• Provide or instruct to follow a clear liquid diet for 24 hrs. prior to
the test. All foods and fluids may be with held for 8 hrs prior to
the test.
• Administer laxative, enema or suppositories as ordered the
evening prior to the procedure.
• Additional bowel preparation may be ordered for the morning
just prior to the procedure
• Make sure patient remove any jewellary and change into hospital
gown.
24. PREPROCEDURAL STEPS-NURSING
RESPOSIBILITIES
• Identify if the patient have allergies to any
medications
• Record the date of menstrual period and determine
the possibility of pregnancy
• Explain to the patient that some pain may be
experienced during the test and there may be
moments of discomfort
31. Intraoperative
• Barium sulphate is instilled rectally with the use of firm enema tip or
ballon catheter and with extreme caution
• The barium container should be raised only 2-3 feet above the table
• Barium flow is rigorously controlled to prevent rapid colonic
distension and resultant rectal spasm
• The patient may be asked to assume different positioning such s
supine and prone to promote visualization during the 45 to 60
minutes.
• A serious of x-ray film is taken as per physician order
• The final x ray should be obtained after the patient has evacuated the
enema. (the post evacuation x ray provides information about
mucosal pattern and collapsibility of the colon.
32.
33.
34.
35. Post procedure steps (after care)
• A laxative or cleansing enema is given to empty the large intestine
and to prevent barium impaction
• Provide adequate rest after procedure as procedure causes fatiguing
• Encourage adequate fluids and fibre to prevent constipation
• Observe stool for passage of barium and assess the regularity of
bowel movement
• Tell the patient that stool may be white up to 72 hrs after the test.
• Notify the physician if there is pain, bloating sensation, absence of
stool, or bleeding. An enema may be required if the enema is not
eliminated completely
