There is always some risk when introducing barium sulfate or a similar contrast agent into the GI tract.
Barium radiography may interfere with many other abdominal examinations. A number of studies—including other x-rays, tests using iodine, ultrasound procedures, radioisotope studies, tomograms, computed tomography (CT), and proctoscopy—must be scheduled before or several days following barium studies. Consult with the radiography department for the proper sequencing of studies.
Increased consumption of fluids will help to clear the bowel of barium.
Older, inactive persons should be checked for stool impaction if they fail to defecate within a reasonable length of time after a barium procedure. The first sign of impaction in an older person is fainting.
Observe and record findings regarding stool color and consistency for at least 2 days to determine whether barium has been evacuated. Stools will be light in color until all barium has been expelled. Outpatients should be given a written reminder to observe their stools for at least 2 days following barium administration.
If possible, avoid giving narcotic agents, especially codeine, when barium x-rays are ordered because these drugs can cause decreased bowel motility that can compound possible barium-associated constipation.
Clinical Alert
Rare instances of severe allergic reactions to barium sulfate have been reported. All patients should be questioned regarding their allergic history before administration of any type of contrast agent. A history of hay fever, asthma, and other allergies places the patient at higher risk for reactions to all types of contrast agents.
The risk for post procedure constipation or blockage of the bowel is increased in patients with the following conditions:
Cystic fibrosis
Dehydration
Acute ulcerative colitis
Barium should not be used for intestinal study in the following circumstances:
When a bowel perforation is suspected.
Following sigmoidoscopy or colonoscopy, especially if a biopsy was performed, because leakage of barium from the alimentary canal can cause peritonitis. Iodinated contrast should be used in these cases.
There are special clinical considerations for patients who have underwent an ostomy while undergoing bowel preparation for GI studies; examination preparation and procedure should be tailored by the primary care provider and the radiology department to achieve the most optimal outcomes. In most cases, standard dietary and medication restrictions apply, but modifications involving mechanical bowel cleansing with enemas and physiologic cleansing with laxatives may be necessary.
Procedural Alert
Enemas and laxatives should not be given to a person with an ileostomy in preparation for x-rays or endoscopy (see Chapter 12) because this puts the person at risk for dehydration and electrolyte imbalance. The person with a sigmoid colostomy requires irrigation of the stoma the night before and the morning of the study. Consequently, it is important to identify the type of surgical procedure the patient has undergone. Moreover, not all colostomies need irrigation. For example, a person with an ascending right-sided colostomy will usually pass a liquid, pasty stool high in water content and digestive enzymes—such a patient may only require laxatives.
Notify the radiology department that the person has underwent an ostomy.
Advise all patients to bring extra ostomy supplies and pouches for use after the procedure is completed.